Efavirenz

Efavirenz Brand Name– Sustiva

What is Efavirenz

Efavirenz is an oral, non-nucleoside reverse transcriptase inhibitor (NNRTI) indicated for use with other antiretrovirals to treat HIV-1 infections in adult and pediatric patients of at least 3 months of age.

Since resistant virus emerges rapidly when NNRTIs are used as monotherapy, efavirenz should be used in combination with other antiretrovirals.

Advantages of efavirenz include once-daily dosing and penetration into the cerebrospinal fluid (CSF).

Efavirenz is available in capsule and tablet formulations.

Indications

1. human immunodeficiency virus (HIV)
2. human immunodeficiency virus (HIV) infection
3. human immunodeficiency virus (HIV) prophylaxis

NOTE: HIV guidelines recommend consideration be given to avoiding use of efavirenz-containing regimens in patients with pre-existing psychiatric illnesses, HIV-associated dementia (HAD), prolongation of the QTc interval, or who are receiving methadone as narcotic replacement therapy.

Side Effects

1. abdominal pain
2. agitation
3. amnesia
4. anorexia
5. anxiety
6. arthralgia
7. asthenia
8. ataxia
9. confusion
10. constipation
11. Cushingoid features
12. depression
13. diarrhea
14. dizziness
15. drowsiness
16. dyspepsia
17. dyspnea
18. elevated hepatic enzymes
19. emotional lability
20. encephalopathy
21. erythema
22. erythema multiforme
23. euphoria
24. fatigue
25. flushing
26. gynecomastia
27. hallucinations
28. headache
29. hepatic failure
30. hepatitis
31. hyperamylasemia
32. hypercholesterolemia
33. hyperglycemia
34. hypertriglyceridemia
35. hypoesthesia
36. insomnia
37. lipodystrophy
38. maculopapular rash
39. mania
40. myalgia
41. myopathy
42. nausea
43. neutropenia
44. nightmares
45. palpitations
46. pancreatitis
47. paranoia
48. paresthesias
49. photosensitivity
50. pruritus
51. psychosis
52. QT prolongation
53. rash
54. seizures
55. Stevens-Johnson syndrome
56. suicidal ideation
57. teratogenesis
58. tinnitus
59. tremor
60. urticaria
61. vertigo
62. visual impairment
63. vomiting

Monitoring Parameters

• blood glucose
• CBC with differential
• CD4+ T cell count
• hepatitis B serology
• LFTs
• plasma hepatitis C RNA
• plasma HIV RNA
• pregnancy testing
• serum bilirubin (total and direct)
• serum cholesterol
• serum lipid profile
• urinalysis

Contraindications

• alcoholism
• apheresis
• Asian patients
• autoimmune disease
• AV block
• bipolar disorder
• Black patients
• bradycardia
• breast-feeding
• cardiomyopathy
• celiac disease
• children
• contraception requirements
• depression
• driving or operating machinery
• females
• fever
• geriatric
• Graves’ disease
• Guillain-Barre syndrome
• heart failure
• hepatic disease
• hepatitis
• hepatitis B and HIV coinfection
• hepatitis C and HIV coinfection
• Hispanic patients
• human immunodeficiency virus (HIV) infection
• human immunodeficiency virus (HIV) infection resistance
• hypercholesterolemia
• hyperparathyroidism
• hypertriglyceridemia
• hypocalcemia
• hypokalemia
• hypomagnesemia
• hypothermia
• hypothyroidism
• immune reconstitution syndrome
• long QT syndrome
• mania
• myocardial infarction
• neurotoxicity
• pheochromocytoma
• pregnancy
• pregnancy testing
• psychosis
• QT prolongation
• reproductive risk
• rheumatoid arthritis
• schizophrenia
• seizure disorder
• seizures
• serious rash
• sickle cell disease
• sleep deprivation
• stroke
• substance abuse
• suicidal ideation
• systemic lupus erythematosus (SLE)

Interactions

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