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Drug Reference

zinc sulfate

mineral supplement (essential trace element)· Brands: Solvazinc, Orazinc, VerazincIVPOTOP

Mechanism of action
Zinc sulfate dissociates in the gastrointestinal tract to release zinc ions, and it acts by restoring body stores of an essential trace element rather than by binding a receptor. Zinc is a catalytic and structural cofactor for more than 300 enzymes, including carbonic anhydrase, alkaline phosphatase, alcohol dehydrogenase and superoxide dismutase, and it forms zinc finger motifs in many transcription factors and DNA-binding proteins. Through these roles it supports nucleic acid synthesis, cell division, protein synthesis, immune cell function, wound healing, growth, and taste and smell acuity. In the gut, zinc also tightens epithelial junctions and modulates secretory transport, which underpins its adjunctive use in acute childhood diarrhoea. At high intakes zinc induces enterocyte metallothionein, which buffers further absorption and increases faecal loss.
Pharmacokinetics
Absorption occurs mainly in the jejunum via the ZIP4 transporter, is saturable, and accounts for roughly 20 to 30 percent of an oral dose in healthy people, with a higher fractional absorption in deficiency states. Phytates, dietary fibre, calcium, iron and copper taken in the same meal reduce absorption, so zinc sulfate is best given on an empty stomach when tolerated, although food reduces nausea. Absorbed zinc is carried in plasma largely bound to albumin and alpha-2-macroglobulin with a small free fraction, and distributes to muscle, bone, skin, liver and prostate. It crosses the placenta and appears in breast milk. Elimination is mainly faecal through pancreatic and intestinal secretion, with small renal losses; whole body turnover is slow, so plasma zinc reflects recent intake only partly and is a crude guide to total body status.
Indications & dosing

Zinc deficiency (treatment)

Typical elemental zinc dose. Zinc sulfate 220 mg provides 50 mg elemental zinc. Adjust according to severity and response.

  • adult · PO: 50 mg elemental zinc once daily · Typical elemental zinc dose. Zinc sulfate 220 mg provides 50 mg elemental zinc. Adjust according to severity and response.

Zinc deficiency (treatment)

Typical dose for children. Adjust by age and severity. Zinc sulfate 220 mg provides 50 mg elemental zinc.

  • pediatric · PO: 10–20 mg elemental zinc once daily · Typical dose for children. Adjust by age and severity. Zinc sulfate 220 mg provides 50 mg elemental zinc.

Adjunct in acute diarrhoea in childrenoff-label

For 10 to 14 days. Infants under 6 months: 10 mg daily. WHO recommends; may be off-label in some regions.

  • pediatric · PO: 10–20 mg elemental zinc once daily · For 10 to 14 days. Infants under 6 months: 10 mg daily. WHO recommends; may be off-label in some regions.

Wilson's disease (maintenance therapy)off-label

Usually as zinc acetate; zinc sulfate may be used. Monitor copper balance. Not for acute treatment.

