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Chemistry

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Also known as: 3056-17-5, Sanilvudine, Zerit, 2',3'-didehydro-3'-deoxythymidine, Stavudinum, Zerit xr
Molecular Formula
C10H12N2O4
Molecular Weight
224.21  g/mol
InChI Key
XNKLLVCARDGLGL-JGVFFNPUSA-N
FDA UNII
BO9LE4QFZF

Stavudine
A dideoxynucleoside analog that inhibits reverse transcriptase and has in vitro activity against HIV.
Stavudine is a Human Immunodeficiency Virus Nucleoside Analog Reverse Transcriptase Inhibitor. The mechanism of action of stavudine is as a Nucleoside Reverse Transcriptase Inhibitor.
1 2D Structure

Stavudine

2 Identification
2.1 Computed Descriptors
2.1.1 IUPAC Name
1-[(2R,5S)-5-(hydroxymethyl)-2,5-dihydrofuran-2-yl]-5-methylpyrimidine-2,4-dione
2.1.2 InChI
InChI=1S/C10H12N2O4/c1-6-4-12(10(15)11-9(6)14)8-3-2-7(5-13)16-8/h2-4,7-8,13H,5H2,1H3,(H,11,14,15)/t7-,8+/m0/s1
2.1.3 InChI Key
XNKLLVCARDGLGL-JGVFFNPUSA-N
2.1.4 Canonical SMILES
CC1=CN(C(=O)NC1=O)C2C=CC(O2)CO
2.1.5 Isomeric SMILES
CC1=CN(C(=O)NC1=O)[C@H]2C=C[C@H](O2)CO
2.2 Other Identifiers
2.2.1 UNII
BO9LE4QFZF
2.3 Synonyms
2.3.1 MeSH Synonyms

1. 2',3' Didehydro 3' Deoxythymidine

2. 2',3'-didehydro-2',3'-dideoxythmidine

3. 2',3'-didehydro-3'-deoxythymidine

4. Bmy 27857

5. Bmy-27857

6. Bmy27857

7. D4t

8. Stavudine, Monosodium Salt

9. Zerit

2.3.2 Depositor-Supplied Synonyms

1. 3056-17-5

2. Sanilvudine

3. Zerit

4. 2',3'-didehydro-3'-deoxythymidine

5. Stavudinum

6. Zerit Xr

7. D4t

8. Bmy-27857

9. Estavudina

10. Stavudinum [inn-latin]

11. Estavudina [inn-spanish]

12. Thymidine, 2',3'-didehydro-3'-deoxy-

13. 3'-deoxy-2'-thymidinene

14. Ddethd

15. 2',3'-didehydro-3'-deoxythimidine

16. 3'-deoxy-2',3'-didehydrothymidine

17. Bmy 27857

18. 1-((2r,5s)-5-(hydroxymethyl)-2,5-dihydrofuran-2-yl)-5-methylpyrimidine-2,4(1h,3h)-dione

19. Dideoxydidehydrothymidine

20. 1-(2,3-dideoxy-beta-d-glycero-pent-2-enofuranosyl)thymine

21. Nsc 163661

22. Sanilvudine (jan)

23. Bo9le4qfzf

24. Stavudine (d4t)

25. 1-[(2r,5s)-5-(hydroxymethyl)-2,5-dihydrofuran-2-yl]-5-methylpyrimidine-2,4(1h,3h)-dione

26. Stv

27. Chembl991

28. Nsc-759897

29. Zerut Xr

30. Mls000028546

31. D-4t

32. Chebi:63581

33. 1-[(2r,5s)-5-(hydroxymethyl)-2,5-dihydrofuran-2-yl]-5-methylpyrimidine-2,4-dione

34. Nsc-163661

35. Ncgc00023212-07

36. Smr000058350

37. D 4t (nucleoside)

38. Sanilvudine [jan]

39. Dsstox_cid_3819

40. Dsstox_rid_77198

41. Dsstox_gsid_23819

42. 1-[(2r,5s)-5-(hydroxymethyl)-2,5-dihydrofuran-2-yl]-5-methyl-1,2,3,4-tetrahydropyrimidine-2,4-dione

