Selecting a Treatment Regimen
Table 5B. Characteristics of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)
Drug
Delavirdine (DLV) Rescriptor®
Efavirenz (EFV) Sustiva®
FTC/TDF/EFV Atripla®
Formulation Dosing Recommendations
100, 200 mg tablets 400 mg tid; four 100 mg tablets can be dispersed in > 3 oz of water to produce slurry; 200 mg tablets should be taken as intact tablets ▶ Take without regard to meals ▶ ≥ 1 hr between dose and antacids
50, 200 mg capsules or 600 mg tablets
FTC 200 mg + TDF 300 mg + EFV 600 mg
600 mg once daily at or before bedtime ▶ Take on an empty stomach to reduce side effects
1 tablet once daily at or before bedtime
Etravirine (ETR) Intelence®
100 mg tablets 200 mg tablets
200 mg bid ▶ Take following a meal
Nevirapine (NVP) Viramune® Viramune XR®
200 mg tablets or 50 mg/5 mL oral suspension 400 mg extended release tablets
200 mg once daily for 14 days (lead-in period); thereafter, 200 mg bid OR 400 mg extended release daily ▶ Take without regard to meals ▶ Repeat lead-in period if therapy is discontinued for > 7 days
▶ In patients who develop mild to moderate rash without constitutional symptoms, continue lead-in period until rash resolves but no longer than 28 days total.
Rilpivirine (RPV) Edurant™
FTC/TDF/RPV Complera™
25 mg tablets
FTC 200 mg + TDF 300 mg + RPV 25 mg
25 mg once daily with a meal One tablet once daily with meal
a
b
During clinical trials, NNRTI was discontinued because of rash among 7% of NVP-treated, 4.3% of DLV-treated, 1.7% of EFV-treated, and 2% of ETR-treated patients. Rare cases of Stevens-Johnson syndrome have been reported with all NNRTIs; the highest incidence was seen with NVP.
Adverse events can include dizziness, somnolence, insomnia, abnormal dreams, confusion, abnormal thinking, impaired concentration, amnesia, agitation, depersonalization, hallucinations, and euphoria. Overall frequency of any of these symptoms associated with use of efavirenz was 52% compared with 26% among controls subjects; 2.6% of those persons on EFV discontinued the drug because of these symptoms. Symptoms usually subside spontaneously after 2-4 weeks.
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