  • adult · PO: 50 mg elemental zinc three times daily · Usually as zinc acetate; zinc sulfate may be used. Monitor copper balance. Not for acute treatment.
Contraindications & precautions
  • Known hypersensitivity to zinc sulfate or other components of the formulation · Discontinue and manage the reaction; severe hypersensitivity is rare.
  • Acute zinc overdose or established zinc toxicity · Further zinc administration worsens toxicity; manage with supportive care and specialist advice on chelation if indicated.
  • Pre-existing copper deficiency or conditions predisposing to it · Zinc induces metallothionein, which reduces copper absorption and may worsen anaemia or neuropathy. Use only with specialist monitoring.
  • Severe renal impairment · Zinc excretion may be reduced, increasing the risk of accumulation. Use with caution and monitor zinc and copper concentrations.
  • Administer with food if gastrointestinal upset occurs; note that food reduces absorption, so timing should be matched to the indication.
  • Separate oral zinc from tetracyclines, fluoroquinolones, penicillamine, iron, calcium and other chelating or divalent cation drugs by at least 2 hours.
  • During long-term high-dose therapy, monitor serum zinc and copper (or ceruloplasmin) to detect copper deficiency.
  • Do not exceed recommended elemental zinc doses; chronic intake above 40 to 50 mg daily is associated with copper deficiency.
  • Use with caution in renal impairment and in older patients with reduced renal function; monitor for accumulation.
  • Check local formulary and product information for elemental zinc content, as the salt and formulation vary between products.
Adverse effects
  • Nausea and vomiting
  • Abdominal pain and dyspepsia
  • Diarrhoea or constipation
  • Metallic taste in the mouth
  • Headache
  • Gastric erosion or gastrointestinal bleedingserious
  • Copper deficiency with anaemia or myelopathyserious
  • Acute zinc toxicity: severe vomiting, dehydration, hypotension, jaundice, convulsionsserious
Monitoring, pregnancy & toxicity
  • Serum zinc concentration · Baseline and periodically during high-dose or prolonged therapy, or if deficiency or toxicity is suspected.
  • Serum copper and caeruloplasmin · Baseline and every 3 to 6 months during long-term high-dose zinc, or if anaemia or neurological features develop.
  • Full blood count · At baseline and periodically during long-term therapy to detect copper-deficiency anaemia or neutropenia.
  • Renal function and electrolytes · Before and during high-dose therapy, or in chronic kidney disease, because zinc excretion may be reduced.
  • Clinical response and tolerability · Review symptoms such as diarrhoea in acrodermatitis enteropathica, and assess nausea, abdominal pain and adherence.
  • Interacting medicines · Separate zinc from tetracyclines, quinolones, bisphosphonates, iron and calcium by at least 2 hours.
  • Pregnancy: Zinc sulfate may be used in pregnancy when there is documented zinc deficiency or a clinical need for supplementation. Zinc requirements increase in pregnancy, but routine high-dose supplementation is not recommended unless advised by a clinician. Do not exceed the product's recommended dose, because chronic high-dose zinc can cause copper deficiency. Follow local antenatal guidance and formulary advice.
  • Toxicity: Acute overdose: nausea, vomiting, abdominal pain, diarrhoea, metallic taste, headache, and dehydration or electrolyte disturbance with large ingestions. · Stop zinc. Seek poisons or emergency advice. Provide supportive care, oral or intravenous fluids, and electrolyte correction. Activated charcoal is not routinely effective for zinc salts.
  • Toxicity: Severe acute ingestion: persistent vomiting, haematemesis, gastric erosion, lethargy, dizziness, ataxia, and possible acute kidney injury. · Urgent hospital assessment. Support airway, breathing and circulation. Monitor renal function, electrolytes and blood count. Gastric decontamination is not routinely recommended; endoscopy if corrosive injury is suspected.
  • Toxicity: Chronic excessive intake: copper deficiency with anaemia, neutropenia, peripheral neuropathy, myelopathy, or reduced caeruloplasmin. · Stop zinc supplementation. Confirm copper status. Give copper replacement under specialist guidance if deficiency is confirmed. Neurological and haematological follow-up as needed.
  • Toxicity: Zinc fume inhalation from occupational exposure, not zinc sulfate ingestion: metal fume fever with fever, myalgia, cough, dyspnoea and metallic taste. · Remove from exposure. Provide supportive care, rest, fluids and oxygen if hypoxic. Symptoms usually resolve, but severe respiratory features need medical assessment.
Clinical notes
Indications include confirmed or suspected zinc deficiency from poor intake, malabsorption, chronic liver disease, alcohol use, burns, or prolonged parenteral nutrition without supplements; acrodermatitis enteropathica; and adjunctive treatment of acute diarrhoea in children, where World Health Organization and UNICEF guidance supports a short course. Zinc salts, often as acetate, are also used in Wilson's disease to block intestinal copper absorption, and zinc sulfate is added to some parenteral nutrition regimens. Teaching examples only: elemental zinc 15 to 25 mg daily by mouth for adult deficiency, up to about 50 mg daily short term under supervision, and 1 to 3 mg/kg daily in acrodermatitis enteropathica. Products vary widely by region and are labelled inconsistently as salt weight or elemental zinc, for example zinc sulfate 220 mg provides about 50 mg elemental zinc, so the elemental content must always be checked. Adverse effects are nausea, vomiting, abdominal pain, metallic taste, headache, and, with prolonged high doses, copper deficiency with anaemia or myelopathy. Separate oral zinc from tetracyclines, quinolones, iron, calcium and penicillamine by at least two hours. Monitor plasma zinc, copper, caeruloplasmin and full blood count during long-term therapy, and use caution in renal impairment.

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BNF; local formulary; product SPC or equivalent prescribing information; WHO/UNICEF guidance on childhood diarrhoea; parenteral nutrition guidelines such as ESPEN or ASPEN.