A patient beginning efavirenz-based ART should be counselled about which characteristic adverse effect of this drug?
- A Vivid dreams, dizziness and other neuropsychiatric symptoms ✓
- B Painless jaundice from isolated hyperbilirubinemia
- C Injection site nodules at the administration site
- D Hemolysis in patients with G6PD deficiency
Correct answer: A. Vivid dreams, dizziness and other neuropsychiatric symptoms
Explanation
Efavirenz characteristically causes CNS effects including vivid dreams, insomnia, dizziness and depression, usually worst in the first weeks and improved by bedtime dosing. Isolated indirect hyperbilirubinemia without transaminitis is the signature of atazanavir through UGT1A1 inhibition, making option B the strongest distractor but wrong drug.
Reference: Katzung's Basic and Clinical Pharmacology, 16th ed.
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