Question
Will my side effects from efavirenz subside soon?
11 March 2008. Related: All topics, Side effects.
Hi,
I’m in my fifth week on Atripla (efavirenz + tenofovir + FTC) after starting with CD4 at 135, and viral load at about 11,000.
My problem is that I am still suffering from drowsiness, severe dizziness and poor concentration during the day. When I take my pill at night, I need to lie down within 30 minutes or I start feeling ‘high’ and a little nauseous. On the whole, the side-effects are really annoying.
Can I expect them to decrease anytime soon. Or should I talk to my doctor about changing meds?
If so, what would be a good alternative? Thanks in advance for your help!
Answer
Although less than 5% of people stopped efavirenz because they could not tolerate the side effects, in the first studies, ‘real’ life reports suggest that up to 20% of people may switch in the first year because of these difficulties.
For most people, side effects subside and peter out within a few weeks or the first month or two. Sometimes, however, they can last for much longer, or never improve, in which case switching is easy. Unfortunately, in some people the side effects are so severe, that they experience difficulties that mean they switch within the first week or two, because of the effect this has on their daily life.
Some people find helpful taking haloperidol to reduce anxiety while on efavirenz and also metoclopramide to treat nausea and vomiting. In addition, avoiding fatty food is important, as high fat can increase the levles of efavirenz by up to 60% and hence the side effects are stronger.
Whether and when to change your medication is something that you need to decide. If your quality of life is affected and the side effects are not improving, then you’ll need to talk to your doctor for a possible switch.
If you decide to switch, then the new compound will depend on your treatment history and whether you have any resistance to any of the medications, what your current CD4 count is and several other factors.
Possible options are atazanavir/r, Kaletra, nevirapine and others.
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