U.S. Department of Health & Human Services Divider Arrow National Institutes of Health Divider Arrow NCATS

Details

Stereochemistry ABSOLUTE
Molecular Formula C14H9ClF3NO2
Molecular Weight 315.675
Optical Activity ( - )
Defined Stereocenters 1 / 1
E/Z Centers 0
Charge 0

SHOW SMILES / InChI
Structure of EFAVIRENZ

SMILES

FC(F)(F)[C@]1(OC(=O)NC2=C1C=C(Cl)C=C2)C#CC3CC3

InChI

InChIKey=XPOQHMRABVBWPR-ZDUSSCGKSA-N
InChI=1S/C14H9ClF3NO2/c15-9-3-4-11-10(7-9)13(14(16,17)18,21-12(20)19-11)6-5-8-1-2-8/h3-4,7-8H,1-2H2,(H,19,20)/t13-/m0/s1

HIDE SMILES / InChI

Description
Curator's Comment: Description was created based on several sources, including

Efavirenz (brand names Sustiva® and Stocrin®) is a non-nucleoside reverse transcriptase inhibitor (NNRTI) and is used as part of highly active antiretroviral therapy (HAART) for the treatment of a human immunodeficiency virus (HIV) type 1. For HIV infection that has not previously been treated, efavirenz and lamivudine in combination with zidovudine or tenofovir is the preferred NNRTI-based regimen. Efavirenz is also used in combination with other antiretroviral agents as part of an expanded postexposure prophylaxis regimen to prevent HIV transmission for those exposed to materials associated with a high risk for HIV transmission.

Originator

Curator's Comment: # Merck & Co

Approval Year

Targets

Targets

Primary TargetPharmacologyConditionPotency
4.0 nM [EC50]
26.1 µM [IC50]
52.0 µM [IC50]
20.0 nM [EC50]
Conditions

Conditions

ConditionModalityTargetsHighest PhaseProduct
Primary
SUSTIVA

Approved Use

SUSTIVA is a non-nucleoside reverse transcriptase inhibitor indicated in combination with other antiretroviral agents for the treatment of human immunodeficiency virus type 1 infection.

Launch Date

1998
Cmax

Cmax

ValueDoseCo-administeredAnalytePopulation
12.9 μM
600 mg 1 times / day steady-state, oral
dose: 600 mg
route of administration: Oral
experiment type: STEADY-STATE
co-administered:
EFAVIRENZ plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
7.04 μg/mL
300 mg 1 times / day steady-state, oral
dose: 300 mg
route of administration: Oral
experiment type: STEADY-STATE
co-administered:
EFAVIRENZ plasma
Homo sapiens
population: UNHEALTHY
age: CHILD
sex: UNKNOWN
food status: UNKNOWN
AUC

AUC

ValueDoseCo-administeredAnalytePopulation
184 μM × h
600 mg 1 times / day steady-state, oral
dose: 600 mg
route of administration: Oral
experiment type: STEADY-STATE
co-administered:
EFAVIRENZ plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
257.56 μM × h
300 mg 1 times / day steady-state, oral
dose: 300 mg
route of administration: Oral
experiment type: STEADY-STATE
co-administered:
EFAVIRENZ plasma
Homo sapiens
population: UNHEALTHY
age: CHILD
sex: UNKNOWN
food status: UNKNOWN
T1/2

T1/2

ValueDoseCo-administeredAnalytePopulation
40 h
600 mg 1 times / day steady-state, oral
dose: 600 mg
route of administration: Oral
experiment type: STEADY-STATE
co-administered:
EFAVIRENZ plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
Funbound

Funbound

ValueDoseCo-administeredAnalytePopulation
0.5%
600 mg 1 times / day steady-state, oral
dose: 600 mg
route of administration: Oral
experiment type: STEADY-STATE
co-administered:
EFAVIRENZ plasma
Homo sapiens
population: UNHEALTHY
age: ADULT
sex: UNKNOWN
food status: UNKNOWN
Doses

