Stavudine, more commonly known as d4T, is one of our earliest nucleoside analogue (NRTI) drugs. It is still in use but no longer recommended as first-line therapy due to concerns about long-term toxicities, most significantly lipoatrophy (facial wasting).

Basic info

Generic name stavudine
Brand name Zerit
Also known as d4T
Drug class Nucleoside/Nucleotide Reverse Transcriptase Inhibitors
Pediatric dosing? Available in doses suitable for children and/or young people.
Availability in Australia Available on the Pharmaceutical Benefits Scheme (PBS) through S100 prescribers since
This drug may be available through clinical trials in Australia.
You may be able to import this drug from overseas for your personal use.
Formulation Capsule 20mg; capsule 30mg; capsule 40mg; powder for oral solution 1mg per ml.

Taking it

Like most anti-HIV drugs, stavudine must be taken in combination with other drugs to be completely effective. Commonly, stavudine is combined with one other nucleoside (NRTI) drug and either a protease inhibitor or non-nucleoside, although other combinations are sometimes used. Your doctor will advise you on the right combination of drugs to suit your circumstances.


The usual adult dose of stavudine is one 40mg capsule taken twice a day for people over 60kg body weight, or one 30mg capsule taken twice a day for people under 60kg. Alternative doses for children are also available.

Regardless of what you read on this website or elsewhere, you should always take your medications according to your doctor's instructions. If you're unsure, speak to your doctor or pharmacist.

With or without food

stavudine may be taken with or without food

Side effect

All drugs can produce side effects in some people. These may be mild, moderate or severe, so you should be aware of potential side effects before starting any drug, and speak to your doctor if you experience side effects that concern you.

  • Common side effects may include nausea (upset stomach, feeling sick to the stomach), diarrhoea, vomiting, abdominal pain, fever, constipation, chills, headaches, listlessness, dehydration..
  • Less common side effects may include lipodystrophy, peripheral neuropathy, metabolic abnormalities.
  • Rare side effects may include pancreatitis, lactic acidosis, fatty liver.
  • It's unlikely you will experience all of these side effects, and you may not experience any side effects at all. Before starting any new drug, ask your doctor about side effects you might experience and discuss strategies for dealing with side effects if they do occur. If you experience any significant side effect you should continue taking your medicine and see your doctor as soon as possible.

Interactions with other drugs

d4T should not be combined with AZT. They are "antagonistic," which means that they do not work well together and can cause additional side effects. Zerit should not be combined with ribavirin — an oral medication used to treat hepatitis C. Ribavirin can affect the way Zerit is broken down by the body into its active form. This can make Zerit less effective against HIV. Methadone, a painkiller used to treat heroin addiction, can decrease Zerit levels in the bloodstream. Drug levels of methadone are not changed when combined with Zerit. There is no need to change the dose of either drug if they are used together. Combining Zerit with didanosine (ddI), another NRTI, may increase the risk of developing lactic acidosis and other side effects. This is especially true in HIV-positive pregnant women who take both of these drugs together. This combination may increase the risk of developing peripheral neuropathy, a side effect caused by both drugs.