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Zinc Chloride

Pronunciation

(zink KLOR ide)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Solution, Intravenous:

Generic: 1 mg/mL (10 mL)

Pharmacologic Category

  • Trace Element

Distribution

Storage sites are liver and skeletal muscle; serum levels do not adequately reflect whole-body zinc status

Excretion

Primarily in feces (Anderson 1998)

Protein Binding

55% bound to albumin; 40% bound to alpha 1-macroglobulin

Use: Labeled Indications

Cofactor for replacement therapy to different enzymes; helps maintain normal growth rates, normal skin hydration, and senses of taste and smell

Dosing: Adult

Nutritional supplement: IV:

Stable with fluid loss from small bowel: 12.2 mg zinc/L TPN or 17.1 mg zinc/kg (added to 1000 mL IV fluids) of stool or ileostomy output

Metabolically stable: 2.5-4 mg/day, add 2 mg/day for acute catabolic states

Note: Clinical response may not occur for up to 6-8 weeks.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Nutritional supplement: IV: Added to IV solutions:

Premature Infants <1500 g, up to 3 kg: 300 mcg/kg/day

Infants (full term) and Children ≤5 years: 100 mcg/kg/day

Dosing: Renal Impairment

No dosage adjustment provided in manufacturer’s labeling. However, dosage adjustment may be necessary in severe impairment since zinc is primarily renally excreted. Additionally, aluminum accumulation may occur in the setting of renal impairment.

Dosing: Hepatic Impairment

No dosage adjustment provided in manufacturer’s labeling.

Storage

Store intact vial at 20°C to 25°C (68°F to 77°F).

Drug Interactions

Dolutegravir: Zinc Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral zinc salts. Consider therapy modification

Eltrombopag: Zinc Salts may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any zinc-containing product. Consider therapy modification

Trientine: May decrease the serum concentration of Zinc Salts. Zinc Salts may decrease the serum concentration of Trientine. Consider therapy modification

Adverse Reactions

<1% (Limited to important or life-threatening): Hypotension, indigestion, jaundice, leukopenia, nausea, neutropenia, pulmonary edema, vomiting

Warnings/Precautions

Disease-related concerns:

• Renal impairment: Use with caution in patients with renal impairment.

Concurrent drug therapy issues:

• Copper: IV administration of zinc without copper may cause a decrease in copper serum concentrations.

Dosage form specific issues:

• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer’s labeling.

Pregnancy Risk Factor

C

Pregnancy Considerations

Zinc crosses the placenta and can be measured in the cord blood and placenta. Fetal concentrations are regulated by the placenta (de Moraes, 2011).

Patient Education

• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)

• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.

Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.

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