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# Zinc (Oral)
## Overview
Zinc is an essential trace element involved in DNA synthesis, protein metabolism, and immune function. It acts as a cofactor for over 300 enzymes. It is available as various salts (e.g., gluconate, sulfate, acetate), which differ in their elemental zinc content.
## Primary Indications
* Treatment/prevention of zinc deficiency.
* Adjunctive therapy for severe diarrhea (WHO/UNICEF guidelines).
* Wilson’s disease (zinc acetate).
* Dietary supplementation for total parenteral nutrition (TPN).
## Adult Dosing
* **Dietary Supplementation:** 15–50 mg elemental zinc daily.
* **Zinc Deficiency:** 50–100 mg elemental zinc daily in divided doses.
* **Wilson’s Disease (Maintenance):** 50 mg elemental zinc three times daily (take at least 1 hour before or after other medications).
* **Maximum:** Tolerable Upper Intake Level (UL) is 40 mg/day for adults; higher doses used for specific medical conditions should be under clinical supervision.
## Pediatric Dosing
* **Acute Diarrhea (WHO recommendation, 6 months to 5 years):** 20 mg elemental zinc daily for 10–14 days. For infants under 6 months, 10 mg daily.
* **Deficiency/Supplementation:** Consult local pediatric guidelines or specific institutional protocols; typically 0.5–1 mg/kg/day or based on RDA (0–6 months: 2 mg; 7–12 months: 3 mg; 1–3 years: 3 mg; 4–8 years: 5 mg).
## Dose Adjustments
* **Renal Impairment:** No specific adjustment, but use caution; monitor for accumulation in severe impairment.
* **Hepatic Impairment:** Use caution; zinc is primarily excreted via the biliary/gastrointestinal tract.
## Contraindications
* Hypersensitivity to zinc or any components of the formulation.
* Excessive intake in the absence of deficiency or medical indication.
## Adverse Effects
* **Common:** Nausea, vomiting, abdominal pain, diarrhea, dyspepsia.
* **Chronic Overdose:** Copper deficiency (manifesting as anemia, neutropenia, and neurologic symptoms), headache, metallic taste, immune dysfunction.
## Key Drug Interactions
* **Antibiotics (Fluoroquinolones/Tetracyclines):** Zinc forms insoluble chelation complexes; separate doses by at least 2–4 hours.
* **Penicillamine:** Zinc reduces absorption of penicillamine; space doses by at least 2 hours.
* **Copper-containing supplements:** Excess zinc interferes with copper absorption; chronic zinc therapy often requires supplemental copper.
## Monitoring
* **Serum Zinc:** Levels may not accurately reflect total body stores; monitor during long-term high-dose therapy.
* **Copper:** Monitor serum copper and ceruloplasmin during prolonged (>1 month) high-dose zinc therapy to prevent secondary hypocupremia.
* **Hemoglobin/WBC:** Monitor for signs of bone marrow suppression/anemia resulting from copper deficiency.
## Clinical Pearls
* **Elemental Content:** Always verify the elemental zinc content of the specific salt (e.g., 220 mg of zinc sulfate heptahydrate provides ~50 mg of elemental zinc).
* **Administration:** Take with food if GI upset occurs, though absorption may be slightly reduced.
* **Wilson's Disease:** Zinc is used as maintenance therapy for patients who cannot tolerate penicillamine or trientine. It is not indicated for the initial treatment of acute symptomatic Wilson's disease.
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**Educational Disclaimer:** This information is for educational purposes and does not constitute medical advice. Dosing and clinical protocols may vary by institution and patient physiology. Always verify current prescribing information, package inserts, and local guidelines before administration.
