Can I use 50 mg of zinc on alternate days?

Zinc Supplementation on Alternate Days

Taking 50 mg of zinc on alternate days is generally acceptable for adults requiring zinc supplementation, though daily administration is typically preferred for most clinical situations requiring zinc therapy.

Dosage Recommendations for Zinc

The appropriate zinc dosage depends on the clinical indication and patient characteristics:

Standard Adult Dosing

• For general supplementation in adults: 0.5-1 mg/kg/day of elemental zinc for 3-4 months 1
• Maximum routine supplementation: 5 mg/day 2, 1
• For Wilson's disease: 150 mg/day in three divided doses 2, 1

Age-Specific Dosing

• Children >12 months: 50 μg/kg/day up to maximum 5 mg/day 2
• Infants 3-12 months: 100 μg/kg/day 2
• Term to 3 months infants: 250 μg/kg/day 2
• Preterm infants: 400-500 μg/kg/day 2

Alternate Day Dosing Considerations

While most guidelines recommend daily zinc administration, alternate-day dosing of 50 mg may be reasonable in certain situations:

• Maintenance therapy: After adequate treatment with a chelator for Wilson's disease, stable patients may be shifted to zinc therapy 2
• Gastrointestinal tolerance: Alternate-day dosing might improve tolerability if daily dosing causes gastric irritation, which is a common side effect 2, 1
• Long-term supplementation: For chronic supplementation where daily compliance is challenging

Special Clinical Situations

Higher zinc doses or daily administration are required for:

• Wilson's disease: Requires 150 mg/day in three divided doses 2
• Gastrointestinal losses: Patients with fistulae, stomas, or diarrhea require up to 12 mg/day IV 2, 1
• Major burns: 30-35 mg/day IV for 2-3 weeks for patients with burns >20% BSA 2
• Common cold treatment: 75 mg/day of elemental zinc as zinc gluconate 1

Administration Guidelines

For optimal absorption and effectiveness:

• Take zinc on an empty stomach, at least 30 minutes before meals 1
• Avoid taking with foods high in phytates or with other mineral supplements (especially iron and calcium) 1
• Organic compounds (zinc gluconate, histidinate, orotate) have better tolerability than inorganic forms (zinc sulfate, chloride) 2, 1

Monitoring and Safety Concerns

Monitoring

• Regular monitoring of plasma zinc levels is recommended for long-term supplementation 2
• Measure CRP and albumin simultaneously for proper interpretation 1
• Monitor alkaline phosphatase levels 2, 1

Potential Adverse Effects

• Gastric irritation (varies by zinc salt used) 2, 1
• Elevations in serum lipase and/or amylase 2
• With high doses or long-term use:
  • Copper deficiency leading to anemia and neutropenia 3
  • Impaired immune function 3
  • Adverse effects on lipid profiles (decreased HDL) 3

Conclusion

While 50 mg of zinc on alternate days may be acceptable for certain patients, daily administration is generally preferred for most clinical indications. The optimal dosing regimen should be based on the specific clinical indication, patient characteristics, and tolerability. For maintenance therapy after stabilization, alternate-day dosing might be reasonable, but this should be monitored with appropriate laboratory tests.