Neonatal Drug Therapy Manual

Zidovudine

Disclaimer: Official controlled document is the CHEO and Ottawa Hospital online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Updated August 29, 2022 - 1:41pm

Alternate Name(s): 
AZT, Retrovir
Classification: 
Antiretroviral
Original Date: 
June 1996
Revised Date: 
November 2020
Indications: 
  • To reduce the risk of transmission of the HIV virus from an HIV positive mother to her baby. Administration to the baby is part of a defined protocol in which the mother has received antenatal combination antiretroviral therapy.
Administration: 
  • PO
  • IV intermittent infusion: over 30 minutes
Dosage: 
Gestational Age (GA) Dose Duration
> 35 weeks PO: 4 mg/kg/dose q12h 4 - 6 weeks
IV: 3 mg/kg/dose q12h
 
> 30 to < 35 weeks PO: 2 mg/kg/dose q12h 2 weeks
IV: 1.5 mg/kg/dose q12h
Followed by:

PO: 3 mg/kg/dose q12h

4 weeks

 
IV: 2.3 mg/kg/dose q12h
 
< 30 weeks PO:2 mg/kg/dose q12h 4 weeks

IV: 1.5 mg/kg/dose q12h

 

Followed by:

PO: 3 mg/kg/dose q12h

 2 weeks
IV: 2.3 mg/kg/dose q12h

 *** Zidovudine should be started as soon as possible after birth and no later than 2-6 hours after delivery.  Continue for 4 - 6 weeks

Side Effects: 
  • Endocrine and metabolic: lactic acidosis
  • Hematologic: anemia, neutropenia, thrombocytopenia, leukopenia
  • Hepatic: cholestatic hepatitis, hepatomegaly, elevated AST, LDH and ALP
Parameters to Monitor: 
  • CBC and differential (hemoglobin, absolute neutrophil count)
  • Liver transaminases (ALT, AST)
  • Lactic acid.
Reconstitution and Stability: 

IV intermittent infusion:

  • Zidovudine 10 mg/mL
    • Add 5 mL (50 mg) to 45 mL D5W
    • Final concentration: 1 mg/mL
Compatibility: 

- Solutions Compatible: D5W and 0.9 % NaCl

- Y-site Compatible: acyclovir, dobutamine, dopamine, gentamicin, morphine, potassium chloride, SMOF, TPN, vancomycin

References: 

- Panel on Antiretroviral Therapy and Medical Management of Children Living with HIV. Guidelines for the Use of Antiretroviral Agents in Pediatric HIV Infection. versio Date: April 14, 2020. Available at http://aidsinfo.nih.gov/contentfiles/lvguidelines/pediatricguidelines.pdf.

- Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for Use of Antiretroviral Drugs in Pregnant HIV-1-Infected Women for Maternal Health and Interventions to Reduce Perinatal HIV Transmission in the United States. Version Date: April 14, 2020 (Table 7).  Available at http://aidsinfo.nih.gov/ContenetFiles/PerinatalGL.pdf

-  Guidelines for the Prevention of Mother-to-Child HIV Transmission.  Information and Practice Guidance for Health Practitioners in Ontario.  Working with HIV-infected Women with Inadequate Control of HIV, and Women with Unknown HIV Status Who Present in Labor. Version Date: January 20, 2017

The information contained on this website is provided for informational purposes only, as a guide to assist physicians, nurses and other healthcare providers in deciding on the appropriate care required for a particular patient. At all times, physicians, nurses and other healthcare providers must exercise their independent clinical judgment, based on their knowledge, training and experience, taking into account the specific facts and circumstances of each patient, when deciding on the appropriate course of investigation and/or treatment to recommend in a particular clinical situation.

CHEO has made every effort to ensure that the information contained on this website is as current and accurate as possible. However, changes can occur due to ongoing research and the constant influx of new information. Where possible, hospitals and healthcare practitioners should verify the information before acting on it.

Reliance on any information in this website is at the user's own risk. CHEO is not responsible or liable for any harm, loss or other consequences from the use or misuse of the information on this website.