Talk:Efavirenz

Wiki Education Foundation-supported course assignment

This article is or was the subject of a Wiki Education Foundation-supported course assignment. Further details are available on the course page. Student editor(s): Stephwong, Mqawam, Dtran48, J1lee. Peer reviewers: DavidSzeto, Wzhao0, Lindur, Nicolenahigian.

Above undated message substituted from Template:Dashboard.wikiedu.org assignment by PrimeBOT (talk) 20:15, 16 January 2022 (UTC)

Violence/aggression

I've dialed back a little on the language on violence/aggression as an adverse effect of efavirenz based on the following considerations.

• The package insert shows an incidence of aggressive behavior that was actually greater in the placebo arm (0.5%) than in the treatment arm (0.4%).
• As a component of Atripla and other HIV regimens, the drug is prescribed over 2 million times a year in the U.S. alone, and has been on the market for well over a decade. So any effects of this type should be readily apparent. Nonetheless, the only primary research suggesting a connection (and presumably the basis of the Prescrire review's comments, which I cannot see due to the paywall), seems to be 25 case reports in France out of some millions of patients treated.
• Treatment guidelines do not mention this AE.
• A pubmed search on "efavirenz & aggression" turns up no hits other than the Prescrire article and the single case report article. Prescrire has an impact factor of close to zero. It lacks a traditional peer review process.

Formerly 98 (talk) 14:24, 10 January 2015 (UTC)

UCSF Wikipedia Pharmacologic Project

Our group split up the different areas already on the content page and decided to comb through the material and update any important information that is missing.

1) Introduction paragraph = Diana - Approach to improvements = take out a few redundancies on the page and fulfill the criteria outlined in our lab

2) Medical uses = Jessica - Approach to improvements = take out single trials and refer to tertiary sources (Lexicomp, Micromedex) to identify points that need to be added

3) Adverse effects = Stephanie - Approach to improvements = Use of lexicomp/micromedex to compare the side effects currently listed vs. ones that should be added to the wiki page.

4) Drug interactions = Diana - Approach to improvements = Lexicomp/Micromedex/Other Han Code Certified Databases to see what drug interactions are significant

5) Mechanism of action = Masih - Anti-HIV effects / Neuropsychiatric effects

Stephwong (talk) 15:38, 4 November 2016 (UTC)

Please be aware that the "introduction paragraph" - what we call the WP:LEAD, only summarizes information that is in the body (and sourced there). Please update the LEAD last; WP:WEIGHT in the lead follows WEIGHT given in the body.

As described in WP:MEDRS, we prefer secondary sources - recent literature reviews published in good journals, or statements by major medical/scientific bodies. Tertiary sources are OK but not preferred. At the top of this Talk page, you will find a box that provides a link to a pre-formatted search at Pubmed. Great starting point for finding MEDRS sources.

Thanks! Jytdog (talk) 19:18, 4 November 2016 (UTC)

brand names

the below is mostly spam. will restore this later with independent sources

Brand names

• Sustiva (USA, Bristol-Myers Squibb)
• Stocrin (EU, MSD)
• Aspen Efavirenz (Sub-Saharan Africa, Aspen Pharmacare)

Generic brands India:

• E.F (McNeil & Argus)
• Efavir (Cipla)
• Efcure (Emcure Pharmaceuticals)
• Efferven (Ranbaxy Laboratories)
• Estiva (Hetero)
• Evirenz (Alkem Laboratories)
• Regast (Pharmasyntez)
• Viranz (Aurobindo Pharma)

References

-- Jytdog (talk) 21:44, 9 November 2016 (UTC)

UCSF CP 133 Peer Review - Group 11

STUDENT 1 (David Szeto) - Does the draft submission reflect a neutral point of view? If not, specify...

• While reading the article for a "neutral point of view", I am actively reflecting on both the material in class and comparing to the example drug article, Cefalexin. I am also only evaluating the neutral point of view, and nothing else.
• Overall, nothing much to add! I just have to small comments below. Everything else sounds super neutral and objective and balanced.
• "As of 2010 it appeared that efavirenz was safe to use during the first trimester of pregnancy." - I think this sentence is written in a way that suggests interpretation, therefore non-neutral. Maybe it can be worded as "As of 2010, efavirenz was shown to be X during the first trimester of pregnancy" where "X" is whatever the source said.
• The mentions of cost seem non-neutral since they are different in the beginning and end (Pricing information). I think pricing itself is subjective and non-neutral, though I know Wikipedia people seem to disagree. However, the price for efavirenz is definitely not $200 a month or $550 a month right now. I suggest just removing cost. :) Though Wikipedia authors might add it back in and standardize it. Okay now I'm rambling...

[adding signature late even though I made the edits yesterday]DavidSzeto (talk) 02:51, 14 November 2016 (UTC)

STUDENT 2 (Nicole Nahigian) - Are the points included verifiable with cited secondary sources that are freely accessible? If not, specify...

• All points had attached references.
• All references are freely accessible, current and peer reviewed/ public/ news reports from reputable sources
• Most scholarly articles included the original source and a pub med ID number, so that the user could access both.

Very well done, indeed.

STUDENT 3 (Linda Lee) - Are the edits formatted consistent with Wikipedia’s manual of style for medicine-related articles? If not, specify...

• Tone is generally good. There aren’t any glaring issues with the language and format, although the MOA section does get a bit convoluted, especially in the “Neuropsychiatric effects” section with all the technical terms and numbers.