Doses

DosePopulationAdverse events​
3 g single, oral
Overdose
Dose: 3 g
Route: oral
Route: single
Dose: 3 g
Sources:
unhealthy, 12 years
n = 1
Health Status: unhealthy
Condition: HIV infection
Age Group: 12 years
Sex: M
Population Size: 1
Sources:
600 mg 1 times / day multiple, oral
Recommended
Dose: 600 mg, 1 times / day
Route: oral
Route: multiple
Dose: 600 mg, 1 times / day
Co-administed with::
abacavir(300 mg q12h)
nelfinavir(1250 mg q12h)
Sources:
unhealthy, 33 years
n = 1
Health Status: unhealthy
Condition: HIV infection
Age Group: 33 years
Sex: F
Population Size: 1
Sources:
Disc. AE: Mania...
AEs leading to
discontinuation/dose reduction:
Mania (1 patient)
Sources:
25 mg/kg 1 times / day steady, oral
Highest studied dose
Dose: 25 mg/kg, 1 times / day
Route: oral
Route: steady
Dose: 25 mg/kg, 1 times / day
Sources:
unhealthy, 33.9 months (range: 29.2–40.2 months)
n = 52
Health Status: unhealthy
Condition: HIV infection
Age Group: 33.9 months (range: 29.2–40.2 months)
Sex: M+F
Population Size: 52
Sources:
800 mg 1 times / day steady, oral
Highest studied dose
Dose: 800 mg, 1 times / day
Route: oral
Route: steady
Dose: 800 mg, 1 times / day
Sources:
unhealthy, 37.3 years
n = 67
Health Status: unhealthy
Condition: tuberculosis
Age Group: 37.3 years
Sex: M+F
Population Size: 67
Sources:
Disc. AE: Hallucination, Dizziness...
AEs leading to
discontinuation/dose reduction:
Hallucination (1 patient)
Dizziness (1 patient)
Insomnia (1 patient)
Hepatotoxicity (1 patient)
Skin rash (1 patient)
Pruritus (1 patient)
Rash (1 patient)
Sources:
AEs

AEs

AESignificanceDosePopulation
Mania 1 patient
Disc. AE
600 mg 1 times / day multiple, oral
Recommended
Dose: 600 mg, 1 times / day
Route: oral
Route: multiple
Dose: 600 mg, 1 times / day
Co-administed with::
abacavir(300 mg q12h)
nelfinavir(1250 mg q12h)
Sources:
unhealthy, 33 years
n = 1
Health Status: unhealthy
Condition: HIV infection
Age Group: 33 years
Sex: F
Population Size: 1
Sources:
Dizziness 1 patient
Disc. AE
800 mg 1 times / day steady, oral
Highest studied dose
Dose: 800 mg, 1 times / day
Route: oral
Route: steady
Dose: 800 mg, 1 times / day
Sources:
unhealthy, 37.3 years
n = 67
Health Status: unhealthy
Condition: tuberculosis
Age Group: 37.3 years
Sex: M+F
Population Size: 67
Sources:
Hallucination 1 patient
Disc. AE
800 mg 1 times / day steady, oral
Highest studied dose
Dose: 800 mg, 1 times / day
Route: oral
Route: steady
Dose: 800 mg, 1 times / day
Sources:
unhealthy, 37.3 years
n = 67
Health Status: unhealthy
Condition: tuberculosis
Age Group: 37.3 years
Sex: M+F
Population Size: 67
Sources:
Hepatotoxicity 1 patient
Disc. AE
800 mg 1 times / day steady, oral
Highest studied dose
Dose: 800 mg, 1 times / day
Route: oral
Route: steady
Dose: 800 mg, 1 times / day
Sources:
unhealthy, 37.3 years
n = 67
Health Status: unhealthy
Condition: tuberculosis
Age Group: 37.3 years
Sex: M+F
Population Size: 67
Sources:
Insomnia 1 patient
Disc. AE
800 mg 1 times / day steady, oral
Highest studied dose
Dose: 800 mg, 1 times / day
Route: oral
Route: steady
Dose: 800 mg, 1 times / day
Sources:
unhealthy, 37.3 years
n = 67
Health Status: unhealthy
Condition: tuberculosis
Age Group: 37.3 years
Sex: M+F
Population Size: 67
Sources:
Pruritus 1 patient
Disc. AE
800 mg 1 times / day steady, oral
Highest studied dose
Dose: 800 mg, 1 times / day
Route: oral
Route: steady
Dose: 800 mg, 1 times / day
Sources:
unhealthy, 37.3 years
n = 67
Health Status: unhealthy
Condition: tuberculosis
Age Group: 37.3 years
Sex: M+F
Population Size: 67
Sources:
Rash 1 patient
Disc. AE
800 mg 1 times / day steady, oral
Highest studied dose
Dose: 800 mg, 1 times / day
Route: oral
Route: steady
Dose: 800 mg, 1 times / day
Sources:
unhealthy, 37.3 years
n = 67
Health Status: unhealthy
Condition: tuberculosis
Age Group: 37.3 years
Sex: M+F
Population Size: 67
Sources:
Skin rash 1 patient
Disc. AE
800 mg 1 times / day steady, oral
Highest studied dose
Dose: 800 mg, 1 times / day
Route: oral
Route: steady
Dose: 800 mg, 1 times / day
Sources:
unhealthy, 37.3 years
n = 67
Health Status: unhealthy
Condition: tuberculosis
Age Group: 37.3 years
Sex: M+F
Population Size: 67
Sources:
PubMed

