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potential should use two methods of birth control to avoid becoming pregnant when taking this drug.

Efavirenz interacts with many drugs via the cytochrome P450 pathways. It induces and is metabolized by CYP3A4 and inhibits CYP2C9 and CYP2C19. It should not be given with cisapride, ergot alkaloids, midazolam, or triazolam because of the potential for life-threatening reactions. Efavirenz has the potential to decrease blood levels of methadone, rifabutin, keto-conazole, and itraconazole. It may inhibit the metabolism of drugs such as alosetron, diazepam, ethinyl es-tradiol, imipramine, losartan, omeprazole, warfarin, tolbutamide, and topiramate. Efavirenz interacts with cytochrome P450 inducers and substrates (e.g., phenyt-oin, phenobarbital) in a complex manner; blood levels and side effects should be closely monitored. Patients taking efavirenz should avoid herbal preparations containing St. John's wort because the herb induces CYP3A4 and may cause drug failure or viral resistance. Saquinavir should not be used as the sole protease inhibitor in a regimen containing efavirenz.

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