43. Stavudine [usan:ban:inn]

44. 1-(2,3-dideoxy-.beta.-d-glycero-pent-2-enofuranosyl)thymine

45. D 4t

46. Ddetyd

47. 1-(cis-5-(hydroxymethyl)-2,5-dihydrofuran-2-yl)-5-methylpyrimidine-2,4(1h,3h)-dione

48. 1-[(2r,5s)-5-(hydroxymethyl)-2,5-dihydrofuran-2-yl]-5-methyl-pyrimidine-2,4-dione

49. 220020-60-0

50. Cas-3056-17-5

51. Zerit(tm)

52. Zerit (tn)

53. Hsdb 7338

54. Sr-01000075802

55. Unii-bo9le4qfzf

56. Stavudine (usan/inn)

57. Brn 0618327

58. D4t & Gm-csf

59. 2'-thymidinene, 3'-deoxy-

60. Nsc163661

61. Stavudine [usan:usp:inn:ban]

62. Stavudine (dt4)

63. Stavudine- Bio-x

64. D4tmby-27857-3

65. Stavudine [inn]

66. Stavudine [mi]

67. Stavudine [hsdb]

68. Stavudine [usan]

69. Opera_id_1281

70. 3'-deoxythymidin-2'-ene

71. Stavudine [mart.]

72. D 1413

73. Cid_5155

74. Stavudine [usp-rs]

75. Stavudine [who-dd]

76. Stavudine [who-ip]

77. 1-((2r,5s)-5-hydroxymethyl-2,5-dihydro-furan-2-yl)-5-methyl-1h-pyrimidine-2,4-dione

78. 3''-deoxy-2''-thymidine

79. Lopac0_000336

80. Schembl38661

81. Stavudine [ema Epar]

82. Cid_18283

83. Mls000759504

84. Mls001055348

85. Mls001077292

86. Mls001424091

87. Mls006011922

88. Bidd:gt0082

89. 2',3'-anhydrothymidine; D4t

90. Stavudine [ep Impurity]

91. Stavudine [orange Book]

92. Dtxsid1023819

93. Stavudine [ep Monograph]

94. 1-(2,3-dideoxy-beta-d-glycero-2-pentenofuranosyl)thymine

95. Stavudine [usp Monograph]

96. Stavudinum [who-ip Latin]

97. Hms2051o20

98. Hms2234c10

99. Hms3039o05

100. Hms3259l21

101. Hms3261c13

102. Hms3428c07

103. Hms3714n22

104. Pharmakon1600-01502339

105. Stavudine (d4t) [vandf]

106. Stavudine (dt4) [vandf]

107. Zinc137884

108. Bcp02952

109. Hy-b0116

110. Tox21_110886

111. Tox21_201393

112. Tox21_300583

113. Tox21_500336

114. Bbl033763

115. Bdbm50013111

116. Nsc759897

117. Stk801888

118. Akos005622554

119. Tox21_110886_1

120. Ac-5263

121. Ccg-100902

122. Cs-1872

123. Db00649

124. Ks-1115

125. Lp00336

126. Nc00152

127. Nc00684

128. Sdccgsbi-0050324.p002

129. Zidovudine Impurity A [who-ip]

130. 2'',3''-didehydro-3''-deoxythymidine

131. 3''-deoxy-2'',3''-didehydrothymidine

132. Ncgc00023212-03

133. Ncgc00023212-04

134. Ncgc00023212-05

135. Ncgc00023212-08

136. Ncgc00023212-09

137. Ncgc00023212-10

138. Ncgc00023212-11

139. Ncgc00023212-12

140. Ncgc00023212-13

141. Ncgc00023212-14

142. Ncgc00023212-25

143. Ncgc00023212-30

144. Ncgc00254372-01

145. Ncgc00258944-01

146. Ncgc00261021-01

147. Stavudine 100 Microg/ml In Acetonitrile

148. 1-[5-(hydroxymethyl)-2,5-dihydro-2-furanyl]-5-methyl-2,4(1h,3h)-pyrimidinedione & Colony-stimulating Factor 2

