Dizziness efavirenz

Children - Clinical adverse experiences observed in 10% or more of pediatric patients 3 to 16 years of age who received efavirenz capsules were the following Rash, diarrhea/loose stools, fever, cough, dizziness/lightheadedness/fainting ache/pain/discomfort, nausea/vomiting, headache. 

Efavirenz (Sustiva) [Antiretroviral/NNRTI] Uses Hiv infxns Action Antiretroviral nonnucleoside RTI Dose Adults. 600 mg/d PO qhs Feds. See package insert avoid high-fat meals Caution [D, ] CDC recommends HIV-infected mothers not breast-feed Contra Component sensitivity Disp Caps SE Somnolence, vivid dreams, dizziness, rash, N/V/D Interactions T Effects W/ ritonavir T effects OF CNS depressants, ergot derivatives, midazolam, ritonavir, simvastatin, triazolam, warfarin X effects W/ carbamazepine, phenobarbital, rifabutin, rifampin, saquinavir, St. John s wort i effects OF amprenavir, carbamazepine, clarithromycin, indinavir, phenobarbital, saquinavir, warfarin may alter effectiveness OF OCPs EMS Concurrent EtOH usage can t CNS d ression OD May cause muscle contractions and adverse CNS effects activated charcoal may be effective... 

Efavirenz (Sustiva) is approved for the therapy of HIV infection of adults and children and is also used for postexposure prophylaxis. It is the only NNRTI approved for once-daUy dosing. Rash, although rarely severe, is a common adverse effect of efavirenz. Elevated liver enzymes and serum cholesterol also may occur. Central nervous system (CNS) effects in approximately half of patients may include dizziness, headache, insomnia, drowsiness, euphoria, agitation, impaired cognition, nightmares, vivid dreams, and hallucinations. These effects often subside after several weeks to months of therapy. 

The principal adverse effects of efavirenz involve the central nervous system. Dizziness, drowsiness, insomnia, and headache tend to diminish with continued therapy ... 

The most serious side effects of efavirenz are psychiatric symptoms, rash and nervous symptoms. The psychiatric symptoms include suicide thoughts, depression, paranoia, manic disorders and aggressive behavior the rashes include macu-lopapular skin eruptions and life-threatening Stevens-Johnson syndrome has also been reported. The neurological symptoms are difficulty in concentration, insomnia, dizziness, confusion, agitation, hallucinations and amnesia. Additional side effect may include an increase in cholesterol and hepatic transaminase levels. 

Skin rashes are the most common side effect of the NNRTIs, and efavirenz may cause nervous system symptoms such as headache, dizziness, and insomnia.41... 

Efavirenz NNRTI 600 mg qd Not to be taken with a fatty meal Dizziness, insomnia, rash, transaminitis Embryotoxic see footnote 2 for concurrent drug contraindication s... 

IMATINIB 1. ANTIBIOTICS - clarithromycin, erythromycin 2. ANTIFUNGALS -fluconazole, itraconazole, ketoconazole voriconazole 3. ANTIVIRALS -efavirenz, ritonavir 4. GRAPEFRUIT JUICE 5. H2 RECEPTOR BLOCKERS - cimetidine t imatinib levels with t risk of toxicity (e.g. abdominal pain, constipation, dyspnoea) and of neurotoxicity (e.g. taste disturbances, dizziness, headache, paraesthesia, peripheral neuropathy) Due to inhibition of CYP3A4-mediated metabolism of imatinib Monitor for clinical efficacy and for the signs of toxicity listed, along with convulsions, confusion and signs of oedema (including pulmonary oedema). Monitor electrolytes and liver function, and for cardiotoxicity... 

EFAVIRENZ RITONAVIR t efficacy and t adverse effects of ritonavir, e.g. dizziness, nausea, paraesthesia and liver dysfunction t bioavailability of ritonavir competition for metabolism via CYP3A4 Combination not well tolerated. Monitor closely including LFTs. Low-dose ritonavir has not been studied... 

Efavirenz is a non-nucleoside reverse transcriptase inhibitor with excellent inhibitory activity against HTV-l. Its most frequent adverse effects involve the central nervous system and the skin (1). At the start of therapy, dizziness, insomnia, or fatigue is observed in most patients, and headache and even psychotic reactions have also been observed. A maculopapular rash is seen in about 10%. These adverse effects usually vanish within the first 2-4 weeks of therapy (2). About 1-2% of individuals stop taking efavirenz because of neurological or dermatological adverse events. Administration of efavirenz at bedtime reduces the incidence of severe adverse effects, and the rash can be managed by short-term antihistamines or topical corticosteroids (1). Nausea and vomiting are less often observed than in patients treated with zidovudine, lamivudine, or indinavir. 

In an open comparison of efavirenz and indinavir (plus two nucleoside analogues) in predominantly treatment-naive patients efavirenz-based triple therapy provided at least similar antiviral effects over 48 weeks (7). Furthermore, fewer patients discontinued efavirenz-based triple therapy than indinavir-based therapy because of adverse events. Adverse effects associated with efavirenz included a maculopapular rash and central nervous system disturbances (dizziness, vivid dreams, poor concentration, sleep disturbances), which generally occurred (but later resolved) within the first weeks of therapy. 

In an open, 48-week, single-arm, multicenter phase II study in 99 patients abacavir 300 mg bd, amprenavir 1200 mg bd, and efavirenz 600 mg/day were associated with rashes in 50 patients, possibly because of abacavir hjrpersensitivity 17 permanently discontinued one or more drugs as a result (5). Other adverse effects included nausea (n = 41), diarrhea (n = 27), sleep disorders (n = 27), dizziness (n = 25), fatigue (n = 23), hypertriglyceridemia (n = 18), neutropenia (n = 8), hyperamylasemia (n = 4), leukopenia (n = 3), hypercholesterolemia (n = 2), raised alkaline phosphatase (n = 1), and raised aspartate transaminase (n = 1). 

The most important adverse effects of efavirenz involve the CNS. Up to 53% of patients report some CNS or psychiatric side effects, but fewer than 5% discontinue the drug for this reason. CNS symptoms may occur with the first dose and may last for hours. More severe symptoms may require weeks to resolve. Patients commonly report dizziness, impaired concentration, dysphoria, vivid or disturbing dreams, and insomnia. Episodes of frank psychosis (depression, hallucinations, and/or mania) have been associated with initiating efavirenz. Fortunately, CNS side effects generally become more tolerable and resolve within the first 4 weeks of therapy. 

The side effects of efavirenz include dizziness, insomnia, impaired concentration, abnormal dreams, and drowsiness. The most common adverse effect is a skin rash. Other side effects are diarrhea, headache, and dizziness. Efavirenz is recommended to be taken at bedtime with or without food. Patients on efavirenz should avoid driving or operating machinery and the intake of high fat meals. It should always be taken in combination with at least one other anti-HIV agent. Efavirenz is contraindicated with midazolam, triazolam, or ergot derivatives. 

Efavirenz 3-5 h Chronic CNS effects confusion, disengagement, dizziness, hallucinations, insomnia, somnolence, vivid dreams. ... 

The UK manufactuer of efavirenz advises caution, because the possibility of an increase in the incidence of ebvirenz-associated adverse events should be considered with any ritonavir-boosted regimen used with efavirenz, due to a possible interaction. This is because the combination of efavirenz with ritonavir at antiviral doses caused increased dizziness, nausea, paraesthesia and elevated transaminase levels. 

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