| Management |
Close observation for signs and symptoms of toxicity is recommended if ddI and d4T must be used together, particularly in patients with advanced HIV disease and/or elderly patients. Both drugs should be suspended if pancreatitis is suspected, and ddI discontinued permanently if pancreatitis is confirmed. Reinstitution of d4T, if necessary, should be undertaken with caution following recovery. Prompt withdrawal of these drugs is also essential in patients who develop peripheral neuropathy to avoid irreversible damage. Therapy may be reinstituted following resolution of neuropathy symptoms, but reduced dosages are recommended. Likewise, treatment should be suspended in any patient who develops clinical or laboratory findings suggestive of lactic acidosis or pronounced hepatotoxicity, and permanent discontinuation considered if the syndrome is confirmed. In pregnant women, the manufacturers recommend that the combination of ddI and d4T be used with caution and only if potential benefit clearly outweighs the risks. Patients should be advised to seek medical attention promptly if symptoms of toxicity occur such as nausea, vomiting, abdominal pain/distention, fatigue, unexplained weight loss, tachypnea, dyspnea, motor weakness, numbness, tingling, and pain in hands and feet. |
