The drug should be used with caution in patients with an increased risk of peripheral neuropathy, with progressive HIV infection, with a history of peripheral neuropathy. The risk of developing this effect increases with simultaneous use in combination with neurotoxic drugs, including
didanosine. Feeling of numbness, tingling, or pain in the extremities can indicate the development of peripheral neuropathy. These symptoms may disappear immediately after discontinuation of the drug. If these symptoms occur, you should temporarily stop treatment with the drug. Resumption of treatment with the drug can only be after complete disappearance of symptoms. You may need to adjust the dose of the drug. In addition to the dose of the drug, the frequency of these phenomena depends and / or the stage of the disease (in the early stages are recorded less frequently).
The drug should be used with caution in patients with an increased risk of developing pancreatitis, with progressive HIV infection, while concomitant administration with didanosine. Pancreatitis of various severity, including cases with a fatal outcome, can develop in the patient at different stages of treatment, regardless of the degree of immunosuppression and dose.When symptoms of pancreatitis appear, drug treatment should be discontinued. When re-appointing the drug to exclude the simultaneous use of didanosine and hydroxycarbamide, the patient should be under close medical supervision. Patients with a pancreatitis in the anamnesis are a special group of risk. For the purpose of early detection of the development of pancreatitis, it is often necessary to check the function of the pancreas.
Lactoacidosis and severe liver steatosis with hepatomegaly, including fatal cases, are noted when nucleoside analogues are used in combination with other antiretroviral drugs. With the use of stavudine in combination with didanosine, the risk of liver dysfunction significantly increases. Risk factors are female sex, obesity and long-term use of nucleoside analogues. A special group of risk is represented by pregnant women. Signs of the development of symptomatic hyperlactatemia or lactic acidosis can be general fatigue, symptoms of the digestive system (nausea, vomiting, abdominal pain, sudden unexplained weight loss), symptoms from the respiratory system (rapid breathing,shortness of breath), muscle weakness, often associated with symptomatic hyperlactatemia or lactic acidosis syndrome, was rarely noted in the treatment of stavudine. If these symptoms appear, or if laboratory confirmation of lactic acidosis or severe hepatotoxicity is obtained, discontinue drug treatment.
When using a combination of antiretroviral drugs in combination with hydroxycarbamide, as well as in the administration of stavudine, patients with liver disease should be carefully monitored for patients, if signs of deterioration appear, liver function should be considered, the question of withdrawal of treatment. In connection with the frequency of deaths in the appointment of combined therapy with hydroxycarbamide, didanosine and stavudine, this scheme should be avoided.
Due to the fact that the clearance of stavudine decreases with a decrease in creatinine clearance, the dose of stavudine for patients with impaired renal function (creatinine clearance ≤ 50 ml / min) should be corrected.
Redistribution of fatty tissue is observed in patients receiving antiretroviral therapy - obesity by the central type,an increase in the amount of fat in the dorsocervical zone ("buffalo" hump), a decrease in fatty tissue of the limbs and face, a "cushingoid face," an increase in the mammary glands.
In rare cases, stavudine treatment develops muscle weakness with symptoms similar to the clinical signs of Guillain-Barre syndrome (including respiratory failure). Symptoms may persist or worsen after discontinuation of therapy.
In patients taking
stavudine, especially with prolonged treatment with antiretroviral drugs, there was a case of osteonecrosis, in the etiology of which factors such as treatment with corticosteroids, alcohol abuse, pronounced immunosuppression, obesity play an important role.
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There are reports of mitochondrial dysfunction (often transient, anemia, neutropenia, hyperlactatemia, hyperlipazemia) in HIV-negative children exposed to nucleoside analogues in utero or immediately after birth. To later manifestations of this disorder are hypertonic musculature, sudrogs, behavioral anomalies.
It should be carefully monitored for patients older than 65 years, tk.they represent a group with an increased risk of developing peripheral neuropathy, in addition, this age group has an average higher frequency of renal dysfunction, which should be considered when administering stavudine.
The immune reactivation syndrome is manifested by the exacerbation of sluggish infections and activation of the opportunistic flora and is also observed at the initial stage of treatment. Patients should be monitored carefully to detect any inflammatory diseases and treat them in a timely manner.