Chemical structure of zalcitabine.
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Zalcitabine

Zalcitabine (2'-3'-dideoxycytidine, ddC), also called dideoxycytidine, is a nucleoside analog reverse transcriptase inhibitor (NARTI) sold under the trade name HividĀ®. more...

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Zalcitabine is the least potent of all antiretroviral drugs, is inconvenient to take, and has serious side effects. For these reasons it is now rarely used to treat human immunodeficiency virus (HIV).

History

Zalcitabine was developed in the National Cancer Institute (NCI) by Samuel Broder, Hiroaki Mitsuya, and Robert Yarchoan at the National Cancer Institute (NCI). Like didanosine, it was then licensed because the NCI may not market drugs. The National Institutes of Health (HIH) thus licensed it to Hoffman LaRoche Co.

Zalcitabine was the third antiretroviral to be approved by the Food and Drug Administration (FDA) for the treatment of HIV infection and AIDS. It was approved on Jun 19, 1992 as a monotherapy and again in 1996 for use in combination with Zidovudine (AZT). Using combinations of NRTIs was in practice prior to the second FDA approval and the triple drug combinations with dual NRTIs and a protease inhibitor (PI) were not far off by this time.

Mechanism of action

Zalcitabine is an analog of pyrimidine. It is a derivative of the naturally existing deoxycytidine, made by replacing the hydroxyl group in position 3' with a hydrogen.

It is phosphorylated in the T cell and other HIV target cells into its active triphosphate form, ddCTP. This active metabolite works as a substrate for HIV reverse transcriptase, and also by incorporation into the viral DNA, hence terminating the chain elongation due to the missing hydroxyl group. Since zalcitabine is a reverse transcriptase inhibitor it possess activity only against retroviruses. It is used for the treatment of HIV infection only in combination with zidovudine.

Zalcitabine has a very high oral absorption rate, of over 80%. The most common side effect in the beginning of the treatment is nausea and headache. The more serious side effects are peripheral neuropathy, oesophagitis and pancreatitis.

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Patient meds … more important than you think
From Dental Assistant, The, 9/1/02 by Diane Chandler

This is the kind of story that makes you upset. Jeff is an oral surgery resident in an urban hospital with a dental clinic. One day in the clinic, Jeff heard screaming in one of the treatment rooms and went to see if he could be of some assistance. There he saw an 8-year-old boy who was having a tooth extracted. The first year resident trying to operate on the boy was having a really hard time--the tooth just wouldn't numb up. Jeff reviewed the boy's health history and, although the AIDS box on the questionnaire wasn't checked, Jeff was able to quickly zero in on the problem.

The mother of the child was pressed to disclose any debilitating illness her son might have, but repeatedly responded with "none". Jeff next questioned her about the answers she gave on the health history questionnaire. Knowing that one of the medications she indicated her son was taking was a very current medication for the treatment of AIDS, he was finally able to get the mother to disclose that her son had AIDS.

The mother confessed that she just wanted the tooth extracted because he was constantly crying and keeping her up at night. They did not extract the boy's tooth that day but made an appointment for him to have his tooth extracted under general anesthetic in a hospital operating room where they would be prepared for any emergency that might occur.

The dental assistant is the front line for patients coming into the practice. Would the average dental assistant have had any clue that the medication listed was a medication for the treatment of AIDS? The answer is no. It is the responsibility of every health professional to get the most accurate and complete health history, and that includes questioning patients' medications. Further, it includes knowledge of current medications so that you know what questions to ask.

We are taught to treat all patients as if they had AIDS, and so the mother's omission probably would not have made a difference in what was done or the way it was done, but it certainly might have made a difference in another way.

For whatever reason, the mother did not let the resident know the status of her son's health, and because of that her son was traumatized. If one was familiar with the current meds used to treat AIDS, then that child could have been shielded from needlessly suffering pain.

So often in the assisting profession we update our knowledge of current medications but for some reason it seems that the current drugs for AIDS are rarely listed in these updates. Because it is the responsibility of everyone in the health care field to keep up to date, we have reviewed the approved antiretroviral agents for the treatment of HIV infection. They are listed in a chart first published in The Rx Consultant. Because new medications are constantly being introduced, this is by no means an exhaustive list; but it is a current one. Read on and be current!

Diane Chandler, CDA has been practicing in the dental field for 15 years. Every February she does a public service cable program on dental oral hygiene.

Michael Palmer, RPh is a 2000 graduate of Wayne State University School of Pharmacy and Allied Health Professions. He is presently employed full-time at St. John's Hospital and Medical Center. His previous publication was entitled "Appropriate Use of Stress Ulcer Prophylaxix in Surgical Intensive Care Patients".

Chart used with the permission of "The Rx Consultant": www.rxconsultant.com

COPYRIGHT 2002 American Dental Assistants Association
COPYRIGHT 2003 Gale Group

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