Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous [preservative free]:
Generic: 1 mg/mL (10 mL)
Pharmacokinetics/Pharmacodynamics
Distribution
Storage sites are liver and skeletal muscle; serum levels do not adequately reflect whole-body zinc status
Excretion
Primarily in feces (Anderson 1998)
Protein Binding
55% bound to albumin; 40% bound to alpha 1-macroglobulin
Use: Labeled Indications
Trace element added to parenteral nutrition (PN) to prevent deficiency
Dosage and Administration
Dosing: Adult
Parenteral nutrition, maintenance requirement: IV: Note: Dosage expressed in terms of elemental zinc:
Acute metabolic states: 4.5 to 6 mg/day
Metabolically stable: 2.5 to 5 mg/day (ASPEN [Vanek 2012])
Stable with fluid loss from small bowel: 12.2 mg zinc/L TPN or 17.1 mg zinc/kg (added to 1000 mL IV fluids) of stool or ileostomy output
Note: Clinical response from deficiency may not occur for up to 6 to 8 weeks.
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Note: Dosages may be presented in units of mcg or mg, use caution to ensure correct units. Clinical response may not occur for up to 6 to 8 weeks:
Parenteral nutrition, maintenance zinc requirement: Note: Higher doses may be needed if impaired intestinal absorption or an excessive loss of zinc (eg, excessive, prolonged diarrhea, high-output intestinal fistula, burns).
Age-directed dosing (ASPEN [Vanek 2012]):
Infants <3 months: IV: 250 mcg/kg/day elemental zinc as an additive to parenteral nutrition solution.
Infants ≥3 months: IV: 50 mcg/kg/day elemental zinc as an additive to parenteral nutrition solution.
Children: 50 mcg/kg/day elemental zinc as an additive to parenteral nutrition solution; maximum daily dose: 5,000 mcg/day.
Weight-directed dosing (ASPEN [Mirtallo 2004]):
Infants <10 kg: 50 to 250 mcg/kg/day elemental zinc as an additive to parenteral nutrition solution.
Children 10 to 40 kg: 50 to 125 mcg/kg/day elemental zinc as an additive to parenteral nutrition solution; maximum daily dose: 5,000 mcg/day.
Children and Adolescents >40 kg: 2,000 to 5,000 mcg/day elemental zinc as an additive to parenteral nutrition solution.
Administration
Solution for IV injection: Administer after dilution in volume of fluid ≥100 mL
Storage
Store intact vial at 20°C to 25°C (68°F to 77°F).
Drug Interactions
Dolutegravir: Zinc Salts may decrease the serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral zinc salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral zinc salts. Consider therapy modification
Adverse Reactions
<1%, postmarketing, and/or case reports: Dyspepsia, hypotension, jaundice, leukopenia, nausea, neutropenia, pulmonary edema, vomiting
Warnings/Precautions
Disease-related concerns:
- Renal impairment: Use with caution in patients with renal impairment.
Concurrent drug therapy issues:
- Copper: IV administration of zinc without copper may cause a decrease in copper serum concentrations.
Dosage form specific issues:
- Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register, 2002). See manufacturer’s labeling.
Monitoring Parameters
Patients on parenteral nutrition or chronic therapy should have periodic serum copper and serum zinc levels; alkaline phosphatase, taste acuity, mental depression
Pregnancy
Pregnancy Risk Factor
C
Pregnancy Considerations
Zinc crosses the placenta and can be measured in the cord blood and placenta. Fetal concentrations are regulated by the placenta (de Moraes, 2011).
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
