d4T (stavudine)

No longer recommended in the UK.

dee-for-TEE  (stav-yoo-deen)

  • d4T is no longer recommended in the UK. This is because safer alternative drugs are available which have a lower risk of side effects. Even though d4T may still be used in a few countries, the World Health Organisation (WHO) no longer recommends using d4T.
  • d4T, also called stavudine, (tradename Zerit in Europe) is a nucleoside analogue.
  • Standard adult dose: 1 x 40 mg twice-daily (every 12 hours). For adults weighing less than 60 kg the standard dose is 1 x 30 mg twice-daily.
    NOTE: Some guidelines recommend the 30 mg lower dose for all patients and/or a 20 mg dose for those weighing less than 60 kg. Anyone with side effects should first talk to their doctor about switching to another drug. If changing treatment is not possible, then discuss using a lower dose.
  • d4T should be taken on an empty stomach (at least one hour before a meal). Note: taking d4T with food is likely to be okay because it leads to the same drug levels over the dosing period).
  • Side effects: peripheral neuropathy (painful nerve damage), lipoatrophy (fat loss) and lactic acidosis. This are serious side effects that can be difficult to reverse.
  • Other notes: d4T should only be used when there are no alternative options. People taking d4T should be monitored carefully and if side effects occur they should be switched to an alternative drug.

Further information

The European patient information and detailed Product Information for d4T are available in PDF format from this link at the European Medicines Agency (EMA) website.

The Patient Information is a simplified summary: what the drug is, why it is used, results from studies and cautions including side effects.

The Product Information is a detailed technical summary that you can access as a PDF file by clicking the ‘Product Information’ tab. It describes more precisely how the drug works and how it is processed by your body. This includes, for example, reported food interaction studies in terms of calories or fat content. It includes more details of the study results and a full list of side effects and drug interactions.