Zidovudine
Clinical data | |
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Trade names | Retrovir, others |
AHFS/Drugs.com | Monograph |
MedlinePlus | a687007 |
License data |
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Routes of administration | By mouth, intravenous, rectal suppository |
ATC code | |
Legal status | |
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Pharmacokinetic data | |
Bioavailability | Complete absorption, following first-pass metabolism systemic availability 75% (range 52 to 75%) |
Protein binding | 30 to 38% |
Metabolism | Liver |
Elimination half-life | 0.5 to 3 hours |
Excretion | Kidney and Bile duct |
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Zidovudine (ZDV), also known as azidothymidine (AZT), was the first
Common side effects include headaches, fever, and nausea.
Zidovudine was first described in 1964.
Medical uses
HIV treatment
AZT was usually dosed twice a day in combination with other antiretroviral therapies. This approach is referred to as Highly Active Antiretroviral Therapy (
HIV prevention
AZT has been used for post-exposure prophylaxis (PEP) in combination with another antiretroviral drug called lamivudine. Together they work to substantially reduce the risk of HIV infection following the first single exposure to the virus.[15] More recently, AZT has been replaced by other antiretrovirals such as tenofovir to provide PEP.[16] Before tenofovir, a principal part of the
During 1994 to 1999, AZT was the primary form of prevention of mother-to-child HIV transmission. AZT prophylaxis prevented more than 1000 parental and infant deaths from AIDS in the United States.
Antibacterial properties
Zidovudine also has antibacterial properties,
Side effects
Most common side effects include nausea, vomiting,
Early long-term higher-dose therapy with AZT was initially associated with side effects that sometimes limited therapy, including
Viral resistance
Even at the highest doses that can be tolerated in patients, AZT is not potent enough to prevent all HIV replication and may only slow the replication of the virus and progression of the disease. Prolonged AZT treatment can lead to HIV developing resistance to AZT by
Mechanism of action
AZT is a thymidine analogue. AZT works by selectively inhibiting HIV's reverse transcriptase, the enzyme that the virus uses to make a DNA copy of its RNA. Reverse transcription is necessary for production of HIV's double-stranded DNA, which would be subsequently integrated into the genetic material of the infected cell (where it is called a provirus).[40][41][42]
Cellular enzymes convert AZT into the effective 5'-triphosphate form. Studies have shown that the termination of HIV's forming DNA chains is the specific factor in the inhibitory effect.[43]
At very high doses, AZT's triphosphate form may also inhibit
Chemistry
Enantiopure AZT crystallizes in the monoclinic space group P21. The primary intermolecular bonding motif is a hydrogen bonded dimeric ring formed from two N-H...O interactions.[51][52]
History
Initial cancer research
In the 1960s, the theory that most
In parallel work, other compounds that successfully blocked the synthesis of nucleic acids had been proven to be both antibacterial, antiviral, and anticancer agents, the leading work being done at the laboratory of Nobel laureates
Richard E. Beltz first synthesized AZT in 1961, but did not publish his research.
This report attracted little interest from other researchers as the Friend leukemia virus is a retrovirus, and at the time, there were no known human diseases caused by retroviruses.[62]
HIV/AIDS research
In 1983, researchers at the Institut Pasteur in Paris identified the retrovirus now known as the Human Immunodeficiency Virus (HIV) as the cause of acquired immunodeficiency syndrome (AIDS) in humans.[63][64] Shortly thereafter, Samuel Broder, Hiroaki Mitsuya, and Robert Yarchoan of the United States National Cancer Institute (NCI) initiated a program to develop therapies for HIV/AIDS.[65] Using a line of CD4+ T cells that they had made, they developed an assay to screen drugs for their ability to protect CD4+ T cells from being killed by HIV. In order to expedite the process of discovering a drug, the NCI researchers actively sought collaborations with pharmaceutical companies having access to libraries of compounds with potential antiviral activity.[40] This assay could simultaneously test both the anti-HIV effect of the compounds and their toxicity against infected T cells.
In June 1984, Burroughs-Wellcome virologist Marty St. Clair set up a program to discover drugs with the potential to inhibit HIV replication. Burroughs-Wellcome had expertise in nucleoside analogs and viral diseases, led by researchers including
In February 1985, the NCI scientists found that AZT had potent efficacy in vitro.[40][57] Several months later, a phase 1 clinical trial of AZT at the NCI was initiated at the NCI and Duke University.[41][46][66] In doing this Phase I trial, they built on their experience in doing an earlier trial, with suramin, another drug that had shown effective anti-HIV activity in the laboratory. This initial trial of AZT proved that the drug could be safely administered to patients with HIV, that it increased their CD4 counts, restored T cell immunity as measured by skin testing, and that it showed strong evidence of clinical effectiveness, such as inducing weight gain in AIDS patients. It also showed that levels of AZT that worked in vitro could be injected into patients in serum and suppository form, and that the drug penetrated deeply only into infected brains.
Patent filed and FDA approval
A flawed
AZT was subsequently approved unanimously for infants and children in 1990.[71] AZT was initially administered in significantly higher dosages than today, typically 400 mg every four hours, day and night, compared to modern dosage of 300 mg twice daily.[72] The paucity of alternatives for treating HIV/AIDS at that time unambiguously affirmed the health risk/benefit ratio, with inevitable slow, disfiguring, and painful death from HIV outweighing the drug's side effect of transient anemia and malaise.
Society and culture
Until 1991, 80% of the $420 million allocated to the National Institute of Health's AIDS Clinical Trials Group, went toward studies of AZT. Aside from two similarly designed chemotherapies, ddI and ddC, from approval of the drug until 1993, no other drugs against AIDS were approved, leading to criticism that research preoccupation with AZT and its close relatives, and the massive diverting of funds to such, had delayed the development of more efficacious drugs.[8]
In 1991, the advocacy group
In 2002, another lawsuit was filed challenging the patent by the
GSK's patents on AZT expired in 2005, and in September 2005, the FDA approved three generic versions.[76]
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External links
- "Zidovudine". Drug Information Portal. U.S. National Library of Medicine.