General Management Strategies for Efavirenz Therapy and Associated Adverse Events

Efavirenz therapy-related central nervous system symptoms oftenoccur shortly after initiation of treatment; therefore, the timing oftherapy initiation must be carefully considered so that if side effects dooccur, it is at a time when the patient is not mentally overburdenedand when support is readily available. Current literature contains contradictorydata on the relationship between plasma levels of efavirenzand the occurrence of neuropsychiatric adverse events; therefore, routinemeasurement of plasma concentrations is not recommendedexcept under certain circumstances. Clinician management of generalneuropsychiatric symptoms comprises four steps: preparation, education,reassurance and treatment. Among the specific central nervoussystem symptoms that are known to occur with efavirenz therapy areagitation, sleep disturbances, dreams, dizziness, impaired concentrationand depression. There are recommended pharmacological andnonpharmacological protocols for managing these symptoms. Prompt,successful management of treatment-emergent neuropsychiatric symptomsis important so that the patient may receive the optimal longtermviral suppression that is possible with efavirenz therapy