PubMed

TitleDatePubMed
A novel genotype encoding a single amino acid insertion and five other substitutions between residues 64 and 74 of the HIV-1 reverse transcriptase confers high-level cross-resistance to nucleoside reverse transcriptase inhibitors. Abacavir CNA2007 International Study Group.
1999 Oct 1
Prevalence and characteristics of multinucleoside-resistant human immunodeficiency virus type 1 among European patients receiving combinations of nucleoside analogues.
2000 Aug
Novel 2,2-dioxide-4,4-disubstituted-1,3-H-2,1,3-benzothiadiazines as non-nucleoside reverse transcriptase inhibitors.
2000 Jan 17
Non-nucleoside HIV-1 reverse transcriptase inhibitors: synthesis and biological evaluation of novel quinoxalinylethylpyridylthioureas as potent antiviral agents.
2000 Mar
Mutational analysis of trp-229 of human immunodeficiency virus type 1 reverse transcriptase (RT) identifies this amino acid residue as a prime target for the rational design of new non-nucleoside RT inhibitors.
2000 May
In vitro inhibition of HIV-1 by Met-SDF-1beta alone or in combination with antiretroviral drugs.
2000 Sep
The tolerability of efavirenz after nevirapine-related adverse events.
2000 Sep
Efavirenz: a pharmacoeconomic review of its use in HIV infection.
2001
Smaller amounts of antiretroviral drugs are needed when combined with an active ribozyme against HIV-1.
2001 Apr
Performance of a quadruple combination including nelfinavir plus efavirenz in naive subjects with high baseline viral load and in patients failing protease inhibitor-containing regimens.
2001 Apr 1
Antiretroviral rounds. When success is a pain.
2001 Aug
Antiretrovirals: simultaneous determination of five protease inhibitors and three nonnucleoside transcriptase inhibitors in human plasma by a rapid high-performance liquid chromatography--mass spectrometry assay.
2001 Aug
Structure-based design, synthesis, and biological evaluation of conformationally restricted novel 2-alkylthio-6-[1-(2,6-difluorophenyl)alkyl]-3,4-dihydro-5-alkylpyrimidin-4(3H)-ones as non-nucleoside inhibitors of HIV-1 reverse transcriptase.
2001 Aug 2
Antiretroviral therapy for previously treated patients.
2001 Aug 9
Quinoxalinylethylpyridylthioureas (QXPTs) as potent non-nucleoside HIV-1 reverse transcriptase (RT) inhibitors. Further SAR studies and identification of a novel orally bioavailable hydrazine-based antiviral agent.
2001 Feb 1
Therapy with efavirenz plus indinavir in patients with extensive prior nucleoside reverse-transcriptase inhibitor experience: a randomized, double-blind, placebo-controlled trial.
2001 Feb 1
Inhibition of human cytochrome P450 isoforms by nonnucleoside reverse transcriptase inhibitors.
2001 Jan
3,3a-Dihydropyrano[4,3,2-de]quinazolin-2(1H)-ones are potent non-nucleoside reverse transcriptase inhibitors.
2001 Jan 22