149. Bd164571

150. Smr000673569

151. Thymidine, 2',3'-didehydro-, 3'-deoxy-

152. Zidovudine Impurity A [ep Impurity]

153. D3580

154. Eu-0100336

155. 2'',3''-dideoxy-2'',3''-didehydrothymidine

156. C07312

157. D00445

158. Ab00383018_18

159. 056s175

160. Q423984

161. J-700246

162. Q-201742

163. Sr-01000075802-1

164. Sr-01000075802-4

165. 2',3'-didehydro-3'-deoxythymidine, >=98% (tlc)

166. Z1695906749

167. Stavudine, European Pharmacopoeia (ep) Reference Standard

168. Stavudine, United States Pharmacopeia (usp) Reference Standard

169. Thymine, 1-(2,3-dideoxy-beta-d-glycero-pent-2-enofuranosyl)-

170. 1-(5-hydroxymethyl-2,5-dihydro-furan-2-yl)-5-methyl-1h-pyrimidine-2,4-dione

171. 1-(5-hydroxymethyl-2,5-dihydro-furan-2-yl)-5-methyl-1h-pyrimidine-2,4-dione (ddethd)

172. 1-[(2r,5s)-2,5-dihydro-5-(hydroxymethyl)-2-furanyl]-5-methyl-2,4(1h,3h)-pyrimidinedione

173. 3'- Azido-3'-deoxythymidine & Granulocyte-macrophage Colony-stimulating Factor

174. Stavudine For System Suitability, European Pharmacopoeia (ep) Reference Standard

2.4 Create Date
2005-06-24
3 Chemical and Physical Properties
Molecular Weight 224.21 g/mol
Molecular Formula C10H12N2O4
XLogP3-0.8
Hydrogen Bond Donor Count2
Hydrogen Bond Acceptor Count4
Rotatable Bond Count2
Exact Mass224.07970687 g/mol
Monoisotopic Mass224.07970687 g/mol
Topological Polar Surface Area78.9 Ų
Heavy Atom Count16
Formal Charge0
Complexity388
Isotope Atom Count0
Defined Atom Stereocenter Count2
Undefined Atom Stereocenter Count0
Defined Bond Stereocenter Count0
Undefined Bond Stereocenter Count0
Covalently Bonded Unit Count1
4 Drug and Medication Information
4.1 Drug Information
1 of 4  
Drug NameStavudine
PubMed HealthStavudine (By mouth)
Drug ClassesAntiretroviral Agent
Drug LabelStavudine (d4T), a synthetic thymidine nucleoside analogue, active against the human immunodeficiency virus (HIV). Stavudine Capsules are supplied for oral administration in strengths of 15, 20, 30, and 40 mg of stavudine. Each capsule also contains...
Active IngredientStavudine
Dosage FormCapsule; For solution
Routeoral; Oral
Strength1mg/ml; 30mg; 15mg; 40mg; 20mg
Market StatusTentative Approval; Prescription
CompanyHetero Labs Ltd Iii; Aurobindo Pharma; Cipla; Matrix Labs; Emcure Pharma; Strides Acrolab; Mylan

2 of 4  
Drug NameZerit
PubMed HealthStavudine (By mouth)
Drug ClassesAntiretroviral Agent
Drug LabelZERIT is the brand name for stavudine (d4T), a synthetic thymidine nucleoside analogue, active against the human immunodeficiency virus (HIV).ZERIT (stavudine) Capsules are supplied for oral administration in strengths of 15, 20, 30, and 40 mg of s...
Active IngredientStavudine
Dosage FormCapsule; For solution
RouteOral
Strength1mg/ml; 30mg; 15mg; 40mg; 20mg
Market StatusPrescription
CompanyBristol Myers Squibb

