Usage
- Zinc sulfate monohydrate is primarily prescribed for the treatment and prevention of zinc deficiency. This can arise from inadequate dietary intake, malabsorption syndromes, or increased losses. It is also used for the treatment of acute and persistent diarrhea in infants and children up to 5 years of age.
- Pharmacological classification: Mineral supplement, essential trace element.
- Mechanism of Action: Zinc is an essential cofactor for numerous enzymes involved in various metabolic processes. It plays a crucial role in cell growth, immune function, protein synthesis, wound healing, and DNA synthesis. Zinc supplementation replenishes depleted zinc stores, restoring normal physiological function. For diarrhea, zinc is thought to reduce fluid loss and improve intestinal mucosal integrity. It also has some immunomodulatory effects and may inhibit the binding of certain bacterial toxins to the intestinal wall.
Alternate Names
- Zinc sulfate
- Optizinc
- Zincate
How It Works
-
Pharmacodynamics: Zinc exerts its effects by acting as a cofactor for over 300 enzymes involved in various metabolic pathways. It influences cell growth and differentiation, immune function, protein and DNA synthesis, and wound healing.
-
Pharmacokinetics:
- Absorption: Zinc absorption is pH-dependent, enhanced at lower pH levels. Food, especially phytates found in grains and legumes, impairs zinc absorption.
- Distribution: Zinc is stored primarily in skeletal muscle and bone. It is also present in most tissues and organs, with higher concentrations in the eyes, brain, pancreas, kidneys, liver, and adrenal glands.
- Metabolism: Zinc does not undergo extensive metabolism.
- Elimination: Zinc is primarily excreted in feces, with a small amount eliminated in urine.
-
Mode of Action: Zinc binds to specific sites on enzymes, enabling them to function properly. It does not bind to receptors or modulate neurotransmitters directly. It can, however, indirectly influence the function of some hormone systems, such as insulin.
Dosage
Standard Dosage
Adults:
- Dietary Supplement: 50 mg of elemental zinc once daily (this corresponds to about 220 mg of zinc sulfate monohydrate), taken orally. Dosages may range from 12-150 mg of elemental zinc daily. Higher doses (up to 220 mg of elemental zinc as sulfate) can be used for specific medical indications. Avoid high-dose, long-term supplementation.
- Parenteral Nutrition: IV: 2.5 to 4 mg of elemental zinc daily for metabolically stable adults on TPN. Dosage is individualized based on clinical needs.
Children:
- Dietary Supplement: Dosage is age dependent and expressed as elemental zinc. See below for age breakdown from NIH recommendations:
- 0-6 months: 2 mg daily (upper limit 4 mg)
- 7-12 months: 3 mg daily (upper limit 5 mg)
- 1-3 years: 3 mg daily (upper limit 7 mg)
- 4-8 years: 5 mg daily (upper limit 12 mg)
- 9-13 years: 8 mg daily (upper limit 23 mg)
- 14-18 years: Males: 11 mg daily (upper limit 34 mg); Females: 9 mg daily (upper limit 34 mg)
- For acute diarrhea: 10 mg (for infants under 6 months) or 20 mg (for children 6 months to 5 years) daily for 10-14 days. The tablet should be dissolved in water or breast milk.
Special Cases:
- Elderly Patients: No specific dosage adjustment is typically recommended.
- Patients with Renal Impairment: Use with caution as zinc may accumulate. Monitor closely.
- Patients with Hepatic Dysfunction: No specific dosage adjustment is typically recommended.
- Patients with Comorbid Conditions: Monitor closely, especially those with diabetes, copper deficiency, or immune disorders.
Clinical Use Cases
Zinc sulfate monohydrate is not typically indicated for use in these clinical settings. It is primarily used for the treatment of zinc deficiency. Intravenous zinc preparations may be used in parenteral nutrition solutions to address deficiencies.
Dosage Adjustments
Dosage may need to be adjusted based on patient-specific factors, such as clinical indication, severity of zinc deficiency, or coexisting medical conditions.
Side Effects
Common Side Effects
- Nausea
- Vomiting
- Stomach upset
- Indigestion
- Diarrhea or constipation
- Metallic taste in mouth
Rare but Serious Side Effects
- Copper deficiency (with long-term, high-dose use)
- Neurological problems
- Immunosuppression
- Pulmonary complications (when receiving parenteral nutrition)
Long-Term Effects
Copper deficiency can occur with prolonged high-dose zinc intake, potentially leading to neurological complications.
