Based on available evidence, it has been concluded that the 30 mg formulation
of stavudine, dosed twice daily, should be used for all adult and adolescent
patients, irrespective of body weight. This recommendation, which was previously
considered an option, is now established as the preferred approach when d4T is used as
part of an ARV therapeutic regimen.
Programmatic implications:
1) All new patients with weight over 60 kg being prescribed a stavudine-containing
regimen should be started on d4T 30 mg only. No patients already receiving d4T 30mg
should be stepped up to d4T 40 mg.
2) All patients receiving d4T 30 mg or 40 mg with evidence of stavudine-related
toxicity (even with no signs of treatment failure) should be moved to a non-stavudine
containing regimen , according to current WHO ART guidelines.
3) All patients receiving d4T 40 mg without evidence of stavudine toxicity, should be
moved to d4T 30 mg , as soon as possible, considering the programmatic feasibility.
4) Any new procurement orders of stavudine in either single or fixed dose combinations
should only include d4T 30 mg.
