Version July 2025
Note: Dosage expressed in terms of elemental zinc.
Adequate intake (AI): Note: Recommended intake from dietary sources (eg, breast milk, formula).
Neonates: Oral: 2 mg elemental zinc/day (Ref).
Parenteral nutrition, maintenance zinc requirement: Higher doses than those shown may be needed if impaired intestinal absorption or an excessive loss of zinc (eg, excessive, prolonged diarrhea; high-output intestinal fistula; burns) (Ref).
Preterm and term neonates:
<3 kg: IV: 400 to 500 mcg elemental zinc/kg/day as an additive to parenteral nutrition solution (Ref).
≥3 kg: Usual dose: IV: 250 mcg elemental zinc/kg/day as an additive to parenteral nutrition solution (Ref); reported range: 50 to 250 mcg elemental zinc/kg/day (Ref).
Note: Dosages may be presented in units of mcg or mg; use caution to ensure correct units.
Parenteral nutrition, maintenance zinc requirement: Note: Higher doses may be needed (in some cases between 2 to 3 times the maintenance requirement) if impaired intestinal absorption or an excessive loss of zinc (eg, excessive, prolonged diarrhea; high-output intestinal fistula; burns) (Ref).
ASPEN recommendations: Infants, Children, and Adolescents:
3 to <10 kg: IV: Usual dose: 250 mcg elemental zinc/kg/day as an additive to parenteral nutrition solution (Ref); reported range: 50 to 250 mcg elemental zinc/kg/day (Ref).
10 to 40 kg: IV: Usual dose: 50 mcg elemental zinc/kg/day as an additive to parenteral nutrition solution (Ref); reported range: 50 to 125 mcg elemental zinc/kg/day; maximum daily dose: 5,000 mcg elemental zinc/day (Ref).
>40 kg: IV: 2,000 to 5,000 mcg elemental zinc/day as an additive to parenteral nutrition solution.
ESPGHAN recommendations: Infants, Children, and Adolescents:
Infants <3 months: IV: 250 mcg elemental zinc/kg/day as an additive to parenteral nutrition solution (Ref).
Infants ≥3 months: IV: 100 mcg elemental zinc/kg/day as an additive to parenteral nutrition solution (Ref).
Children and Adolescents: IV: 50 mcg elemental zinc/kg/day as an additive to parenteral nutrition solution; maximum daily dose: 5,000 mcg elemental zinc/day (Ref).
Diarrhea, treatment; malnourished patient: Limited data available (Ref): Note: Zinc should be started in conjunction with oral rehydration solutions at first sign of diarrhea; zinc therapy may shorten the duration and severity of episodes and prevent subsequent episodes (Ref).
Infants <6 months: Oral: 10 mg elemental zinc once daily for 10 to 14 days (Ref).
Infants ≥6 months and Children: Oral: 20 mg elemental zinc once daily for 10 to 14 days (Ref). Note: Lower doses of 5 mg or 10 mg once daily for 14 days have shown noninferior efficacy and have been associated with less vomiting (Ref).
Zinc deficiency, treatment: Limited data available:
Acquired (eg, secondary to cystic fibrosis, liver disease, sickle cell disease, short-bowel syndrome, intestinal failure): Infants, Children, and Adolescents: Oral: 0.5 to 2 mg elemental zinc/kg/day (Ref); dose should be individualized; required dose dependent upon multiple factors, which may include the following: age (younger patients, especially infants, have higher requirements), underlying cause of deficiency, physiologic status of other trace elements, enteral/parenteral nutrition intake (Ref).
Acrodermatitis enteropathica: Infants, Children, and Adolescents: Oral: 3 mg elemental zinc/kg/day; duration of therapy is typically life-long (Ref).
There are no dosage adjustments provided in the manufacturer's labeling; however, zinc and aluminum accumulation may occur in the setting of renal impairment.
There are no dosage adjustments provided in the manufacturer's labeling.
(For additional information see "Zinc sulfate: Drug information")
Note: Dosing units: All dosages are expressed as elemental zinc unless stated otherwise. Oral zinc sulfate contains ~23% elemental zinc.
Dietary supplement: Oral: 50 mg once daily.
Parenteral nutrition additive, maintenance requirement: Note: Individualize dose based on the patient's clinical condition, nutritional requirements, and the contribution of oral or enteral zinc intake.
Acute metabolic states: IV: Optimal dose not determined; monitor and replace as clinically indicated. Expert consensus recommendation suggest: 2.5 to 6.5 mg/day (Ref).
Metabolically stable: IV: 3 to 5 mg/day (Ref).
Replacement for small bowel fluid loss (metabolically stable): IV: Additional zinc replacement may be required for patients with high-output intestinal fistula, ostomy effluent, or severe diarrhea due to excessive zinc loss. Estimated loss ranges from up to an additional 12 mg zinc per L for small bowel fluid loss or an additional ~17 mg zinc per kg of stool or ileostomy output (Ref).
