Sustiva Disease Interactions

Increases in total cholesterol and triglycerides have resulted during treatment with efavirenz. Lipid levels monitoring should be performed before starting treatment and at periodic intervals during therapy.

Efavirenz is primarily metabolized by the liver. Patients with liver disease may be at greater risk for adverse effects from efavirenz due to decreased drug clearance. Therapy with efavirenz should be administered cautiously in patients with liver disease. In addition, elevations in serum transaminases to greater than five times the upper limit of normal as well as acute liver failure requiring transplantation have occurred during therapy with efavirenz, most often in patients with a prior history of Hepatitis B and/or C. Monitoring of liver function tests is recommended in these patients.

During clinical trials, there have been infrequent reports of delusions and inappropriate behavior associated with the use of efavirenz, predominantly in patients with a history of mental illness or substance abuse. Severe acute depression, including suicide attempts and suicidal ideation, has also been reported but was not limited to efavirenz treated patients. Therapy with efavirenz should be administered cautiously in patients with a current or past history of psychiatric illness, emotional instability, or substance abuse. If symptoms develop or worsen during treatment, discontinuation of efavirenz may be necessary.

QTc prolongation has been observed with the use of efavirenz. Alternatives to efavirenz should be considered when administered to patients at higher risk of torsade de pointes or when coadministered with a medication with known risk of torsade de pointes.

Convulsions have been observed in adult and pediatric patients receiving efavirenz, generally in the presence of known medical history of seizures. Caution should be taken with any patient with a history of seizures. Anticonvulsant medication such as phenytoin and phenobarbital may require periodic monitoring of plasma levels.