3 of 4  
Drug NameStavudine
PubMed HealthStavudine (By mouth)
Drug ClassesAntiretroviral Agent
Drug LabelStavudine (d4T), a synthetic thymidine nucleoside analogue, active against the human immunodeficiency virus (HIV). Stavudine Capsules are supplied for oral administration in strengths of 15, 20, 30, and 40 mg of stavudine. Each capsule also contains...
Active IngredientStavudine
Dosage FormCapsule; For solution
Routeoral; Oral
Strength1mg/ml; 30mg; 15mg; 40mg; 20mg
Market StatusTentative Approval; Prescription
CompanyHetero Labs Ltd Iii; Aurobindo Pharma; Cipla; Matrix Labs; Emcure Pharma; Strides Acrolab; Mylan

4 of 4  
Drug NameZerit
PubMed HealthStavudine (By mouth)
Drug ClassesAntiretroviral Agent
Drug LabelZERIT is the brand name for stavudine (d4T), a synthetic thymidine nucleoside analogue, active against the human immunodeficiency virus (HIV).ZERIT (stavudine) Capsules are supplied for oral administration in strengths of 15, 20, 30, and 40 mg of s...
Active IngredientStavudine
Dosage FormCapsule; For solution
RouteOral
Strength1mg/ml; 30mg; 15mg; 40mg; 20mg
Market StatusPrescription
CompanyBristol Myers Squibb

4.2 Therapeutic Uses

Stavudine in combination with other antiretroviral agents is indicated for the treatment of HIV-1 infection. Additionally, stavudine is indicated for the treatment of patients with HIV infection who have received prolonged previous treatment with zidovudine. /Included in US product labeling/

Thomson.Micromedex. Drug Information for the Health Care Professional. 25th ed. Volume 1. Plus Updates. Content Reviewed by the United States Pharmacopeial Convention, Inc. Greenwood Village, CO. 2005., p. 2676


4.3 Drug Warning

Lactic acidosis and severe hepatomegaly with steatosis, including some fatalities, have been reported rarely in patients receiving stavudine and also have been reported in patients receiving other NRTIs. Female gender, obesity, and long-term therapy with NRTIs may be risk factors. Fatal lactic acidosis has been reported in pregnant women who received antiretroviral regimens that included both didanosine and stavudine. Stavudine should be used with caution in patients with known risk factors for liver disease; however, lactic acidosis and severe hepatomegaly with steatosis have been reported in patients with no known risk factors. Generalized fatigue, digestive symptoms (nausea, vomiting, abdominal pain, sudden unexplained weight loss), respiratory symptoms (tachypnea, dyspnea), or neurologic symptoms (including motor weakness) might be indicative of lactic acidosis development, and patients should be advised to contact their clinician immediately if these symptoms occur. Stavudine therapy should be discontinued in any patient with clinical or laboratory findings suggestive of lactic acidosis or pronounced hepatotoxicity (which may include hepatomegaly and steatosis even in the absence of marked increases in serum aminotransferase concentrations). Permanent discontinuance of stavudine therapy should be considered in patients with confirmed lactic acidosis. Because an increased risk of potentially fatal hepatotoxicity may occur in patients receiving stavudine in conjunction with didanosine and hydroxyurea, patients receiving such regimens should be closely monitored for signs of hepatotoxicity.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 721


Lactic acidosis is a serious complication of antiretroviral therapy. Symptomatic hyperlactatemia is a milder form of this syndrome, but its incidence is unclear. In this prospective ongoing observational study of a large cohort of HIV-infected adults, hyperlactataemia was diagnosed in 64 patients. Incidences were 18.3/1000 person-years with antiretroviral therapy, and 35.8/1000 person-years for stavudine (d4T) regimens. Ten of the 64 patients developed lactic acidosis during the first 13 months of treatment (incidence 2.9/1000 treated person-years). In four of ten patients, symptoms were absent or mild. More patients on d4T first-line therapy developed lactic acidosis than patients previously treated with other drugs (p = 0.008). Despite the occurrence of one death, the subsequent outcome for the remaining patients was favourable after antiretroviral therapy was stopped and supportive treatment with vitamins and antioxidants initiated. The early diagnosis of cases was the result of great vigilance and, combined with routine measurements of the anion gap, might be the most crucial factor explaining the low mortality rate observed here.