Protease-sparing regimen in a real-life practice with naïve patients: an equal opportunity approach?
2001 Jan-Feb
New developments in anti-HIV chemotherapy.
2001 Jan-Feb
Predictors of protease inhibitor-associated adverse events.
2001 Jul
The steady-state pharmacokinetics of efavirenz and nevirapine when used in combination in human immunodeficiency virus type 1-infected persons.
2001 Jul 1
Synthesis and evaluation of novel quinolinones as HIV-1 reverse transcriptase inhibitors.
2001 Jul 23
In vitro anti-HIV-1 synergy between non-nucleoside reverse transcriptase inhibitors nevirapine and efavirenz.
2001 Jun
Limits of deep salvage antiretroviral therapy with nelfinavir plus either efavirenz or nevirapine, in highly pre-treated patients with HIV disease.
2001 Jun
Phenotypic hypersusceptibility to non-nucleoside reverse transcriptase inhibitors in treatment-experienced HIV-infected patients: impact on virological response to efavirenz-based therapy.
2001 Jun 15
Use of MM-PBSA in reproducing the binding free energies to HIV-1 RT of TIBO derivatives and predicting the binding mode to HIV-1 RT of efavirenz by docking and MM-PBSA.
2001 Jun 6
2-Amino-6-arylsulfonylbenzonitriles as non-nucleoside reverse transcriptase inhibitors of HIV-1.
2001 Jun 7
International perspectives on antiretroviral resistance. Nonnucleoside reverse transcriptase inhibitor resistance.
2001 Mar 1
Competition prompts drug companies to cut antiretroviral drug prices.
2001 Mar 17
Efavirenz-induced acute eosinophilic hepatitis.
2001 May
Efavirenz-induced photoallergic dermatitis in HIV.
2001 May 25
High-performance liquid chromatographic method for the determination of HIV-1 non-nucleoside reverse transcriptase inhibitor efavirenz in plasma of patients during highly active antiretroviral therapy.
2001 May 5
Synthesis and evaluation of efavirenz (Sustiva) analogues as HIV-1 reverse transcriptase inhibitors: replacement of the cyclopropylacetylene side chain.
2001 May 7
[Apropos of atypical melancholia with Sustiva (efavirenz)].
2001 May-Jun
[Drug interactions with antiretroviral agents].
2001 May-Jun
Other issues: penetration into sanctuary sites, immune reconstitution and NNRTI sequencing.
2001 Nov
The stereoselective targeting of a specific enzyme-substrate complex is the molecular mechanism for the synergic inhibition of HIV-1 reverse transcriptase by (R)-(-)-PPO464: a novel generation of nonnucleoside inhibitors.
2001 Nov 30
Thiosugars. VIII. Preparation of new 4'-thio-L-lyxo pyrimidine nucleoside analogues.
2001 Sep
Efavirenz-induced psychosis.
2001 Sep 28
Response to first protease inhibitor- and efavirenz-containing antiretroviral combination therapy. The Swiss HIV Cohort Study.
2001 Sep 28
Structural mechanisms of drug resistance for mutations at codons 181 and 188 in HIV-1 reverse transcriptase and the improved resilience of second generation non-nucleoside inhibitors.
2001 Sep 28
Patents

