|Efavirenz and long-term antidepressant use
Feb 27, 2013
I have a question to ask you. I began taking ARVs, specically Efavirenz (600mg)/Truvada almost 3 months ago. My VL is now suppressed and CD4 is about 380 at 20%. I am able to manage the side effect of Efa after about 2 months but insomnia continues to be a problem. My doctor prescribed me Lorazepam (0.5mg) and they definitely help me sleep better. I fall asleep faster and stay asleep longer. However, I fear the side effect of long term Lorazepam so I am trying to cut down or discontinue the use. However, the insomnia returns. Please note that I have had sleep trouble for years even before I was infected 3 yrs ago but now the problem seems to precipitate a lot more now that I am on Efavirenz. I only have an occasional bad dreams but with bad sleep habits it really does take a toll on me. So the question is whether it is safe to continue using Lorazepam while on EFV until I am able to manage sleep on my own (not sure when this will happen though). My kidney and liver tests are good as of a month ago. Thank you.
| Response from Dr. Henry
It is preferable to not rely on prescribed sleep meds if possible (including lorazepam which belongs to the benzodiazepam class of drugs known to cause dependence/addiction along with less of a sleep benefit -defined as good REM sleep-over time). If the efavirenz is a significant factor for a sleep disorder then it is often preferable to try an alternative HIV medication rather than adding another drug. A full sleep assessment by a sleep specialist is often very useful in my experience. KH
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