Hyperhidrosis in association with efavirenz.
Hyperhidrosis may be an adverse drug event (ADE) induced by the effect on any of the components of human thermoregulation. Some of our efavirenz (EFV)-treated patients have reported excessive nocturnal sweating that resolved after dose reduction. A representative clinical case of a male patient being treated with a night-time 600-mg dose of EFV who reported severe nocturnal sweating is reported here. His EFV plasma concentrations were always above normal and he was homozygous for a deficient function-allele of CYP2D6; for this reason, his EFV dose was reduced to 400mg=d. Simultaneous with this reduction, the patient described a progressive decrease in nocturnal sweating until its complete disappearance 15-20 days after this new drug dosage. The mechanism explaining sweating could be similar to the one suggested for hyperhidrosis related to serotonin uptake inhibitors, because this hyperhidrosis is episodic, nocturnal, and dose dependent. Hyperhidrosis could correspond to a dose-dependent ADE induced by EFV, therefore, a reduction of EFV from 600 to 400mg/d seems to control it. EFV crosses the hematoencephalic barrier and reaches a mean concentration in the cerebroespinal fluid equivalent to 0.69% of the plasma concentration. The ability of EFV to accessing the central nervous system (CNS) could explain an effect on thermoregulation. Hyperhydrosis is not easily discovered through a routine anamnesis because it is not noted on the EFV package insert, so its incidence may be higher than expected. Additionally, hyperhidrosis may be an indicator of elevated EFV plasma concentrations and hence may be controlled through a reduction of dose.
Fuertes
Aurelio
A
Infectious Disease Service, University Hospital of Salamanca, Salamanca, Spain.
Martín
Aurelio Fuertes
AF
Cabrera
Salvador
S
Figueroa
Salvador Cabrera
SC
Valverde
Maria de la Paz
MP
Merino
María de la Paz Valverde
Mde L
Domínguez-Gil
Alfonso
A
Hurléé
Alfonso Domínguez-Gil
AD
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D048588:Benzoxazines / Q000008:administration & dosage / Q000009:adverse effects*; D003521:Cyclopropanes; D004305:Dose-Response Relationship, Drug; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects; D006801:Humans; D006945:Hyperhidrosis / Q000139:chemically induced*; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage / Q000009:adverse effects*; D016896:Treatment Outcome
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; C098320:efavirenz