Efavirenz
=============

**PD Dialyzability**: Unlikely

Pharmacokinetic Parameters [1]_ [2]_ [3]_
------------------------------------------

======= ======
/////// |pk|
======= ======
|pk1|   |v1|
|pk2|   |v2|
|pk3|   |v3|
|pk4|   |v4|
|pk5|   |v5|
|pk6|   |v6|
|pk7|   |v7|
======= ====== 

CAPD/CCPD Dosing: 
------------------

No large studies are available to provide dosing recommendations for efavirenz in PD patients. Two case reports suggest that efavirenz 600 mg PO daily can be used in CAPD [4]_ [5]_. Due to extensive protein binding, primarily hepatic metabolism, and minimal renal clearance of unchanged drug, it is unlikely that dosing adjustment of efavirenz is required.

Literature Summary:
---------------------------

+----------+------------+----------------+--------------+---------------------+
| Title    | Patient    | Intervention   | Outcome      | Note                |
+==========+============+================+==============+=====================+
| |L1|     | * |L2|     | * |L3|         | * |L4|       | None                |
| [4]_     |            |                |              |                     |
+----------+------------+----------------+--------------+---------------------+
| |L5|     | * |L6|     | * |L7|         | * |L8|       | * |L9|              |
| [5]_     |            |                |              |                     |
+----------+------------+----------------+--------------+---------------------+ 

References
------------

.. [1] Tseng A, Foisy M. Selected properties of efavirenz. Immunodeficiency Clinic [Internet]. 2014 Dec [cited 2018 Feb 20]. 1-7. Available from www.hivclinic.ca. 

.. [2] Wishart DS, Knox C, Guo AC, Shrivastava S, Hassanali M, Stothard P, et al. Drugbank: a comprehensive resource for in silico drug discovery and exploration. Nucleic Acids Res. 2006 Jan 1: 34(database issue):D668-672. 

.. [3] Adult Drug Book. Kidney Disease Program [Internet]. Unknown [cited 2018 Feb 20]. Available from: https://kdpnet.kdp.louisville.edu/drugbook/adult/

.. [4] Gill JM, Ostrop NJ, Fiske WD, Brennan JM. Efavirenz dosing in patients receiving continuous ambulatory peritoneal dialysis. AIDS 2000;14(8):1062. 

.. [5] Prime KP, Woolfson RG, Pakianathan MR. Experience with efavirenz in end-stage renal disease. Int J STD AIDS 2003;14(7):497-498. 

.. |pk| replace:: Efavirenz
.. |pk1| replace:: Molecular Weight (Da)  
.. |pk2| replace:: Plasma Protein Binding (%)
.. |pk3| replace:: Volume of Distribution (L/Kg) 
.. |pk4| replace:: Hepatic Metabolism 
.. |pk5| replace:: Excreted Unchanged (%) 
.. |pk6| replace:: Half-Life; Normal Renal Function (hours)
.. |pk7| replace:: Half-Life; ESRD (hours) 
.. |v1| replace:: 315.6
.. |v2| replace:: 99.75
.. |v3| replace:: 4
.. |v4| replace:: Primarily via CYP3A4 and CYP2B6
.. |v5| replace:: < 1
.. |v6| replace:: 40 - 55
.. |v7| replace:: Unknown
.. |L1| replace:: Efavirenz dosing in patients receiving continuous ambulatory peritoneal dialysis
.. |L2| replace:: 53-year-old HIV positive male on CAPD (chronic renal failure secondary to hypertension)
.. |L3| replace:: Efavirenz 600mg PO daily with indinavir 1000 mg PO q8h 
.. |L4| replace:: Efavirenz blood levels following 2 weeks of treatment were consistent with levels seen in patients without renal failure. 
.. |L5| replace:: Experience with efavirenz in end-stage renal disease
.. |L6| replace:: 40-year-old HIV positive African female on CAPD (chronic renal failure secondary to hypertension)
.. |L7| replace:: Efavirenz 600mg PO daily + zidovudine 100mg TID + lamivudine 50mg once daily
.. |L8| replace:: Over 41 weeks: Viral load (copies/mL): 34800 🡪 <50. CD4 (x10^6/L):  230 🡪 340.
.. |L9| replace:: No side effects or problems reported