Zidovudine Side Effects
Some side effects of zidovudine may not be reported. Always consult your doctor or healthcare specialist for medical advice. You may also report side effects to the FDA.
For the Consumer
Applies to zidovudine: oral capsule, oral syrup, oral tablet
Other dosage forms:
Along with its needed effects, zidovudine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur while taking zidovudine:More common
- Fever, chills, or sore throat
- pale skin
- unusual tiredness or weakness
- Abdominal or stomach discomfort
- convulsions (seizures)
- fast, shallow breathing
- general feeling of discomfort
- loss of appetite
- mood or mental changes
- muscle pain, tenderness, weakness, or cramping
- shortness of breath
Some side effects of zidovudine may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:More common
- Difficulty having a bowel movement (stool)
- general feeling of discomfort or illness
- headache (severe)
- lack or loss of strength
- muscle soreness
- trouble with sleeping
- weight loss
- Bluish-brown colored bands on nails
- changes in skin color
- Acid or sour stomach
- burning, tingling, numbness, or pain in the hands, arms, feet, or legs
- muscle or bone pain
- sensation of pins and needles, stabbing pain
- stomach cramps
- stomach pain
- yellow eyes or skin
For Healthcare Professionals
Applies to zidovudine: intravenous solution, oral capsule, oral syrup, oral tablet
The adverse effects of zidovudine are sometimes difficult to distinguish from the symptomatology observed during the clinical course of AIDS, as well as from the possible adverse effects of other drugs used in the treatment of HIV-1 infection. Many of the side effects associated with nucleoside reverse transcriptase inhibitor therapy (myopathy, pancreatitis, liver failure, lactic acidosis, etc.) are attributable to their direct toxic effect on mitochondria which causes decreased mitochondrial energy-generating capacity.
Nervous system side effects have included headache (up to 63%), insomnia (5% or greater), neuropathy (5% or greater), and numbness. Status epilepticus and Wernicke's syndrome have been rarely reported. Seizures, confusion, dizziness, paresthesia, somnolence, vertigo, hearing loss, and loss of mental acuity have been reported during postmarketing experience.
Bone marrow suppression, the most common reason for cessation of zidovudine therapy, appears to be dose-dependent and may be seen as early as 2 to 6 weeks after initiation of therapy. Recombinant GM-CSF (sargramostim), G-CSF (filgrastim), and erythropoietin (epoetin alfa) have been used to control the hematologic toxicity of zidovudine.
Zidovudine should be used with extreme caution in patients with bone marrow suppression indicated by a granulocyte count below 1000 cells/mm3 or hemoglobin less than 9.5 g/dL. Routine blood counts are recommended, and generally should occur more frequently in patients with advanced disease. If bone marrow toxicity occurs, an interruption or discontinuation of zidovudine therapy may be necessary.
Hematologic side effects have included granulocytopenia (less than 750 cells/mm3; up to 2%), anemia (hemoglobin less than 8 g/dL; up to 1.1%), and increased hemoglobin A2 percentage. Hematologic toxicity, including neutropenia and severe anemia, has been reported, mostly in patients with advanced HIV-1 disease. Exacerbation of anemia due to ribavirin has been reported when zidovudine was part of the HIV-1 regimen. Aplastic anemia, hemolytic anemia, leukopenia, lymphadenopathy, pancytopenia with marrow hypoplasia, and pure red cell aplasia have been reported during postmarketing experience.
Gastrointestinal side effects have included nausea (up to 51.4%), anorexia (up to 20.1%), vomiting (up to 17.2%), constipation (up to 6.4%), dyspepsia (5% or greater), abdominal cramps (5% or greater), abdominal pain (5% or greater), diarrhea, stomatitis, and splenomegaly. Dysphagia, constipation, flatulence, oral mucosa pigmentation, mouth ulcer, and pancreatitis have been reported during postmarketing experience.
One patient with preexisting hepatitis B developed acute hepatic failure two weeks after starting zidovudine therapy.
Patients with a history of liver disease should be monitored for further deterioration in liver function.