Zinc deficiency: Oral: Optimal dose not determined; some recommend daily doses of 2 to 3 times the zinc RDA for mild deficiency and 4 to 5 times the RDA for moderate to severe deficiency for 6 months (Ref).
There are no dosage adjustments provided in the manufacturer's labeling; however, zinc and aluminum accumulation may occur in the setting of renal impairment.
There are no dosage adjustments provided in the manufacturer's labeling.
There are no adverse reactions listed in the manufacturer's labeling.
Injection: Hypersensitivity to zinc or any component of the formulation.
Disease-related concerns:
• Renal impairment: Use with caution in patients with renal impairment.
Concurrent drug therapy issues:
• Copper: Chronic administration of high-dose zinc may cause a decrease in enteral copper absorption and subsequent decreased copper deficiency (Kumar 2022; Marumo 2021; manufacturer's labeling).
Dosage form specific issues:
• Aluminum: The parenteral product may contain aluminum; toxic aluminum concentrations may be seen with high doses, prolonged use, or renal dysfunction. Premature neonates are at higher risk due to immature renal function and aluminum intake from other parenteral sources. Parenteral aluminum exposure of >4 to 5 mcg/kg/day is associated with CNS and bone toxicity; tissue loading may occur at lower doses (Federal Register 2002).
Strength of zinc sulfate injection is expressed as elemental zinc
Oral zinc sulfate is approximately 23% elemental zinc
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral:
Orazinc: 220 mg
Generic: 220 mg
Solution, Intravenous:
Generic: 1 mg/mL (10 mL); 3 mg/mL (10 mL); 5 mg/mL (5 mL)
Solution, Intravenous [preservative free]:
Generic: 1 mg/mL (10 mL); 3 mg/mL (10 mL); 5 mg/mL (5 mL)
Tablet, Oral:
Orazinc: 110 mg
Zinc 15: 66 mg
Generic: 220 mg
Yes
Capsules (Orazinc Oral)
220 (50 Zn) mg (per each): $0.08
Capsules (Zinc Sulfate Oral)
220 (50 Zn) mg (per each): $0.23
Solution (Zinc Sulfate Intravenous)
1 mg/mL (per mL): $1.68 - $3.68
3 mg/mL (per mL): $5.04 - $11.07
5 mg/mL (per mL): $8.40 - $18.42
Tablets (Orazinc Oral)
110 mg (per each): $0.04
Tablets (Zinc 15 Oral)
66 mg (per each): $0.02
Tablets (Zinc Sulfate Oral)
220 (50 Zn) mg (per each): $0.04
Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution, Intravenous:
Micro-Zn: 1 mg/mL (10 mL); 5 mg/mL (10 mL)
Generic: 1 mg/mL (10 mL); 5 mg/mL (5 mL)
Oral: Administer with food if GI upset occurs.
Parenteral: IV: Not for direct IV infusion; must be prepared and used as an admixture in parenteral nutrition solutions only.
IV: Not for direct IV infusion; acidic pH of the solution may cause vein irritation, phlebitis, damage, or thrombosis; must be prepared and used as an admixture in parenteral nutrition solutions only.
Capsule: Store at 15°C to 30°C (59°F to 86°F).
Tablet: Store at 13°C to 24°C (55°F to 76°F).
Injection: Store intact vials at 20°C to 25°C (68°F to 77°F); excursions permitted to 15°C to 30°C (59°F to 86°F). Use parenteral nutrition containing zinc sulfate promptly after mixing (limit up to 4 hours at room temperature after container has been penetrated) or may store admixed solution for up to 9 days at 2°C to 8°C (36°F to 46°F); after removal from refrigeration, use promptly and complete infusion within 24 hours. Protect the admixed solution from light.
Oral: Dietary supplementation of zinc (dietary supplement; consult product-specific labeling for manufacturer recommended ages); has also been used to help reduce the duration and severity of diarrhea in malnourished patients.
Parenteral: Prevention of zinc deficiency as an additive to parenteral nutrition (FDA approved in all ages).
