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## Overview Zinc is an essential trace mineral vital for numerous cellular functions, including immune response, wound healing, protein synthesis, and DNA synthesis. ## Primary Indications * **Zinc Deficiency:** Treatment and prevention of zinc deficiency, which can arise from inadequate dietary intake, malabsorption syndromes, chronic liver or kidney disease, or excessive losses. * **Wilson's Disease:** Used as adjunctive therapy in patients with Wilson's disease to induce negative copper balance by increasing fecal copper excretion. ## Adult Dosing * **Zinc Deficiency Treatment:** 100-200 mg elemental zinc per day (e.g., 220-440 mg zinc sulfate 7H₂O) divided in 1-3 doses for 3-6 months. * **Zinc Deficiency Prevention:** 10-30 mg elemental zinc per day. * **Wilson's Disease (Adjunctive):** 100-200 mg elemental zinc per day divided in 2-3 doses. Dosing may be adjusted based on copper levels. ## Pediatric Dosing Dosing is based on elemental zinc. * **Zinc Deficiency Treatment (Infants < 6 months):** 1 mg/kg/day divided in 1-2 doses. Maximum: 5 mg/day. * **Zinc Deficiency Treatment (Infants 6 months - 3 years):** 5-10 mg elemental zinc per day divided in 1-2 doses. * **Zinc Deficiency Treatment (Children 4-8 years):** 10-15 mg elemental zinc per day divided in 1-2 doses. * **Zinc Deficiency Treatment (Children 9-12 years):** 15-20 mg elemental zinc per day divided in 1-2 doses. * **Zinc Deficiency Treatment (Adolescents > 12 years):** 20-30 mg elemental zinc per day divided in 1-2 doses. * **Zinc Deficiency Prevention (Infants < 6 months):** 1 mg/kg/day. Maximum: 3 mg/day. * **Zinc Deficiency Prevention (Infants 6 months - 3 years):** 3-5 mg elemental zinc per day. * **Zinc Deficiency Prevention (Children 4-8 years):** 5 mg elemental zinc per day. * **Zinc Deficiency Prevention (Children 9-12 years):** 10 mg elemental zinc per day. * **Zinc Deficiency Prevention (Adolescents > 12 years):** 10-15 mg elemental zinc per day. *Note: Pediatric dosing for Wilson's disease is not well-established and should be individualized.* ## Dose Adjustments No specific dose adjustments are typically required for hepatic or renal impairment, however, caution is advised in severe renal disease due to potential accumulation and hyperzincemia. Monitor serum zinc levels. ## Contraindications Hypersensitivity to zinc or any component of the formulation. ## Adverse Effects * **Gastrointestinal:** Nausea, vomiting, diarrhea, abdominal pain, metallic taste. These are often dose-related and may be reduced by taking with food. * **Other:** Headache, lethargy, potential for copper deficiency with prolonged high-dose therapy. ## Key Drug Interactions * **Quinolone Antibiotics (e.g., Ciprofloxacin, Levofloxacin):** Zinc can decrease absorption. Separate administration by at least 2 hours before or 4-6 hours after quinolones. * **Tetracycline Antibiotics (e.g., Doxycycline, Minocycline):** Zinc can decrease absorption. Separate administration by at least 2 hours before or 2 hours after tetracyclines. * **Thiazide Diuretics:** May increase urinary zinc excretion. * **Penicillamine:** May reduce the absorption and efficacy of penicillamine. ## Monitoring * **For Deficiency Treatment:** Monitor for improvement in clinical signs and symptoms. Serum zinc levels may be monitored, but they reflect recent intake more than total body stores. * **For Wilson's Disease:** Monitor serum copper, ceruloplasmin, and urinary copper levels. Monitor for signs of copper deficiency. * **For Prolonged High-Dose Therapy:** Monitor for signs of copper deficiency (e.g., anemia, neutropenia). ## Clinical Pearls * Elemental zinc content varies by salt form (e.g., zinc sulfate, zinc gluconate, zinc acetate). Always calculate dose based on elemental zinc. * Administer oral zinc formulations with food to minimize gastrointestinal upset. * Long-term high-dose zinc therapy can lead to copper deficiency. * Topical zinc oxide is used for skin protection (e.g., diaper rash) and is not absorbed systemically. *** *Disclaimer: This information is intended for healthcare professionals and is not a substitute for professional medical advice. Always consult the most current prescribing information and a qualified healthcare provider for any health concerns or before making any treatment decisions.*