PMID:12942856 Gerard Y et al; Therapie 58 (2): 153-8 (2003)


Potentially severe peripheral neuropathy, manifested by numbness, tingling, or pain in the hands or feet, has been reported in about 52% of patients receiving stavudine alone and in 8-21% of patients receiving stavudine in conjunction with other antiretroviral agents (indinavir and either lamivudine or didanosine). Stavudine-associated peripheral neuropathy appears to be dose-related, and has been reported most frequently in patients with advanced HIV, patients with a history of peripheral neuropathy, or patients receiving other neurotoxic drugs, including didanosine. Symptoms of peripheral neuropathy generally resolve if stavudine therapy is promptly discontinued; however, symptoms may worsen temporarily in some patients following discontinuance of the drug. If such symptoms resolve completely, patients may tolerate resumption of stavudine therapy using a reduced dosage. If neuropathy recurs after stavudine therapy is reinitiated, consideration should be given to permanently discontinuing the drug.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 720


Pancreatitis, which has been fatal in some cases, has occurred in patients receiving stavudine in conjunction with didanosine (with or without hydroxyurea) and has been reported in both treatment-naive and previously treated patients, regardless of degree of immunosuppression. In an early clinical study evaluating stavudine, pancreatitis was observed in less than 1% of adult patients receiving stavudine monotherapy. Patients receiving didanosine in conjunction with stavudine (with or without hydroxyurea) may be at increased risk of pancreatitis; there have been at least 2 fatalities related to pancreatitis in patients receiving didanosine concomitantly with stavudine, indinavir, and hydroxyurea. There also has been at least one death related to pancreatitis in a patient receiving didanosine in conjunction with stavudine and nelfinavir. Stavudine, didanosine, hydroxyurea, and any other agent toxic to the pancreas should be discontinued in any patient who develops suspected pancreatitis.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 720


For more Drug Warnings (Complete) data for STAVUDINE (20 total), please visit the HSDB record page.


4.4 Drug Indication

For the treatment of human immunovirus (HIV) infections.


FDA Label


* Hard capsules:

Zerit is indicated in combination with other antiretroviral medicinal products for the treatment of HIV-infected adult patients and paediatric patients (over the age of three months) only when other antiretrovirals can not be used. The duration of therapy with Zerit should be limited to the shortest time possible.

* Powder for oral solution:

Zerit is indicated in combination with other antiretroviral medicinal products for the treatment of HIV-infected adult patients and paediatric patients (from birth) only when other antiretrovirals can not be used. The duration of therapy with Zerit should be limited to the shortest time possible.


5 Pharmacology and Biochemistry
5.1 Pharmacology

Stavudine is a nucleoside reverse transcriptase inhibitor (NRTI) with activity against Human Immunodeficiency Virus Type 1 (HIV-1). Stavudine is phosphorylated to active metabolites that compete for incorporation into viral DNA. They inhibit the HIV reverse transcriptase enzyme competitively and act as a chain terminator of DNA synthesis. The lack of a 3'-OH group in the incorporated nucleoside analogue prevents the formation of the 5' to 3' phosphodiester linkage essential for DNA chain elongation, and therefore, the viral DNA growth is terminated.


5.2 MeSH Pharmacological Classification

Anti-HIV Agents

Agents used to treat AIDS and/or stop the spread of the HIV infection. These do not include drugs used to treat symptoms or opportunistic infections associated with AIDS. (See all compounds classified as Anti-HIV Agents.)


Antimetabolites

Drugs that are chemically similar to naturally occurring metabolites, but differ enough to interfere with normal metabolic pathways. (From AMA Drug Evaluations Annual, 1994, p2033) (See all compounds classified as Antimetabolites.)


