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Case 7: Efavirenz-Associated Central Nervous System Adverse Effects

You answered:

A When efavirenz is taken with a meal, the levels are significantly lower than when taken on an empty stomach. Thus, the patient has probably developed abnormally high plasma efavirenz levels because he is taking efavirenz on an empty stomach.

This answer is incorrect. Efavirenz plasma levels are substantially higher if taken with a meal than if taken in a fasted state. In addition, this increase in efavirenz levels occurs with both high-fat or reduced fat/normal caloric meals.

B After initiating therapy with an efavirenz-containing regimen, the development of early central nervous system adverse effects, such as dizziness, mild cognitive difficulty, fatigue, and sleep disturbances, usually improve within 4 weeks.
C Plasma efavirenz drug levels should be monitored on a monthly basis during the first 6 months of therapy.
D Patients with a history of recreational drug use should never be prescribed efavirenz because of the high likelihood of developing psychosis if they receive efavirenz.

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