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# Zinc ## Overview Zinc is an essential trace element required for protein synthesis, wound healing, gene expression, and immune function. It acts as a cofactor for over 300 enzymes. Elemental zinc content varies significantly between salt forms (e.g., zinc gluconate ~14%, zinc sulfate ~23%, zinc acetate ~30%). ## Primary Indications * Treatment/prevention of zinc deficiency. * Adjunctive therapy for acute diarrhea (WHO/UNICEF guidelines). * Wilson’s disease (zinc acetate). * Dietary supplementation. ## Adult Dosing * **Dietary supplement:** 8–11 mg elemental zinc daily (RDA). * **Zinc deficiency:** 25–50 mg elemental zinc daily. * **Wilson’s disease:** 50 mg elemental zinc (as acetate) 3 times daily. * **Maximum:** Tolerable Upper Intake Level (UL) for adults is 40 mg/day (prolonged use above this requires medical supervision). ## Pediatric Dosing * **Infants (0–6 months):** 2 mg/day. * **Infants (7–12 months):** 3 mg/day. * **Children (1–3 years):** 3 mg/day. * **Children (4–8 years):** 5 mg/day. * **Children (9–13 years):** 8 mg/day. * **Acute Diarrhea (WHO protocol):** 10 mg elemental zinc daily for 10–14 days (<6 months); 20 mg elemental zinc daily for 10–14 days (≥6 months). * *Note: Dosing for therapeutic deficiency management may vary based on local clinical protocols.* ## Dose Adjustments * **Renal Impairment:** No specific guidelines; use caution in patients with severe renal failure. * **Hepatic Impairment:** No specific adjustments provided by manufacturer; monitor for toxicity in chronic liver disease. ## Contraindications * Hypersensitivity to zinc or any component of the formulation. * Acute phase of copper deficiency. ## Adverse Effects * **Gastrointestinal:** Nausea, vomiting, abdominal pain, diarrhea, metallic taste. * **Systemic (Chronic High-Dose):** Copper deficiency leading to sideroblastic anemia, neutropenia, and neurological symptoms. * **Intranasal (Intranasal zinc products):** Risk of permanent anosmia (loss of smell); these products are no longer recommended. ## Key Drug Interactions * **Antibiotics:** Zinc reduces absorption of tetracyclines and fluoroquinolones. Administer zinc at least 2 hours apart. * **Penicillamine:** Zinc decreases absorption of penicillamine. * **Calcium/Iron:** High doses of iron or calcium may interfere with zinc absorption. ## Monitoring * **Serum Zinc:** Generally unreliable due to rapid redistribution; monitor clinical signs of deficiency (alopecia, skin lesions, hypogeusia, poor wound healing). * **Copper Status:** During long-term or high-dose zinc therapy, monitor serum copper and ceruloplasmin to prevent secondary deficiency. ## Clinical Pearls * **GI Tolerance:** Administer with food if gastric distress occurs, although absorption is best on an empty stomach. * **Formulation:** Always verify the "elemental" zinc content on the label versus the salt weight (e.g., 220 mg zinc sulfate contains ~50 mg elemental zinc). * **Immune Support:** While used for the common cold, evidence for efficacy remains mixed; avoid intranasal delivery routes entirely. *** **Educational Disclaimer:** This information is for educational purposes only. Always verify current prescribing information, institutional protocols, and patient-specific factors with a reliable clinical database (e.g., Lexicomp, Micromedex) or a pharmacist before prescribing or administering medication.