Reverse Transcriptase Inhibitors

Inhibitors of reverse transcriptase (RNA-DIRECTED DNA POLYMERASE), an enzyme that synthesizes DNA on an RNA template. (See all compounds classified as Reverse Transcriptase Inhibitors.)


5.3 FDA Pharmacological Classification
5.3.1 Active Moiety
STAVUDINE
5.3.2 FDA UNII
BO9LE4QFZF
5.3.3 Pharmacological Classes
Nucleoside Analog [EXT]; Nucleoside Reverse Transcriptase Inhibitors [MoA]; Human Immunodeficiency Virus Nucleoside Analog Reverse Transcriptase Inhibitor [EPC]
5.4 ATC Code

J05AF04


J - Antiinfectives for systemic use

J05 - Antivirals for systemic use

J05A - Direct acting antivirals

J05AF - Nucleoside and nucleotide reverse transcriptase inhibitors

J05AF04 - Stavudine


5.5 Absorption, Distribution and Excretion

Absorption

Following oral administration, stavudine is rapidly absorbed (bioavailability is 68-104%).


Volume of Distribution

46 21 L


Clearance

Renal cl=272 mL/min [Healthy subjects receiving 80 mg PO]

594 +/- 164 mL/min [HIV-infected adult and pediatric patients following 1-hour IV infusion]

9.75 +/- 3.76 mL/min/kg [HIV- Exposed or -Infected Pediatric Patients(Age 5 weeks 15 years) following 1-hour IV infusion]


Stavudine is rapidly absorbed following oral administration, and peak plasma concentrations of the drug are attained within 1 hour after the dose. Oral bioavailability of stavudine is reported to be about 86% in adults and 77% in pediatric patients 5 weeks to 15 years of age.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 723


Data from single- and multiple-dose studies indicate that peak plasma concentrations and AUC of stavudine increase in proportion to dose over the dosage range 0.03 -4 mg/kg; there is no evidence that accumulation occurs following multiple doses.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 723


Binding of stavudine to serum proteins is negligible over the concentration range of 0.01-11.4 ug/mL.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 723


Distribution of stavudine into body tissues and fluids has not been fully characterized. The apparent volume of distribution of stavudine following a single oral dose averages 66 L in HIV-infected adults. Following a single IV dose in HIV-infected individuals, the volume of distribution is 58 L in adults and 0.73 L/kg in pediatric patients 5 weeks to 15 years of age.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 723


For more Absorption, Distribution and Excretion (Complete) data for STAVUDINE (12 total), please visit the HSDB record page.


5.6 Metabolism/Metabolites

Phosphorylated intracellularly to stavudine triphosphate, the active substrate for HIV-reverse transcriptase.


The metabolic fate of stavudine has not been elucidated in humans. Intracellularly, in both virus-infected and uninfected cells, stavudine is converted to stavudine monophosphate by cellular thymidine kinase. The monophosphate is subsequently converted to stavudine diphosphate and then to stavudine triphosphate, presumably by the same cellular kinases involved in the metabolism of zidovudine. Intracellular (host cell) conversion of stavudine to the triphosphate derivative is necessary for the antiviral activity of the drug.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 723


5.7 Biological Half-Life

0.8-1.5 hours (in adults)


Intracellular half life of stavudine triphosphate: Approximately 3.5 hours. /Stavudine triphosphate/

Thomson.Micromedex. Drug Information for the Health Care Professional. 25th ed. Volume 1. Plus Updates. Content Reviewed by the United States Pharmacopeial Convention, Inc. Greenwood Village, CO. 2005., p. 2676


Normal renal function: Adults: 0.8 to 1.5 hours (intravenous); 1.14 to 1.74 hours (oral). Children (5 weeks to 15 years): 0.83 to 1/39 hours (intravenous); 0.7 to 1.22 hours (oral). Neonates (14 to 28 days) 1.3 to 1.88 (oral). Neonates (day of birth): 3.26 to 7.28 (oral). Renal function impairment (creatinine clearance 26 to 50 mL/min): Approximately 1 to 6 hours. Renal function impairment (creatinine clearance 9 to 25 mL/min): Approximately 3.7 to 5.5 hours. Renal function impairment (creatinine clearance > 50 mL/min): Approximately 1.3 to 2.1 hours. Renal function impairment (hemodialysis patients): Approximately 4.0 to 6.8 hours.

