Zinc sulfate is a mineral supplement used to correct zinc deficiency, which can cause growth delay, persistent diarrhoea and low immunity. In Angola, it is mainly given to children with diarrhoea, together with oral rehydration salts.
Also known as: Zinco, Solvzinco
Zinc forms chelates with ciprofloxacin in the gut, significantly reducing its absorption and risking treatment failure.
Bi and trivalent cations (Zn2+) chelate quinolones and prevent their absorption: the Prontuário (Quinolones) states that "their absorption is significantly reduced by drugs with bi and trivalent cations such as aluminium, magnesium or calcium antacids, iron or zinc supplements and sucralfate".
Clinical response of the infection; quinolone plasma levels in the critically ill.
Persistent fever, worsening infection signs, lack of antibiotic response.
Give the quinolone 2 h before or 6 h after the zinc supplement; never simultaneously; for short courses, reinforce adherence to the interval.
INFARMED Prontuário Terapêutico (11th ed., 2012), Quinolones 1.1 — chelation by cations including zinc; DailyMed — Ciprofloxacin Tablet label [Bayer, RLD Cipro], Drug Interactions (cations): https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=c47250c2-bece-46b5-8b3b-b7c97d9005d8
Iron and zinc compete for the same intestinal absorption pathway and mutually reduce each other, so simultaneous supplementation may correct neither deficiency.
Competition for the divalent cation transporter (DMT1) in the intestinal mucosa: the Prontuário (Iron 4.1.1) states that "Iron absorption is reduced by: antacids, penicillins, tetracyclines, trientine and zinc" and that "iron salts reduce the absorption of ... zinc".
Full blood count and ferritin, serum zinc, adherence and gastrointestinal tolerance.
Non-correcting anaemia, zinc deficiency symptoms (dermatitis, diarrhoea, taste changes).
Separate the doses by at least 2 h and avoid co-administration; reassess ferritin and serum zinc after 8–12 weeks on a separated schedule.
INFARMED Prontuário Terapêutico (11th ed., 2012), Iron 4.1.1 — zinc among drugs reducing iron absorption and vice versa.
Phytates in wholegrain cereals, bran and legumes bind zinc and reduce its absorption; zinc should be spaced from very high-fibre meals.
Space the supplement dose from very high-fibre meals (bran, wholegrain cereals) by at least 2 h.
Site monograph (zinc — spacing from meals); nutrition literature (phytates).
Zinc accumulates in kidney disease — copper deficiency and neuropathy risk with prolonged treatment.
Monitor serum copper with treatments > 3 months (site monograph).
Site monograph (zinc sulfate — monitor serum copper).
No restrictive Annex 1 entry; zinc is an essential mineral and supplementation at physiological doses is safe in pregnancy (WHO recommends it in documented deficiency). High doses (>40 mg/day) can interfere with copper and iron.
Compatible at physiological/supplementary doses; avoid chronic high doses (copper/iron competition).
Compatible; zinc passes into milk and is beneficial for the infant at usual doses.
Prontuário Terapêutico INFARMED — 11.3.3 (Vitamin and mineral combinations); WHO/UNICEF supplementation guidance.
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Correction of zinc deficiency; reduced duration of childhood diarrhoea and better wound healing.
Cofactor of metalloenzymes (polymerases, superoxide dismutase, carboxypeptidases); modulates innate immunity and enterocyte adaptation in diarrhoea.
Duodenal/jejunal absorption 20–30%; inhibited by phytates, iron, calcium and tetracyclines.
Predominantly faecal excretion (unabsorbed + pancreatic secretion); partly renal (24 mg/day).
~ 12 h (dependent on plasma concentration and stores).
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
