Taking it

The standard dose of d4T (stavudine, Zerit) is one 40mg capsule twice a day, but those weighing less than 60kg usually take 30mg twice daily.

Because of toxicity concerns, in 2007 WHO revised their guidelines to advise 30mg dosing twice a day for adults and adolescents, regardless of weight.^[1] Formerly, someone with evidence of d4T-related toxicity was changed to a reduced dose, but the WHO recommendation now is to change to a regimen that does not contain d4T.

In one 48-week pilot study, the efficacy and safety of lower-dose d4T was examined in patients weighing over 60 kg and with a viral load <400 copies/ml. Patients were switched from their regular 40mg twice daily dose of d4T to 30mg twice-daily dosing. In this small study, clinical and laboratory parameters were either unchanged or improved. Total cholesterol, high-density lipoprotein cholesterol, and alanine aminotransferase levels were reduced at 48 weeks.^[2]  

Because d4T is also available as a powder, it can be dissolved in water before being taken. Although the package information suggests that d4T should always be taken on an empty stomach for faster absorption, studies have shown that food does not make any difference to the total amount of d4T absorbed.

Use of d4T is not recommended for use in an initial antiretroviral regimen in Europe or the United States. It is also not recommended for anyone with lactose intolerance, as d4T contains lactose. In someone with impaired kidney function or peripheral neuropathy, the dose of d4T may be reduced to 15 or 20mg twice daily. Additionally, the combination of d4T/ddI should be avoided in people taking ribavirin for HCV, due to the risk of lactic acidosis. 

It is important to take d4T as prescribed to maintain the right level of the drug in the blood. If blood levels of the drug fall too low, this may allow the development of resistance to d4T and affect future treatment options. This drug comes in immediate release and extended release form.