Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral [preservative free]:
Zn-50: 50 mg [dye free, sugar free, yeast free]
Gum, Oral:
Cold-Eeze: 13.3 mg (18 ea [DSC]) [bubble-gum flavor]
Cold-Eeze: 13.3 mg (20 ea [DSC]) [cinnamon flavor]
Lozenge, Mouth/Throat:
Cold-Eeze: 13.3 mg (6 ea [DSC])
Cold-Eeze: 13.3 mg (18 ea [DSC]) [cherry flavor]
Cold-Eeze: 13.3 mg (18 ea [DSC]) [citrus flavor]
Cold-Eeze: 13.3 mg (18 ea [DSC]) [honey-lemon flavor]
Cold-Eeze: 13.3 mg (18 ea [DSC]) [menthol flavor]
Cold-Eeze: 13.3 mg (18 ea [DSC]) [tropical fruit flavor]
Cold-Eeze: 13.3 mg (2 ea, 10 ea, 18 ea, 24 ea) [gluten free; cherry flavor]
Cold-Eeze: 13.3 mg (18 ea, 24 ea) [gluten free; honey-lemon flavor]
Cold-Eeze: 13.3 mg (18 ea) [gluten free; tropical orange flavor]
Generic: 10 mg (100 ea)
Lozenge, Mouth/Throat [preservative free]:
Cold-Eeze Sugar Free: 13.3 mg (18 ea) [gluten free, no artificial color(s), sugar free]
Cold-Eeze Sugar Free: 13.3 mg (18 ea, 24 ea) [gluten free, no artificial color(s), sugar free; cherry flavor]
Tablet, Oral:
Generic: 15 mg, 30 mg, 50 mg, 100 mg
Tablet, Oral [preservative free]:
Generic: 50 mg
Pharmacology
Mechanism of Action
Zinc is an essential mineral that is found in almost every cell. It stimulates the activity of approximately 100 enzymes (IOM 2001). Zinc deficiency may be associated with an increased risk of infection. When used to treat the common cold, zinc may interfere with rhinovirus cleavage or adhesion, and may protect plasma membranes from microbial toxins and complement (Nahas 2011).
Pharmacokinetics/Pharmacodynamics
Absorption
Small intestine (IOM 2001)
Distribution
Stored primarily in skeletal muscle and bone (IOM 2001)
Excretion
Feces and urine (IOM 2001)
Protein Binding
Primarily to albumin (IOM 2001)
Use: Labeled Indications
Common cold: To reduce the duration and severity of symptoms associated with the common cold.
Dietary supplement: For use as a dietary supplement.
Contraindications
There are no contraindications listed in the manufacturer's labeling.
Dosage and Administration
Dosing: Adult
Common cold: Note: For best results, begin therapy 24 to 48 hours prior to symptom onset: Oral: Dissolve one 13.3 mg lozenge in mouth every 2 to 4 hours as needed. Maximum: 6 lozenges daily.
Dietary supplement: Oral: One capsule/tablet daily or as directed by health care provider.
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Common cold: Note: Consult product-specific labeling for manufacturer-recommended ages. For best results, begin therapy 24 to 48 hours prior to symptom onset: Cold-Eeze Lozenge: Children ≥12 years and Adolescents: Oral topical: Dissolve one lozenge in mouth every 2 to 4 hours as needed. Age-dependent maximum daily dose: 12 to 17 years: 4 lozenges/day; ≥18 years: 6 lozenges/day.
Zinc deficiency, treatment: Limited data available: Note: Dosage expressed in terms of elemental zinc (Kliegman 2016)
Acquired: Infants, Children, and Adolescents: Oral: 0.5 to 1 mg/kg/day
Acrodermatitis enteropathica:Infants, Children, and Adolescents: Oral: 3 mg/kg/day
Administration
Oral: Administer with food to avoid stomach upset.
Lozenge: Dissolve in mouth; do not chew. Avoid eating or drinking for 15 minutes after administration.
Dietary Considerations
Dietary sources of zinc are red meat, some seafood, and whole grains. When dietary phytate is increased (as with some vegetarian diets), dietary absorption of zinc is decreased (IOM 2001).