Adverse Drug Reactions (ADR)
Copper deficiency is a significant ADR that requires close monitoring.
Contraindications
- Hypersensitivity to zinc
- Copper deficiency
- Certain malabsorption syndromes (without addressing underlying cause)
Drug Interactions
- Tetracyclines, quinolone antibiotics, bisphosphonates: Zinc can decrease the absorption of these medications. Separate doses by at least 2-3 hours.
- Penicillamine, trientine, iron supplements, calcium supplements: These can reduce zinc absorption or be affected by zinc. Separate doses appropriately.
- Copper supplements: Zinc can interfere with copper absorption.
- Immunosuppressants: Zinc may counteract the effects of immunosuppressant medications.
- Deferoxamine: This medication can increase zinc loss in urine.
Pregnancy and Breastfeeding
- Pregnancy: Zinc is essential during pregnancy, and pregnant women should meet the RDA (11-12 mg/day). Supplementation should be supervised by a physician. High doses should be avoided.
- Breastfeeding: Zinc is excreted in breast milk. Lactating women should meet the RDA (12-13 mg/day). Supplementation should be supervised by a physician. High doses should be avoided as they might lead to copper deficiency in the infant.
Drug Profile Summary
- Mechanism of Action: Essential cofactor for numerous enzymes, supporting diverse cellular functions.
- Side Effects: Nausea, vomiting, stomach upset, indigestion, metallic taste. Rarely, copper deficiency with long-term, high-dose use.
- Contraindications: Hypersensitivity, copper deficiency.
- Drug Interactions: Tetracyclines, quinolones, bisphosphonates, penicillamine, iron, calcium, copper, immunosuppressants.
- Pregnancy & Breastfeeding: Safe at recommended doses; avoid high doses.
- Dosage: Adult: 50 mg elemental zinc daily as supplement; individualized doses for parenteral use. Pediatric: age-dependent, see detailed guidelines.
- Monitoring Parameters: Monitor for signs of copper deficiency (neurological symptoms, anemia), especially with long-term use. For intravenous administration, monitor fluid and electrolyte balance, blood glucose, liver and kidney function, and blood counts.
Popular Combinations
Zinc sulfate is often included in multivitamin and mineral supplements. There are no specific drug combinations routinely used in clinical practice for isolated zinc sulfate.
Precautions
- Pre-existing medical conditions should be assessed, especially renal or hepatic impairment.
- Monitor copper levels with long-term use.
- Do not use intranasal zinc due to the risk of anosmia.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Zinc Sulphate Monohydrate?
A: The recommended dosage varies by age and indication. Adults: 50 mg elemental zinc daily as a supplement; children: see pediatric dosage guidelines. Intravenous doses are individualized. Always refer to specific product information.
Q2: Can zinc sulfate be used during pregnancy and lactation?
A: Yes, zinc is essential during these periods. However, dosage should not exceed the recommended dietary allowance (RDA) and should be under physician supervision.
Q3: What are the common side effects of zinc sulfate?
A: Nausea, vomiting, gastrointestinal upset, and metallic taste are the most common side effects.
Q4: What are the serious side effects of zinc sulfate?
A: Copper deficiency can occur with prolonged, high-dose use. Neurological complications and immunosuppression have also been reported.
Q5: What are the drug interactions of zinc sulfate?
A: Zinc can interact with certain antibiotics, chelating agents, and other mineral supplements. See the drug interactions section for a detailed list.
Q6: How is zinc sulfate administered?
A: It can be administered orally as tablets, capsules, or syrups. It can also be administered intravenously, usually as part of a parenteral nutrition regimen.
Q7: What should I monitor in patients taking zinc sulfate long term?
A: Monitor for signs of copper deficiency, including neurological symptoms and anemia.
Q8: Can zinc sulfate be used to treat diarrhea in children?
A: Yes, it can be used as an adjunct to oral rehydration therapy for acute and persistent diarrhea in children under 5 years.
Q9: Is there an upper intake limit for zinc?
A: Yes, the upper intake limits vary with age. Refer to the dosage section for specific values.
A: Yes, zinc is available as different salts, such as zinc sulfate, zinc gluconate, zinc acetate, and zinc oxide. The amount of elemental zinc varies in each form. Always calculate the dose based on elemental zinc content.
