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AZT

Also indexed as: Azidothymidine, Retrovir®, ZDV, Zidovudine

Combination drug: Combivir®

AZT inhibits reproduction of retroviruses, including the human immunodeficiency virus (HIV). HIV is considered the cause of acquired immune deficiency syndrome (AIDS). AZT is one of a number of drugs used to treat HIV infection and AIDS.

Interactions with Dietary Supplements

General nutrition
Preliminary human research suggests AZT therapy may cause a reduction in copper and zinc blood levels. Animal studies suggest that vitamin E may improve the efficacy of AZT.1 The practical importance of these findings remains unclear.

Carnitine
Preliminary information suggests that muscle damage sometimes caused by AZT is at least partially due to depletion of carnitine in the muscles by the drug.2 It has been reported that most patients taking AZT have depleted carnitine levels that can be restored with carnitine supplementation (6 grams per day).3

N-acetyl cysteine
Animal research suggests that zinc and N-acetyl cysteine supplementation may protect against AZT toxicity.4 It is not known whether oral supplementation with these nutrients would have similar effects in people taking AZT.

Vitamin B12
Vitamin B12 deficiency in HIV infected persons may be more common in those taking AZT.5 HIV infected people with low vitamin B12 levels were shown in one study to be more likely to develop blood-related side effects (particularly anemia) from taking AZT.6

Riboflavin
Persons with AIDS have developed lactic acidosis and fatty liver while taking AZT and other drugs in its class. AZT can inhibit crucial DNA-related riboflavin activity, which may be normalized by riboflavin supplementation. A 46-year-old woman with AIDS and lactic acidosis received a single dose of 50 mg of riboflavin, after which her laboratory tests returned to normal and her lactic acidosis was completely resolved.7 More research is needed to confirm the value of riboflavin for preventing and treating this side effect.

Thymopentin
Thymopentin is a small protein that comes from a natural hormone in the body known as thymopoietin. This hormone stimulates production of the white blood cells known as T lymphocytes. Combination of thymopentin with AZT tended to decrease the rate at which HIV-infected persons progressed to AIDS.8 Thymopentin alone did not seem to have a benefit in this study. Since thymopentin is administered by injections into the skin, people should consult with a doctor as to the availability of this substance.

Zinc
A study found that adding 200 mg zinc per day to AZT treatment decreased the number of Pneumocystis carinii pneumonia and Candida infections in people with AIDS compared with people treated with AZT alone.9 The zinc also improved weight and CD4 cell levels. The amount of zinc used in this study was very high and should be combined with 1–2 mg of copper to reduce the risk of immune problems from the zinc long term.

Summary of Interactions for AZT

Depletion or interference Carnitine*
Copper
Vitamin B12
Adverse interaction None known
Side effect reduction/prevention Riboflavin
Supportive interaction Thymopentin
Zinc
Reduced drug absorption/bioavailability None known
Other (see text) N-Acetyl Cysteine
Vitamin E

For the convenience of the reader, the information in the summary is categorized as follows: “Depletion or interference” indicates the drug may deplete or interfere with the absorption or function of the supplement or herb. “Adverse interaction” indicates that the supplement or herb used together with the drug may result in undesirable effects. “Side effect reduction/prevention” indicates the supplement or herb may reduce the likelihood and/or severity of a potential side effect caused by the drug. “Supportive interaction” indicates the supplement or herb may support or aid the function of the drug. “Reduced drug absorption/bioavailability” indicates that the supplement or herb may decrease the absorption and/or activity of the drug in the body. An asterisk (*) next to an item in the summary indicates that the interaction is supported only by weak, fragmentary, and/or contradictory scientific evidence.

References:

1. Gogu SR, Beckman BS, Rangan SR, et al. Increased therapeutic efficacy of zidovudine in combination with vitamin E. Biochem Biophys Res Commun 1989;165:401–7.

2. Dalakas MC, Leon-Monzon ME, Bernardini I, et al. Zidovudine-induced mitochondrial myopathy is associated with muscle carnitine deficiency and lipid storage. Ann Neurol 1994;35:482–7.

3. De Simone C, Famularo G, Tzantzoglou S, et al. Carnitine depletion in peripheral blood mononuclear cells from patients with AIDS: effect of oral L-carnitine. AIDS 1994;8:655–60.

4. Gogu SR, Agrawal KC. The protective role of zinc and N-acetyl cysteine in modulating zidovudine-induced hematopoietic toxicity. Life Sci 1996;59:1323–9.

5. Paltiel O, Falutz J, Veilleux M, et al. Clinical correlates of subnormal vitamin B12 levels in patients infected with the human immunodeficiency virus. Am J Hematol 1995;49:318–22.

6. Richman DD, Fischl MA, Griego MH, et al. The toxicity of azidothymidine (AZT) in the treatment of patients with AIDS and AIDS-related complex. New Engl J Med 1987;317:192–7.

7. Fouty B, Frerman F, Reves R. Riboflavin to treat nucleoside analogue-induced lactic acidosis. Lancet 1998;352:291–2 [letter].

8. Goldstein G, Conant MA, Beall G, et al. Safety and efficacy of thymopentin in zidovudine (AZT)-treated asymptomatic HIV-infected subjects with 200–500 CD4 cells/mm3: A double-blind placebo-controlled trial. J Acq Imm Def Syn Human Retrovirol 1995;8:279–88.

9. Mocchegiani E, Veccia S, Ancarani F, et al. Benefit of oral zinc supplementation as an adjunct to zidovudine (AZT) therapy against opportunistic infections in AIDS. Int J Immunopharmacol 1995;17:719–27.