Adult: As part of an IV parenteral nutrition regimen: Dosage is individualised based on the patient's clinical condition, nutritional requirements, and the contribution of oral or enteral Zn intake. In metabolically-stable patients: 3 mg daily; higher doses may be required in monitored patients with small bowel fluid loss or excess stool or ileostomy output. Child: Preterm neonates <3 kg: 400 mcg/kg daily; Term neonates 3-<5 kg: 250 mcg/kg daily; Children 5-<10 kg: 100 mcg/kg daily; ≥10 kg: 50 mcg/kg daily (Max: 3 mg daily).
Oral Zinc deficiency
Adult: As cap: 50 mg (as elemental Zn) 1-3 times daily. As effervescent tab: 45 mg (as elemental Zn) 1-3 times daily. Dosage recommendations may vary among individual products or between countries (refer to specific product guidelines). Child: As syrup: Children 20-40 mg (as elemental Zn) daily. As effervescent tab: <10 kg: 22.5 mg (as elemental Zn) once daily; 10-30 kg: 22.5 mg (as elemental Zn) 1-3 times daily; >30 kg: Same as adult dose. As cap: >12 years Same as adult dose. Dosage recommendations may vary among individual products or between countries (refer to specific product guidelines).
Contraindications
Copper deficiency.
Special Precautions
Zinc sulfate inj is used as an admixture in parenteral nutrition solutions; do not use for direct IV infusion. Renal impairment. Children (including preterm infants). Pregnancy and lactation.
Adverse Reactions
Significant: Copper deficiency. Pulmonary embolism or pulmonary distress (in patients receiving parenteral nutrition). Blood and lymphatic system disorders: Leucopenia, neutropenia. Gastrointestinal disorders: Abdominal pain, dyspepsia, nausea, vomiting, diarrhoea, gastric irritation, gastritis. General disorders and administration site conditions: Lethargy. Nervous system disorders: Headache. Psychiatric disorders: Irritability.
Monitoring Parameters
Monitor fluid and electrolyte status, serum osmolarity, blood glucose, liver and kidney functions, blood count and coagulation parameters throughout treatment in patients receiving parenteral nutrition.
Overdosage
Oral: Symptoms: Corrosion and inflammation of the mucous membrane of the mouth and stomach, ulceration of the stomach followed by perforation. Management: Symptomatic treatment. Zn levels may be diluted by drinking plenty of milk and water or giving IM or IV chelating agents (e.g. edetate calcium disodium at a dose of 50-75 mg/kg daily in 3-6 divided doses for up to 5 days). IV: Hyperamylasemia, thrombocytopenia, anaemia, vomiting, diarrhoea. Management: Supportive treatment.
Drug Interactions
May interfere with the absorption of copper, leading to reduced copper levels or copper deficiency. May reduce the absorption of tetracyclines, penicillamine, oral Fe, trientine and vice versa. May decrease the absorption of quinolones (e.g. ciprofloxacin, levofloxacin, ofloxacin). Reduced absorption with Ca salts.
Food Interaction
Reduced absorption when taken concurrently with phytates (found in bran, whole grain bread) and foods that are high in fibre, Ca or phosphorous.
Action
Description: Mechanism of Action: Zinc sulfate is a mineral supplement which is essential for many different processes in the body. Zinc is a cofactor of various enzymes which helps the body's natural defence against damaging free radicals and helps boost immune function. It also plays an important role in maintaining structure in nucleic acids, protein and cell membranes and is involved in the function of the hormone insulin in the utilisation of carbohydrates. Additionally, it is essential for normal growth rate, development of the reproductive organs, normal function of the prostate gland and the healing of wounds and burns. Pharmacokinetics: Absorption: Incompletely absorbed from the gastrointestinal tract. Bioavailability: Approx 20-30%. Distribution: Widely distributed throughout the body with the highest concentrations in the hair, eyes, male reproductive organs and bones; lower levels are present in the liver, kidneys and muscles. Crosses the placenta and enters breast milk. Plasma protein binding: Approx 50-80% to albumin, approx 7% to amino acids, and the remainder to α2-macroglobulins and other proteins. Excretion: Primarily via faeces (40%); urine and perspiration (small amounts).
Chemical Structure
Zinc sulfate Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 24424, Zinc Sulfate. https://pubchem.ncbi.nlm.nih.gov/compound/Zinc-Sulfate. Accessed Feb. 23, 2023.
Storage
Cap/effervescent tab: Store below 25°C. Protect from light and moisture. Oral syr: Store below 30°C. Solution for inj: Store between 20-25°C.
B05XA18 - zinc sulfate ; Belongs to the class of electrolyte solutions used in I.V. solutions. A12CB01 - zinc sulfate ; Belongs to the class of zinc-containing preparations. Used as dietary supplements.
References
Anon. Zinc Sulfate. Lexicomp Online. Hudson, Ohio. Wolters Kluwer Clinical Drug Information, Inc. https://online.lexi.com. Accessed 03/10/2022.Biozinc 10 mg/mL Syrup (Oral Drops) and 20 mg/5 mL Syrup (Sydenham Laboratories Inc.). MIMS Philippines. http://www.mims.com/philippines. Accessed 03/10/2022.Buckingham R (ed). Zinc. Martindale: The Complete Drug Reference [online]. London. Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/10/2022.E-Zinc 27.5 mg/mL Syrup (Oral Drops) and 55 mg/5 mL Syrup (Amherst Laboratories, Inc). MIMS Philippines. http://www.mims.com/philippines. Accessed 13/02/2023.Joint Formulary Committee. Zinc Sulfate. British National Formulary [online]. London. BMJ Group and Pharmaceutical Press. https://www.medicinescomplete.com. Accessed 03/10/2022.Pharmacy Retailing (NZ) Ltd Trading as Healthcare Logistics. Zincaps 50 mg Capsules data sheet 10 January 2020. Medsafe. http://www.medsafe.govt.nz. Accessed 03/10/2022.Solvazinc 45 mg Effervescent Tablets (Galen Limited). MHRA. https://products.mhra.gov.uk. Accessed 03/10/2022.Zinc Sulfate 220 mg Capsules (Crescent Pharma Ltd). MHRA. https://products.mhra.gov.uk. Accessed 03/10/2022.Zinc Sulfate Injection, Solution (Piramal Critical Care Inc.). DailyMed. Source: U.S. National Library of Medicine. https://dailymed.nlm.nih.gov/dailymed. Accessed 03/10/2022.
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