ZnSO4 is an error-prone abbreviation (mistaken as morphine sulfate)
None known.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program
Baloxavir Marboxil: Polyvalent Cation Containing Products may decrease serum concentration of Baloxavir Marboxil. Risk X: Avoid
Bictegravir: Polyvalent Cation Containing Products may decrease serum concentration of Bictegravir. Management: Administer bictegravir at least 2 hours before or 6 hours after polyvalent cation containing products. Coadministration of bictegravir with or 2 hours after most polyvalent cation products is not recommended. Risk D: Consider Therapy Modification
Bisphosphonate Derivatives: Polyvalent Cation Containing Products may decrease serum concentration of Bisphosphonate Derivatives. Management: Avoid administration of oral medications containing polyvalent cations within: 2 hours before or after tiludronate/clodronate/etidronate; 60 minutes after oral ibandronate; or 30 minutes after alendronate/risedronate. Risk D: Consider Therapy Modification
Cabotegravir: Polyvalent Cation Containing Products may decrease serum concentration of Cabotegravir. Management: Administer polyvalent cation containing products at least 2 hours before or 4 hours after oral cabotegravir. Risk D: Consider Therapy Modification
Deferiprone: Polyvalent Cation Containing Products may decrease serum concentration of Deferiprone. Management: Separate administration of deferiprone and oral medications or supplements that contain polyvalent cations by at least 4 hours. Risk D: Consider Therapy Modification
Dolutegravir: Zinc Salts may decrease serum concentration of Dolutegravir. Management: Administer dolutegravir at least 2 hours before or 6 hours after oral zinc salts. Administer the dolutegravir/rilpivirine combination product at least 4 hours before or 6 hours after oral zinc salts. Risk D: Consider Therapy Modification
Eltrombopag: Polyvalent Cation Containing Products may decrease serum concentration of Eltrombopag. Management: Administer eltrombopag at least 2 hours before or 4 hours after oral administration of any polyvalent cation containing product. Risk D: Consider Therapy Modification
Elvitegravir: Polyvalent Cation Containing Products may decrease serum concentration of Elvitegravir. Management: Administer elvitegravir-containing products 2 hours before, or 2 to 6 hours after, the administration of polyvalent cation containing products. Risk D: Consider Therapy Modification
Levonadifloxacin: Zinc Salts may decrease serum concentration of Levonadifloxacin. Risk X: Avoid
PenicillAMINE: Polyvalent Cation Containing Products may decrease serum concentration of PenicillAMINE. Management: Separate the administration of penicillamine and oral polyvalent cation containing products by at least 1 hour. Risk D: Consider Therapy Modification
Quinolones: Zinc Salts may decrease serum concentration of Quinolones. Management: Give oral quinolones at several hours before (4 h for moxi- and sparfloxacin, 2 h for others) or after (8 h for moxi-, 6 h for cipro/dela-, 4 h for lome-, 3 h for gemi-, and 2 h for enox-, levo-, nor-, pe- or ofloxacin or nalidixic acid) oral zinc salts. Risk D: Consider Therapy Modification
Raltegravir: Polyvalent Cation Containing Products may decrease serum concentration of Raltegravir. Management: Administer raltegravir 2 hours before or 6 hours after administration of the polyvalent cations. Dose separation may not adequately minimize the significance of this interaction. Risk D: Consider Therapy Modification
Roxadustat: Polyvalent Cation Containing Products may decrease serum concentration of Roxadustat. Management: Administer roxadustat at least 1 hour after the administration of oral polyvalent cation containing products. Risk D: Consider Therapy Modification
Tetracyclines: Zinc Salts may decrease absorption of Tetracyclines. Only a concern when both products are administered orally. Management: Separate administration of oral tetracycline derivatives and oral zinc salts by at least 2 hours to minimize this interaction. Risk D: Consider Therapy Modification
Trientine: Polyvalent Cation Containing Products may decrease serum concentration of Trientine. Management: Avoid concomitant use of trientine and polyvalent cations. If oral iron supplements are required, separate the administration by 2 hours. For other oral polyvalent cations, give trientine 1 hour before, or 1 to 2 hours after the polyvalent cation. Risk D: Consider Therapy Modification
Unithiol: May decrease therapeutic effects of Polyvalent Cation Containing Products. Risk X: Avoid
Avoid foods high in calcium or phosphorus.
May be taken with food if GI upset occurs.
Dietary reference intake (IOM 2001):
1 to 6 months: Adequate intake (AI): 2 mg elemental zinc/day.
7 to 12 months: Recommended dietary allowance (RDA): 3 mg elemental zinc/day.
1 to 3 years: RDA: 3 mg elemental zinc/day.
4 to 8 years: RDA: 5 mg elemental zinc/day.
9 to 13 years: RDA: 8 mg elemental zinc/day.
14 to 18 years: RDA:
Females: 9 mg elemental zinc/day.
Males: 11 mg elemental zinc/day.
Pregnancy: 12 mg elemental zinc/day.
Lactation: 13 mg elemental zinc/day.
Adults ≥19 years: RDA:
Females: 8 mg elemental zinc/day.
Males: 11 mg elemental zinc/day.
Pregnancy: 11 mg elemental zinc/day.
Lactation: 12 mg elemental zinc/day.
Zinc crosses the placenta and can be measured in the cord blood and placenta. Fetal concentrations are regulated by the placenta (de Moraes 2011).
Patients on parenteral nutrition or long-term therapy should have periodic serum copper and serum zinc levels (typically every 3 months suggested) (AAP [Kleinman 2019]; ASPEN [Corkins 2015]); alkaline phosphatase, taste acuity, mental depression; for Acrodermatitis enteropathica, monitor plasma zinc levels every 3 to 6 months (Joyce 2020).
Absorption: pH-dependent; enhanced at lower pH; (pH <3); impaired by food (Anderson 1998).
Distribution: Stored primarily in skeletal muscle and bone (IOM 2001).
Protein binding: Albumin and alpha 1-macroglobulin (Foote 1984).
Excretion: Feces and urine (IOM 2001).
