Question

HIV infected patient was started with highly active anti-retroviral therapy containing efavirenz. The patient should be given with which of the following precautions by the pharmacist.

• A. \( \text{Efavirenz should not be taken with a high fat meal as it can increase its absorption in the GI tract and cause some CNS side effects.} \)
• B. \( \text{Efavirenz is associated with the development of painful peripheral neuropathy in some patients.} \)
• C. \( \text{Efavirenz is a strong inhibitor of enzymes needed by other medications, thereby increasing the risk for drug-drug interactions and should be cautious.} \)
• D. \( \text{Efavirenz can cause yellow color to the skin in about 10\% of patients but it is not harmful.} \)

Hint:

Think "empty stomach at night" for efavirenz to help manage its absorption and potential CNS effects.

Answer 1

The Correct Option is A

Efavirenz is a non-nucleoside reverse transcriptase inhibitor (NNRTI) commonly used in HIV treatment regimens. It is known that the absorption of efavirenz is increased when taken with food, particularly high-fat meals. This increased absorption can lead to higher plasma concentrations of the drug, which may exacerbate central nervous system (CNS) side effects such as dizziness, drowsiness, confusion, and abnormal dreams. Therefore, patients taking efavirenz should be advised to take it on an empty stomach, preferably at bedtime to minimize the impact of CNS side effects. Let's briefly consider the other options: - Option B: While efavirenz can cause neurological symptoms, painful peripheral neuropathy is not a primary or common adverse effect associated with it. - Option C: Efavirenz is an inducer of some cytochrome P450 enzymes (e.g., CYP3A4, CYP2C9), which can lead to decreased levels of other medications metabolized by these enzymes, rather than being a strong inhibitor. Caution regarding drug-drug interactions is important, but the mechanism described is incorrect. - Option D: Efavirenz is not typically associated with causing yellow discoloration of the skin. Jaundice (yellowing of the skin) in HIV patients is usually related to liver issues or other infections.