Drug interactions between zalcitabine and Zerit

GENERALLY AVOID: Zalcitabine can cause peripheral neuropathy in up to one-third of patients with advanced HIV disease, and concurrent use of other agents that are also associated with this adverse effect can potentiate the risk. Zalcitabine-related peripheral neuropathy is a sensorimotor neuropathy characterized initially by numbness and burning dysesthesia involving the distal extremities. These symptoms may be followed by sharp shooting pains or severe continuous burning pain if the drug is not withdrawn, and progress to severe pain requiring narcotic analgesics. The neuropathy is potentially irreversible.

MANAGEMENT: Use of zalcitabine in combination with other drugs that have the potential to cause peripheral neuropathy should be avoided whenever possible. If concomitant use is necessary, careful monitoring for symptoms of neuropathy such as burning, tingling, pain, or numbness in the hands and feet is recommended, particularly in patients with a low CD4 cell count. Since the development of peripheral neuropathy appears to be dose-related, the recommended dosage of zalcitabine should not be exceeded. Patients should be advised to promptly discontinue zalcitabine therapy if neuropathy develops. Therapy may be reinstituted following resolution of neuropathy symptoms, but dosage should be reduced to one-half the initially recommended dosage. Zalcitabine should be permanently discontinued in patients who develop severe peripheral neuropathy during treatment.