Stavudine: A Review

Stavudine was the fourth nucleoside analog to be approved in the United States for the management of HIV-1 infections. It is a dideoxy analog of thymidine and is structurally similar to zidovudine. In adults, the usual dose is 40mg twice daily and probably does not have to be altered based on body weight unless the patient shows signs of toxicity from the drug, or has renal insufficiency. Clinical studies indicate that is very well tolerated, and, hematological toxicity is infrequent. Its dose limiting adverse effect is peripheral neuropathy, which is reversible in most cases with dose reduction or discontinuation. It has been shown to have synergistic activity against HIV-1 in vitro when combined with didanosine, lamivudine, nevirapine, and saquinavir. During clinical trials it has been shown that stavudine in combination with other antiviral drugs can reduce the viral load to 2 log(10) copies/ml. Recently it has been observed that Stavudine may have an increased side-effect profile and reduced efficacy when combined with zidovudine, and, therefore, is best used as an alternative to zidovudine in combination drug regimens.