Thomson.Micromedex. Drug Information for the Health Care Professional. 25th ed. Volume 1. Plus Updates. Content Reviewed by the United States Pharmacopeial Convention, Inc. Greenwood Village, CO. 2005., p. 2676


Twenty-two patients were studied after the first oral dose of 0.67, 1.33, 2.67, or 4 mg/kg of body weight; 17 of them underwent an additional steady-state pharmacokinetic evaluation after thrice-daily dosing of the above doses. ... The mean values for plasma elimination half-life ranged from 1 to 1.6 hr.

PMID:1323615 Dudley MN et al; J Infect Dis 166 (3):480-5 (1992)


5.8 Mechanism of Action

Stavudine inhibits the activity of HIV-1 reverse transcriptase (RT) both by competing with the natural substrate dGTP and by its incorporation into viral DNA.


Enzymatic conversion of stavudine to d4T-triphosphate appears to be complex, involving several steps and enzymes. Stavudine is first converted to dideoxydidehydrothymidine-5'-monophosphate (d4T-monophosphate) by thymidine kinase. Subsequently, d4T-monophosphate is converted to dideoxydidehydrothymidine-5'-diphosphate (d4T-diphosphate), and then to d4T-triphosphate, presumably by the same cellular kinases involved in the metabolism of zidovudine. ... d4T-Triphosphate is a structural analog of thymidine triphosphate, the natural substrate for viral RNA-directed DNA polymerase. ... d4T-triphosphate appears to compete with thymidine triphosphate for viral RNA-directed DNA polymerase and incorporation into viral DNA. Following incorporation of d4T-triphosphate into the viral DNA chain instead of thymidine triphosphate, synthesis is terminated prematurely because the absence of the 3'-hydroxy group on the drug prevents further 5' to 3' phosphodiester linkages.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 723


Stavudine is phosphorylated by cellular kinases to the active metabolite stavudine triphosphate. Stavudine triphosphate inhibits the activity of HIV reverse transcriptase both by competing with the natural substrate deoxythymidine triphosphate (Ki =0.0083 to 0.032 uM), and by its incorporation into viral DNA causing a termination of DNA chain elongation because stavudine lacks the essential 3'-OH group. Stavudine triphosphate inhibits cellular DNA polymerase beta and gamma, and markedly reduces the synthesis of mitochondrial DNA.

Physicians Desk Reference. 59th ed. Thomson PDR. Montvale, NJ 2005., p. 1087


d4T-Triphosphate can bind to and inhibit some mammalian cellular DNA polymerases, particularly beta- and gamma-polymerases, in vitro, and markedly reduce the synthesis of mitochondrial DNA. ...gamma-polymerase, an enzyme involved in mitochondrial DNA synthesis, is the polymerase most susceptible to inhibition. However, d4T-triphosphate and other dideoxynucleoside triphosphates appear to have much greater affinity for viral RNA-directed DNA polymerase than for mammalian DNA polymerases. ... Inhibition of beta- and gamma-polymerases by these drugs may account, to some extent, for the toxic effects associated with stavudine and other nucleosides in humans.

McEvoy, G.K. (ed.). American Hospital Formulary Service- Drug Information 2005. Bethesda, MD: American Society of Health-System Pharmacists, Inc. 2005 (Plus Supplements)., p. 723


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DOSAGE - CAPSULE;ORAL - 15MG **Federal Regist...DOSAGE - CAPSULE;ORAL - 15MG **Federal Register determination that product was not discontinued or withdrawn for safety or effectiveness reasons**

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