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When starting an HIV infected patient on highly active antiretroviral therapy (HAART) that contains efavirenz (Sustiva), which of the following would be most important to counsel the patient on?
a. Efavirenz should not be taken with a high fat meal as it can increase its absorption in the GI tract and cause some CNS side effects
b. Efavirenz is associated with the development of painful peripheral neuropathy in some patients
c. Efavirenz is a strong inhibitor of enzymes needed by other medications, thereby increasing the risk for drug-drug interactions
d. Efavirenz can cause a yellow of the skin in about 10% of patients but is not harmful
What is a
Efavirenz (Sustiva) is recommended to not be taken with a high fat meals as it can increase the absorption of the efavirenz thereby putting the patient at increased risk for CNS side effects including vivid dreams, nightmares, and/or psychosis. In most cases these side effects are worse early on in the initiation of efavirenz and decrease in severity over the first 2 weeks. Peripheral neuropathies are associated with the "d-drugs" in the nucleoside reverse transcriptase class of medications not non-nucleoside reverse transcriptase inhibitors. Answer option c is wrong because efavirenz has a net effect of inducing enzymes (i.e., CYP450) involved in drug metabolism, not inhibiting them. The last answer choice is more common with atazanavir and/or indinavir due to their inhibition of UGT mediated conjugation of bilirubin in the liver.