Efavirenz

INTRODUCTION

Indications

HIV infection (in combination with one or more other antiretroviral agents).

Action

Inhibits HIV reverse transcriptase, which results in disruption of DNA synthesis. Therapeutic Effects: Slowed progression of HIV infection and decreased occurrence of sequelae. Increases CD4 cell counts and decreases viral load.

Adverse Reactions/Side Effects

CNS: abnormal dreams, depression, dizziness, drowsiness, fatigue, headache, impaired concentration, insomnia, nervousness, psychiatric symptomatology. GI: nausea, abdominal pain, anorexia, diarrhea, dyspepsia, flatulence. GU: hematuria, renal calculi. Derm: RASH, increased sweating, pruritus. Neuro: hypoesthesia.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor skin rash and other skin reactions (sweating, pruritus). Report severe or unexpected skin reactions to the physician immediately.

• Monitor excessive headache or fatigue. Some fatigue is expected, but any sudden or severe change in muscle strength or energy levels should be reported.

• Assess dizziness that might affect gait, balance, and other functional activities (See Appendix C). Report balance problems and functional limitations to the physician and nursing staff, and caution the patient and family/caregivers to guard against falls and trauma.

• Be alert for nervousness, depression, impaired concentration, excessive drowsiness, or other alterations in behavior or mental status. Notify health care professional promptly if these symptoms develop.

Interventions

• Implement resistive exercises and other therapeutic exercises as tolerated to maintain muscle strength and function and to prevent muscle wasting associated with HIV infection and AIDS.

Patient/Client-Related Instruction

• Emphasize the importance of taking efavirenz as directed even if the patient is asymptomatic, and that this drug must always be used in combination with other antiretroviral drugs. Do not take more than prescribed amount and do not stop taking without consulting health care professional.

• Inform patient that efavirenz does not cure HIV or AIDS or prevent associated or opportunistic infections. Efavirenz does not reduce the risk of transmission of HIV to others through sexual contact or blood contamination. Caution patient to use a condom, and to avoid sharing needles or donating blood to prevent spreading the AIDS virus to others.

• Instruct patient to report signs of kidney stones (renal calculi), including bloody urine, severe pain in the side and back, pain on urination, and a persistent urge to urinate.

• Advise patient about the likelihood of GI reactions, including nausea, vomiting, diarrhea, abdominal pain, heartburn, and loss of appetite. Instruct patient to report severe or prolonged GI reactions.

• Instruct patient to report other troublesome side effects such as prolonged or severe headache, sleep loss, abnormal dreams, or a decreased sense of touch (hypoesthesia).

Pharmacokinetics

Absorption: 50% absorbed when ingested following a ...