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This medication requires careful consideration due to its potential risks and necessary precautions. It is crucial to follow the guidance below to ensure safe use and to recognize when to seek medical attention.

• Hepatitis B and HIV Co-infection: If you have both hepatitis B and HIV, do not stop taking this medication without consulting your doctor, as it may worsen your hepatitis B symptoms. Your healthcare provider will monitor your liver function for several months post-treatment. Report any signs of liver issues to your doctor immediately.

• Lactic Acidosis and Liver Damage: This drug contains lamivudine, which can rarely cause severe acid build-up in the blood and liver damage. Symptoms include loss of appetite, abdominal pain, muscle pain, rapid shallow breathing, extreme fatigue, and sudden weakness. Discontinue use and seek emergency medical care if these symptoms occur. Higher risk for females and those with obesity.

• Kidney Concerns: Tenofovir in this medication can cause or exacerbate kidney problems. Avoid using other kidney-harming drugs like high-dose NSAIDs. Regular kidney function tests may be necessary. Notify your doctor if you experience bone pain, leg or foot pain, fractures, muscle pain, or weakness.

• Mental Health Effects: Efavirenz can increase the risk of mood disturbances, including depression and suicidal thoughts. Monitor mood changes and inform your healthcare provider promptly. Consider involving trusted family or friends to observe changes. Immediate medical attention is needed if self-harm or harm to others is contemplated.

• Central Nervous System Effects: Initial use of efavirenz may cause dizziness, sleep issues, concentration difficulties, drowsiness, and unusual dreams. These typically improve over time. Consult your doctor if these effects persist or interfere with medication adherence. Caution is advised when consuming alcohol or other CNS-affecting substances.

• Rash: Efavirenz may cause a rash, usually mild and resolving within a month. Rarely, severe skin reactions including fever and blistering occur, necessitating immediate discontinuation and medical evaluation.

• Liver Toxicity: The medication can cause serious liver damage, especially in those with existing liver issues or infections. Routine liver function tests may be advised. Report symptoms like fatigue, nausea, vomiting, dark urine, pale stool, abdominal pain, and jaundice immediately.

• Pancreatitis Risk: There is a risk of pancreatitis, particularly in children with prior NRTI use or pancreatitis history. Discontinue use and seek urgent medical care if severe abdominal pain radiating to the back, nausea, vomiting, rapid heart rate, or fever occur.

• Immune Reconstitution Syndrome: As the immune system recovers, it may cause inflammation due to increased activity against infections. Pre-treatment infection screening may be necessary. Report fever, breathing difficulties, or sudden health changes to your provider.

• Contraindication: Do not use alongside elbasvir/grazoprevir (Zepatier) due to potential health risks.

Always consult your healthcare provider if you have questions or concerns about using this medication.

When taking this medication, some common side effects may occur, including dizziness, trouble sleeping, drowsiness, unusual dreams, and trouble concentrating. These effects often appear within the first couple of days but tend to improve over a few weeks. Taking the medication at bedtime might help alleviate these mild symptoms. Additionally, tiredness, headache, and diarrhea are also reported. If these persist or worsen, it's important to consult your healthcare provider.

Occasionally, more serious side effects can develop, such as mental or mood changes like depression or anxiety, feelings of confusion, or hallucinations. Signs of potential kidney issues such as changes in urination, or symptoms of lactic acidosis like unusual tiredness or muscle pain, may also occur. Liver problems may be indicated by persistent nausea, loss of appetite, or yellowing of the skin or eyes, while pancreatitis might present as severe stomach or back pain with nausea or vomiting.

Rarely, individuals may experience significant side effects requiring immediate medical attention, including severe dizziness, fainting, or seizures. Allergic reactions, although uncommon, can be serious, with symptoms such as rash, swelling, or trouble breathing. A rash is a common side effect, but in certain cases, it may signify a severe reaction, so any rash should be evaluated by your doctor promptly.

There are also concerns about bone health, as Tenofovir may increase the risk of bone loss. Discuss with your doctor the potential need for calcium and vitamin D supplements if you are at risk. Lastly, changes in body fat distribution could occur, and it is advisable to talk about these possible changes with your healthcare provider. Always reach out to your doctor if you notice any side effects not listed here.

This medication can interact with certain other drugs and products, affecting how it works or how they work. Here are some important points to consider:

1. Kidney-Affecting Drugs: Avoid using this medication with drugs that may impact kidney function, such as orlistat, sorbitol, adefovir, cidofovir, and aminoglycosides like amikacin and gentamicin.

2. HIV Treatments: Do not take this medication with other HIV treatments or products containing efavirenz, lamivudine, or tenofovir, as they can interfere with its effectiveness.

3. Drug Removal from Body: Some medications, like St. John's wort and certain seizure drugs (e.g., carbamazepine), can alter how efavirenz, lamivudine, and tenofovir are processed in your body.

4. Impact on Other Medications: This medication may speed up the removal of certain drugs, potentially reducing their effectiveness. Affected drugs include atazanavir, atovaquone/proguanil, several azole antifungals (e.g., voriconazole), bedaquiline, cabotegravir, cobicistat, elbasvir/grazoprevir, elvitegravir, macrolide antibiotics (like clarithromycin), rilpivirine, and sofosbuvir/velpatasvir.

5. Hormonal Birth Control: The effectiveness of hormonal contraceptives (such as pills, patches, or rings) may be decreased, leading to an increased risk of pregnancy. Consult your doctor about using an additional reliable birth control method and report any unusual bleeding.

6. Drowsiness-Inducing Products: Be cautious with products that cause drowsiness, including alcohol, marijuana, antihistamines (e.g., cetirizine, diphenhydramine), sleep or anxiety medications (e.g., diazepam, zolpidem), muscle relaxants, and opioid pain relievers (e.g., codeine). Check with your pharmacist to ensure safe use.

7. Lab Test Interference: This medication can affect certain lab tests, such as urine cannabinoid tests, possibly leading to false results. Inform your doctors and lab personnel that you are using this medication.

Always discuss with your healthcare provider before starting or stopping any medication while using this drug.