Nrti toxicity

The NRTIs are primarily renally excreted, and all require dosage adjustment in renal insufficiency except abacavir, which is metabolized by alcohol dehydrogenase and glucuronyl transferase. Dosage adjustment is required when the creatinine clearance drops below 50 mL/min. 3. Adverse effects: inhibition of the mitochondrial DNA polymerase in certain tissues.the dideoxynucleosides, such as zalcitabine, didanosine, and stavudine, have a greater affinity for the mitochondrial DNA polymerase, leading to peripheral neuropathy, pancreatitis, and lipoatrophy. When more than one NRTI is given, care is taken not to have overlapping toxicities. All of the NRTIs have been associated with a potentially fatal liver toxicity characterized by lactic acidosis and hepatomegaly with steatosis. zidovudine and tenofovir have drug interactions