Lozenge: Avoid citrus fruits/juices and products containing citric acid within 30 minutes prior to or after use.
Dietary adequate intake (AI) (IOM 2001): Dose expressed as elemental zinc
1 to 6 months: 2 mg daily
Dietary recommended daily allowance (RDA) (IOM 2001): Dose expressed as elemental zinc
7 to 12 months: 3 mg daily
1 to 3 years: 3 mg daily
4 to 8 years: 5 mg daily
9 to 13 years: 8 mg daily
14 to 18 years: Females: 9 mg daily; Males: 11 mg daily; Pregnancy: 12 mg daily; Lactation: 13 mg daily
>18 years: Females: 8 mg daily; Males: 11 mg daily; Pregnancy: 11 mg daily: Lactation: 12 mg daily
Storage
Store at controlled room temperature.
Zinc Gluconate Images
Drug Interactions
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease the serum concentration of Baloxavir Marboxil. Avoid combination
Bictegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Bictegravir. Management: Administer bictegravir under fasting conditions at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Consider therapy modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease the serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Exceptions: Pamidronate; Zoledronic Acid. Consider therapy modification
Ceftibuten: Zinc Salts may decrease the serum concentration of Ceftibuten. Management: Consider administering oral zinc salts at least 3 hours after ceftibuten. Consider therapy modification
Cephalexin: Zinc Salts may decrease the absorption of Cephalexin. Management: Consider administering oral zinc salts at least 3 hours after cephalexin. Consider therapy modification
Deferiprone: Polyvalent Cation Containing Products may decrease the serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Consider therapy modification
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
Eltrombopag: Polyvalent Cation Containing Products may decrease the serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Consider therapy modification
PenicillAMINE: Polyvalent Cation Containing Products may decrease the serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Consider therapy modification
Quinolones: Zinc Salts may decrease the serum concentration of Quinolones. Management: Give oral quinolones at least several hours before (4 h for moxi- and sparfloxacin, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome-, 3 h for gemi-, and 2 h for levo-, nor-, pe- or ofloxacin or nalidixic acid) oral zinc salts. Exceptions: LevoFLOXacin (Oral Inhalation). Consider therapy modification
Raltegravir: Polyvalent Cation Containing Products may decrease the serum concentration of Raltegravir. Management: Administer raltegravir 2 hours before or 6 hours after administration of the polyvalent cations. Dose separation may not adequately minimize the significance of this interaction. Consider therapy modification
Tetracyclines: Zinc Salts may decrease the absorption of Tetracyclines. Only a concern when both products are administered orally. Management: Consider doxycycline as a noninteracting tetracycline derivative. Separate dose administration of oral tetracycline derivative and oral zinc salts by at least 2 hours to minimize interaction. Exceptions: Doxycycline; Eravacycline. Consider therapy modification
Trientine: Polyvalent Cation Containing Products may decrease the serum concentration of Trientine. Management: Avoid concomitant administration of trientine and oral products that contain polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. If other oral polyvalent cations are needed, separate administration by 1 hour. Consider therapy modification
Adverse Reactions
Frequency not defined; may vary with different salts. Adverse reactions reported with excess dietary zinc (IOM 2001).
Central nervous system: Headache
Endocrine & metabolic: Copper deficiency, decreased HDL cholesterol, decreased LDL cholesterol
Gastrointestinal: Abdominal cramps, decreased appetite, diarrhea, epigastric pain, gastrointestinal distress, nausea, vomiting
Hematologic & oncologic: Immunodeficiency
Warnings/Precautions
Disease related concerns:
- Malabsorption syndromes: Absorption of zinc may be decreased and urinary excretion increased in patients with Crohn’s disease, short bowel syndrome and sprue (IOM 2001).
Other warnings/precautions:
- Self-medication (OTC use): When used for self medication (OTC) to treat the common cold, notify health care provider if symptoms continue for greater than 7 days. Increase fluid intake during therapy.
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). The RDA is increased during pregnancy (IOM 2001).
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.
