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# Zinc ## Overview Zinc is an essential trace element required for protein synthesis, wound healing, immune function, and DNA synthesis. It acts as a cofactor for over 300 enzymes. Zinc salts (gluconate, sulfate, acetate) are used to prevent or treat deficiency. ## Primary Indications * Treatment/prevention of zinc deficiency (e.g., malabsorption, protracted diarrhea, or parenteral nutrition therapy). * Adjunctive therapy in management of Wilson's disease (zinc acetate). * Wound healing (limited evidence). ## Adult Dosing * **Deficiency Treatment:** 25–50 mg elemental zinc daily, divided into 1–3 doses. * **Wilson’s Disease (Maintenance):** 50 mg elemental zinc orally 3 times daily. * **Upper Limit:** 40 mg of elemental zinc per day from all sources (supplements + diet) is generally recommended to avoid chronic toxicity. Acute therapeutic doses for specific clinical conditions of deficiency may temporarily exceed this under medical supervision. ## Pediatric Dosing * **Deficiency/Supplementation:** 0.5–1 mg/kg/day of elemental zinc. * **Acute Diarrhea (WHO guideline):** Infants <6 months: 10 mg/day for 10–14 days. Children ≥6 months: 20 mg/day for 10–14 days. * *Note:* Always verify elemental zinc content, as salt weight (e.g., sulfate vs. gluconate) varies significantly. ## Dose Adjustments * **Renal Impairment:** No standard adjustment; use with caution. Zinc is primarily excreted in feces, but renal accumulation is possible in severe failure. * **Hepatic Impairment:** No standard adjustment; however, zinc is involved in hepatic metabolism. Monitor closely in severe disease. ## Contraindications * Hypersensitivity to zinc or any component of the formulation. * Routine use for viral infections (e.g., common cold) is not standard clinical therapy, though often used off-label. ## Adverse Effects * **Gastrointestinal:** Nausea, vomiting, epigastric pain, metallic taste, diarrhea (most common with empty stomach). * **Neurological (Chronic high-dose):** Copper deficiency leading to sideroblastic anemia and neurological sequelae (myeloneuropathy). ## Key Drug Interactions * **Antibiotics:** Zinc chelates with **tetracyclines** and **fluoroquinolones**, significantly reducing their absorption. Separate doses by at least 2 hours before or 4–6 hours after antibiotic administration. * **Copper:** Chronic zinc supplementation induces metallothionein in the gut, which blocks copper absorption and can lead to secondary copper deficiency. * **Penicillamine:** Zinc decreases absorption of penicillamine. ## Monitoring * **Long-term high-dose therapy:** Serum copper levels and ceruloplasmin levels (to monitor for copper deficiency). * **Clinical status:** Symptom resolution of deficiency. * **Safety:** Monitor for GI distress. ## Clinical Pearls * **Elemental Zinc Content:** Always verify the "elemental" zinc amount on the label. For example, 220 mg of zinc sulfate contains only 50 mg of elemental zinc. * **Administration:** Administer with food if GI upset occurs, though absorption may be slightly reduced. * **Toxicity:** Chronic intake >50 mg/day is associated with copper deficiency; routine preventative doses should not exceed 40 mg daily. *** **Educational Disclaimer:** This information is for educational purposes only. Drug dosing, indications, and safety profiles are subject to change based on new clinical evidence and local institutional protocols. Always consult the most current prescribing information (package insert) or a clinical pharmacist before initiating therapy.