SUGGESTIONS FOR EDITS:

• Separate out the information on pregnancy under a subcategory “Pregnancy and Breastfeeding,” and include any information on breastfeeding while taking this medication.
• Consider separating out the drug interactions section out of the MOA section and including some notable interactions.
• Adverse events section - although bulleted form is easier to read, perhaps converting to paragraph form and elaborating a little more might be worth considering? Furthermore, is the false positive point considered an ADE? — Preceding unsigned comment added by Lindur (talk • contribs) 20:18, 15 November 2016 (UTC)
• Grammatical/diction issues throughout the article need to be addressed. To list a few:

1. Under “Adverse Effects,” there needs to be a correction in the line “An evaluation of the patient’s risk… since OTc prolongation can occur.” Should be “QTc.”
2. “Convulsions should be taking(TAKEN) into concern in adult and pediatric populations who have a history of seizures.[8]”
3. “A one-month supply of 600 mg tablets cost(S) approximately $550 in April 2008.”
4. “In Thailand, one month supply of efavirenz + truvada, as of June 2012, costs THB 2900 ($90), there's also a social program for poorer patients(WORD CHOICE) who can’t(CAN NOT) afford even this price(MAY WANT TO REPHRASE TO BE MORE NEUTRAL).”

— Preceding unsigned comment added by DavidSzeto (talk • contribs) 05:31, 15 November 2016 (UTC)

Certainty of safety in pregnancy

User:Stephwong please explain how this reflects the source provided. Jytdog (talk) 23:53, 16 November 2016 (UTC)

I updated the source and content; the 2014 review is much more definitive than the 2010 ref. Jytdog (talk) 00:19, 17 November 2016 (UTC)

Stub Start assessment

For further development and upgrade in assessment, this article requires expansion. –Vami_IV✠ 05:13, 3 February 2017 (UTC)

User:Vami_IV. This is not a stub; it covers all the sections in MEDMOS. What exactly do you think needs expansion? Jytdog (talk) 05:35, 3 February 2017 (UTC)

User:Jytdog I profess, I am not at all knowledgeable on what a medicine's article should look like, but I feel like some history and de-listifying the article in places would go a long ways toward helping it develop. –Vami_IV✠ 14:09, 3 February 2017 (UTC)

EDIT: Oops, I named this section "stub assessment." It appears that while riding the high of last night's stream of edits, I have blundered. I have rectified this now. Sorry! –Vami_IV✠ 14:09, 3 February 2017 (UTC)

Suicide and birth defects

I personally know several people who have taken Sustiva and discontinued it due to severe side effects. I notice these side effects are downplayed somewhat in the Adverse Effects, which reads like printed material drug companies and pharmacies include with prescriptions. Perhaps this section should be written with a more neutral POV and not by a drug rep due to conflict of interest. Also, in section where it says Efavirenz is safe to take during first trimester of pregnancy, nowhere are *dire* consequences of continuing to take the drug throughout pregnancy mentioned: before human "Phase III" trials, drug was tested on chimpanzees, three of which gave birth to babies born with brains located *outside* their skulls. See, this is why we do not allow drug companies to write copy here: their massive conflicts of interest preclude them from furnishing vital info. Can you imagine a pregnant woman starting Efavirenz and neglecting to see her HIV and ob/gyn doctors until giving birth? It's not uncommon for rural and urban patients to forgo regular doctor visits, so this is not a far-fetched scenario. At the very least readers should know about this and other very good reasons to avoid Efavirenz in some cases. Same problem with downplaying suicides as only hypothetical: due to CNS side effects, several people completed suicide while on drug. I hate doing research, but in this case I'll make an exception. Comments, advice, help all welcome. Please help improve this entry (and possibly prevent hideous birth defects. Life is already freaky enough!)

Kinkyturnip (talk) 08:20, 30 April 2018 (UTC)

A substrate is not necessarily an inhibitor

Under drug interactions there was this:

"Efavirenz is broken down in the liver by enzymes that belong to the cytochrome P450 system, which include both CYP2B6 and CYP3A4. Efavirenz is a substrate of these enzymes and can decrease the metabolism of other drugs that require the same enzymes. However, efavirenz also induces these enzymes, which means the enzyme activity is enhanced and the metabolism of other drugs broken down by CYP2B6 and CYP3A4 can be increased. People who are taking both Efavirenz and other drugs metabolized by the same enzymes might need the dose of their drugs to be increased or decreased."

This makes no sense, and it sounds like the person citing the study didn't know much about this topic, so we might want to look at the whole article. A substrate is not automatically an inhibitor. Otherwise our liver would cease to function over night. A drug cannot be an inducer and inhibitor at the same time for the same enzyme, that makes no sense. I edited this to properly reflect what the study said.

Wiki Education assignment: PHMD 2040 Service - Learning Spring 2023

This article was the subject of a Wiki Education Foundation-supported course assignment, between 2 January 2023 and 30 June 2023. Further details are available on the course page. Student editor(s): Monoclonalantibodies (article contribs).

— Assignment last updated by JustinxLane (talk) 19:04, 2 June 2023 (UTC)

Change to sentence structure of Contraindications paragraph to aid information flow --Monoclonalantibodies (talk) 04:46, 12 April 2023 (UTC)

Updated information in the pregnancy and breastfeeding section based on currently available pregnancy and lactation recommendations from guidelines and pharmaceutical resources. --Monoclonalantibodies (talk) 14:16, 13 April 2023 (UTC)

Updated the introductory paragraph to match the pregnancy and lactation paragraph below - previously the two sub sections contradicted each other. Monoclonalantibodies (talk) 14:30, 13 April 2023 (UTC)

Alternation of grammar in adverse effects sub section Monoclonalantibodies (talk) 15:38, 13 April 2023 (UTC)