A Systematic Review of the Psychiatric Side-Effects of Efavirenz
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Concerns regarding the use of efavirenz in patients with a history of mental illness may predispose clinicians to not offer this agent to psychiatrically ill populations in spite of the convenience of once daily dosing, which can result in improved adherence in these at-risk populations. This systematic review examines the current data regarding the neuropsychiatric effects of efavirenz, and also attempts to provide guidance to clinicians using efavirenz to treat patients with mental illness. The review identified high rates of neuropsychiatric side effects including vivid dreams, insomnia and mood changes in approximately 50% of patients who initiate efavirenz. The effects begin quickly, commonly peak in the first 2 weeks, and are generally mild and transient in nature. Isolated case reports and uncontrolled data suggest higher rates of severe side effects; however, there is no clear evidence of a broadly increased risk of suicide or dangerous behavior for patients taking efavirenz as part of their antiretroviral regimen.
KeywordsEfavirenz Sustiva© HIV Side effects Neuropsychiatric Suicide Insomnia Nightmares Affective disorders Depression Anxiety Mania
Dr. Kenedi has received no financial or material support. Dr. Goforth has received past grant support from Forest Pharmaceuticals. Dr. Goforth has also previously served as a consultant to Eli Lilly and Bristol-Myers-Squibb Pharmaceuticals. That work was independent of this paper and no member of Bristol-Myers-Squibb has been involved with this work or is aware of the project or submission for publication.
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