Hepatic side effects have included increased ALT (greater than 5 times ULN; up to 3.1%) and AST (greater than 5 times ULN; up to 1%), hyperbilirubinemia (less than or equal to 0.8%), fulminate hepatitis, and hepatic failure. Lactic acidosis and severe hepatomegaly with steatosis, including fatal cases, have been reported with the use of nucleoside analogs alone or in combination, including zidovudine and other antiretrovirals. Hepatic decompensation (some fatal) has been reported in patients coinfected with HIV-1 and hepatitis C receiving combination antiretroviral therapy for HIV-1 and interferon alfa with or without ribavirin. Hepatitis, hepatomegaly with steatosis, lactic acidosis, and jaundice have been reported during postmarketing experience.
Other side effects have included malaise (up to 53.2%), asthenia (up to 9%), fatigue (5% or greater), chills (5% or greater), and fever. Zidovudine therapy has been associated with lower levels of vitamins B2 and C, folate, and zinc despite adequate dietary intake. Back pain, chest pain, influenza-like syndrome, generalized pain, syncope, and taste perversion have been reported during postmarketing experience.
In one case of zidovudine-associated fever, no source of infection was found after an extensive evaluation, but an anti-zidovudine immunoglobulin was isolated, indicating a possible hypersensitivity reaction.
Musculoskeletal side effects have included arthralgia, myalgia, and musculoskeletal pain in greater than or equal to 5% of patients. Myopathy, myositis, muscle tenderness, and weakness in the arms and legs have been reported and were generally associated with an elevation in serum creatine kinase. Increased creatine phosphokinase, muscle spasm, myopathy and myositis with pathological changes (similar to that produced by HIV-1 disease), rhabdomyolysis, and tremor have been reported during postmarketing experience.
In one study, myalgias and elevated creatine kinase occurred in 8% of treated patients with a CD4 cell count less than 200/mm3, and in none of the patients with higher CD4 cell counts. Dosage reduction has not affected the course of myopathy, although drug discontinuation sometimes resulted in improvement of symptoms, generally within a month. Muscle biopsy has shown atrophic and sometimes necrotic fibers, ragged-red fibers, and large accumulations of mitochondrial and fibrillar sarcoplasmic inclusions.
Myopathy and myositis with pathological changes, similar to that produced by HIV-1 disease, have been associated with prolonged use of zidovudine.
Psychiatric side effects have included isolated cases of depression, mania, anxiety, and grandiosity. Anxiety, depression, and mania have been reported during postmarketing experience.
Bluish or brownish-black discoloration of nails has developed during the first month or two of zidovudine therapy and usually disappeared within 2 months if the drug was discontinued. Discoloration has occurred as longitudinal streaks or transverse bands.
Dermatologic side effects have included case reports of nailbed hyperpigmentation, particularly in black people. Rarely, nail hyperpigmentation has been accompanied by mucocutaneous pigmentation or hypertrichosis. Skin rashes and leukocytoclastic vasculitis with eosinophilia and fever have also been reported. Changes in skin and nail pigmentation, pruritus, rash, Stevens-Johnson syndrome, toxic epidermal necrolysis, sweat, and urticaria have been reported during postmarketing experience.
Cardiovascular side effects have included rare cases of reversible congestive heart failure and vasodilation. Cardiomyopathy and vasculitis have been reported during postmarketing experience.
Hypersensitivity side effects have included allergic skin rash. Sensitization reactions including anaphylaxis and angioedema have been reported during postmarketing experience.
Metabolic side effects have included hyperlipidemia. Redistribution/accumulation of body fat including central obesity, dorsocervical fat enlargement, peripheral wasting, facial wasting, breast enlargement, and "cushingoid appearance" have been observed in patients receiving antiretroviral therapy. Increased lactate dehydrogenase and redistribution/accumulation of body fat have been reported during postmarketing experience.
Respiratory side effects have included cough, dyspnea, rhinitis, and sinusitis during postmarketing experience.
Immunologic side effects have included immune reconstitution syndrome. Autoimmune disorders (e.g., Graves' disease, polymyositis, and Guillain-Barre syndrome) have been reported in the setting of immune reconstitution.
Ocular side effects have included amblyopia, macular edema, and photophobia during postmarketing experience.
A case of macular edema in a patient with a history of anterior uveitis secondary to syphilis has been reported.
Genitourinary side effects have included gynecomastia, urinary frequency, and urinary hesitancy during postmarketing experience.
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