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Zinc Sulfate

Medically reviewed by Drugs.com. Last updated on Jul 14, 2019.

Pronunciation

(zink SUL fate)

Index Terms

  • ZnSO4 (error-prone abbreviation)

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral:

Orazinc: 220 mg

Zinc-220: 220 mg

Generic: 50 mg, 220 mg

Solution, Intravenous [preservative free]:

Generic: 1 mg/mL (10 mL); 5 mg/mL (5 mL)

Solution, Ophthalmic:

Eye-Sed: 0.217% (15 mL [DSC]) [contains benzalkonium chloride, boric acid]

Tablet, Oral:

Orazinc: 110 mg

Zinc 15: 66 mg

Generic: 220 mg

Tablet, Oral [preservative free]:

Generic: 220 mg [DSC]

Brand Names: U.S.

  • Eye-Sed [OTC] [DSC]
  • Orazinc [OTC]
  • Zinc 15 [OTC]
  • Zinc-220 [OTC]

Pharmacologic Category

  • Trace Element

Absorption

pH-dependent; enhanced at lower pH; (pH <3); impaired by food (Anderson 1998)

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

~80% bound to albumin; ~20% bound to alpha 1-macroglobulin

Use: Labeled Indications

Trace element added to parenteral nutrition (PN) to prevent deficiency; orally as a dietary supplement.

Contraindications

Injection: Hypersensitivity to zinc or any component of the formulation.

Dosing: Adult

Dietary supplement: Oral: 50 mg (dose expressed as elemental zinc) once daily.

Parenteral nutrition additive, maintenance requirement: IV (dose expressed as elemental zinc): Note: Individualize dose based on the patient's clinical condition, nutritional requirements, and the contribution of oral or enteral zinc intake.

Acute metabolic states: Optimal dose not determined; monitor and replace as clinically indicated (Blaauw 2019).

Metabolically stable: 3 to 5 mg/day (ASPEN 2019).

Replacement for small bowel fluid loss (metabolically stable): Additional zinc replacement may be required for patients with intestinal fistula, ostomy effluent, or severe diarrhea due to excessive zinc losses. Estimated losses range from up to 12 mg zinc/L for GI fluid loss and up to 17 mg zinc/L for stool or ileostomy output (Blaauw 2019; Vanek 2012).

Zinc deficiency (Saper 2009): Oral: Some clinicians recommend daily doses of 2 to 3 times the zinc RDA for mild deficiency and 4 to 5 times the RDA for moderate to severe deficiency for 6 months.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Note: Dosages may be presented in units of mcg or mg; use caution to ensure correct units.

Parenteral nutrition, maintenance requirement: IV: Note: Dosage expressed in terms of elemental zinc; higher doses may be needed if impaired intestinal absorption or an excessive loss of zinc (eg, excessive, prolonged diarrhea, high-output intestinal fistula, burns)

Age-directed dosing (ASPEN [Vanek 2012]):

Infants <3 months: 250 mcg/kg/day

Infants ≥3 months: 50 mcg/kg/day

Children: 50 mcg/kg/day; maximum daily dose: 5,000 mcg/day

Weight-directed dosing (ASPEN [Mirtallo 2004]):

Infants <10 kg: 50 to 250 mcg/kg/day

Children 10 to 40 kg: 50 to 125 mcg/kg/day; maximum daily dose: 5,000 mcg/day

Children and Adolescents >40 kg: 2,000 to 5,000 mcg/day

Diarrhea, treatment; malnourished patient (WHO/UNICEF 2004): Note: Dosage expressed in terms of elemental zinc; Note: Zinc should be started in conjunction with oral rehydration solutions at first sign of diarrhea:

Infants <6 months: Oral:10 mg once daily for 10 to 14 days

Infants ≥6 months and Children: Oral: 20 mg once daily for 10 to 14 days

Zinc deficiency; treatment: Limited data available (Kliegman 2016): Note: Dosage expressed in terms of elemental zinc

Acquired: Infants, Children, and Adolescents: Oral: 0.5 to 1 mg/kg/day

Acrodermatitis enteropathica: Infants, Children, and Adolescents: Oral: 3 mg/kg/day

Administration

IV: Not for direct IV infusion; must be prepared and used as an admixture in parenteral nutrition solutions only.

Dietary Considerations

May be taken with food if GI upset occurs.

Dietary adequate intake (AI) (IOM 2001):

1 to 6 months: 2 mg/day

Dietary recommended daily allowance (RDA) (IOM 2001):

7 to 12 months: 3 mg/day

1 to 3 years: 3 mg/day

4 to 8 years: 5 mg/day

9 to 13 years: 8 mg/day

14 to 18 years: Females: 9 mg/day; Males: 11 mg/day; Pregnancy 12 mg/day; Lactation: 13 mg/day

Adults ≥19 years: Females: 8 mg/day: Males: 11 mg/day; Pregnancy: 11 mg/day; Lactation: 12 mg/day

Storage

Capsule: Store at 15°C to 30°C (59°F to 86°F).

Tablet (Orazinc®): Store at 13°C to 24°C (55°F to 76°F).

Injection: Prior to use, store at room temperature of 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F).

Drug Interactions

Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Avoid combination

Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Consider therapy modification

Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. Consider therapy modification

Ceftibuten: Zinc Salts may decrease the serum concentration of Ceftibuten. Management: Consider administering oral zinc salts at least 3 hours after ceftibuten. Consider therapy modification

Cephalexin: Zinc Salts may decrease the absorption of Cephalexin. Management: Consider administering oral zinc salts at least 3 hours after cephalexin. Consider therapy modification

Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Consider therapy modification

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. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral zinc salts. Consider therapy modification

Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Consider therapy modification

PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Consider therapy modification

Quinolones: Zinc Salts may decrease the serum concentration of Quinolones. Management: Give oral quinolones at least several hours before (4 h for moxi- and sparfloxacin, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome-, 3 h for gemi-, and 2 h for levo-, nor-, pe- or ofloxacin or nalidixic acid) oral zinc salts. Exceptions: LevoFLOXacin (Oral Inhalation). Consider therapy modification

Raltegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Raltegravir. Management: Administer raltegravir 2 hours before or 6 hours after administration of the polyvalent cations. Dose separation may not adequately minimize the significance of this interaction. Consider therapy modification

Tetracyclines: Zinc Salts may decrease the absorption of Tetracyclines. Only a concern when both products are administered orally. Management: Consider doxycycline as a noninteracting tetracycline derivative. Separate dose administration of oral tetracycline derivative and oral zinc salts by at least 2 hours to minimize interaction. Exceptions: Doxycycline; Eravacycline. Consider therapy modification

Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Consider therapy modification

Adverse Reactions

Frequency not defined.

Central nervous system: Dizziness, headache

Gastrointestinal: Abdominal cramps, diarrhea, nausea, 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.

Monitoring Parameters

Patients on parenteral nutrition or chronic therapy should have periodic serum copper and serum zinc levels; alkaline phosphatase, taste acuity, mental depression

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 healthcare 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.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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