Efavirenz teratogenicity

Women of reproductive potential prescribed efavirenz should be counseled on its potentially teratogenic effects and the importance of birth control. Additionally, nevirapine, nelfinavir, ritonavir, lopinavir/ritonavir, and tipranavir/ritonavir have been shown to decrease the concentrations of estrogens and/or progestins in oral contraceptives, which could lead to failure.2 For patients prescribed these drugs, barrier forms of contraception are preferred to prevent pregnancy. DepoProvera may be... 

Efavirenz should be avoided during pregnancy because primate studies have shown it to be teratogenic at doses near therapeutic levels. Women of childbearing... 

Efavirenz NNRTI 600 mg daily Take on empty stomach. Bedtime dosing recommended initially to minimize central nervous system side effects Central nervous system effects, rash, t liver enzymes, headache, nausea See footnote 4 for contraindicated medications. Teratogenic In primates... 

The most common adverse effects associated with nelfinavir are diarrhea and flatulence. Diarrhea often responds to antidiarrheal medications but can be dose-limiting. Nelfinavir is an inhibitor of the CYP3A system, and multiple drug interactions may occur (Tables 49-3 and 49-4). An increased dosage of nelfinavir is recommended when co-administered with rifabutin (with a decreased dose of rifabutin), whereas a decrease in saquinavir dose is suggested with concurrent nelfinavir. Co-administration with efavirenz should be avoided due to decreased indinavir levels. Nelfinavir has a favorable safety and pharmacokinetic profile for pregnant women compared with that of other Pis (Table 49-5) there is no evidence of human teratogenicity. 

Therapy during pregnancy is warranted, particularly in light of the dramatic reduction in transmission seen with zidovudine monotherapy. In general, pregnant women should be treated similar to nonpregnant adults if possible, zidovudine should be used for both mother and infant. Efavirenz should not be used, particularly in the first trimester, because of the risk of teratogenicity. 

Shanske AL. Bilateral obEque facial clefts and extremity anomaly in an infant after intrauterine efavirenz exposure and review of its teratogenic risk. AIDS 2012 26(14) 1775-9. 

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