Atripla should not be in patients with creatinine clearance less than 50 min min.Serious psychiatric adverse experiences, including severe depression , suicidal ideation , nonfatal suicide attempts , aggressive behavior , paranoid reactions and manic reactions were in patients with efavirenz, a component of Atripla treated, reported. In addition to efavirenz, additional factors in a clinical study that identifies with an increase in psychiatric symptoms have a history of injection drug use, psychiatric history and use of psychotropic drugs. There were occasional reports of death by suicide, delusions, and psychosis-like behavior, but it could not be determined if efavirenz was the cause. Patients with serious psychiatric adverse experiences should be evaluated immediately to determine whether the risks of continued therapy outweigh the benefits.
These symptoms usually begin during the first or second day of treatment and generally resolve after the first two to four weeks of therapy. After four weeks of therapy treats the prevalence of of central nervous system symptoms of at least moderate severity was 5-9 % in patients receiving efavirenz. Nervous system symptoms are not predictive of the less frequent psychiatric symptoms.. Fifty – three % of patients in clinical studies of central nervous system symptoms including dizziness , insomnia , impaired concentration , somnolence , reported abnormal dreams and hallucinations when taking efavirenz compared to 25 % of patients in the control group.The report makes a number of recommendations to governments, regulatory agencies, Education Sites, professional associations and International Organisations, means could help these problems and strengthen the state of the midwives in its 58 countries studied. .