Sample Use Guides

SUSTIVA should be taken orally once daily on an empty stomach, preferably at bedtime. • Recommended adult dose: 600 mg. • With voriconazole, increase voriconazole maintenance dose to 400 mg every 12 hours and decrease SUSTIVA dose to 300 mg once daily using the capsule formulation.
Route of Administration: Oral
10 pM efavirenz completely inhibited 0.5 U HIV RT.
Name Type Language
EFAVIRENZ
EMA EPAR   HSDB   INN   JAN   MART.   MI   ORANGE BOOK   USP-RS   VANDF   WHO-DD   WHO-IP  
USAN   INN  
Official Name English
L-743726
Code English
EFAVIRENZ [USP MONOGRAPH]
Common Name English
SUSTIVA
Brand Name English
(S)-6-Chloro-4-(cyclopropylethynyl)-1,4-dihydro-4-(trifluoromethyl)-2H-3,1-benzoxazin-2-one
Systematic Name English
EFAVIRENZ [EMA EPAR]
Common Name English
NSC-742403
Code English
DMP-266
Code English
EFAVIRENZ [MI]
Common Name English
EFAVIRENZ [VANDF]
Common Name English
EFAVIRENZ [ORANGE BOOK]
Common Name English
EFAVIRENZ [WHO-IP]
Common Name English
EFAVIRENZ [USAN]
Common Name English
EFAVIRENZUM [WHO-IP LATIN]
Common Name English
EFAVIRENZ [HSDB]
Common Name English
EFAVIRENZ [JAN]
Common Name English
VIRADAY
Brand Name English
efavirenz [INN]
Common Name English
(4S)-6-Chloro-4-(2-cyclopropylethynyl)-1,4-dihydro-4-(trifluoromethyl)-2H-3,1-benzoxazin-2-one
Systematic Name English
TELURA COMPONENT EFAVIRENZ
Brand Name English
Efavirenz [WHO-DD]
Common Name English
2H-3,1-Benzoxazin-2-one, 6-chloro-4-(2-cyclopropylethynyl)-1,4-dihydro-4-(trifluoromethyl)-, (4S)-
Systematic Name English
STOCRIN
Brand Name English
EFAVIRENZ [USP-RS]
Common Name English
EFAVIRENZ TEVA
Brand Name English
EFV
Common Name English
EFAVIRENZ [MART.]
Common Name English
EFAVIRENZ COMPONENT OF ATRIPLA
Common Name English
ATRIPLA COMPONENT EFAVIRENZ
Common Name English
(-)-Efavirenz
Common Name English
Classification Tree Code System Code
NDF-RT N0000009948
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
LIVERTOX NBK548521
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
WHO-ATC J05AR11
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NDF-RT N0000175460
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
EMA ASSESSMENT REPORTS SUSTIVA (AUTHORIZED: HIV INFECTIONS)
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EMA ASSESSMENT REPORTS ATRIPLA (AUTHORIZED: HIV INFECTIONS)
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
NDF-RT N0000175463
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
WHO-ESSENTIAL MEDICINES LIST 6.4.2.3 (EFV/FTC/TEN)
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
WHO-VATC QJ05AR11
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WHO-ATC J05AR06
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WHO-VATC QJ05AR06
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WHO-ESSENTIAL MEDICINES LIST 6.4.2.2
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
NCI_THESAURUS C97453
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WHO-VATC QJ05AG03
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WHO-ATC J05AG03
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
EMA ASSESSMENT REPORTS STOCRIN (AUTHORIZED: HIV INFECTIONS)
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
EMA ASSESSMENT REPORTS EFAVIRENZ TEVA (AUTHORIZED: HIV INFECTIONS)
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
Code System Code Type Description
NDF-RT
N0000182140
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
PRIMARY Cytochrome P450 2C19 Inhibitors [MoA]
DAILYMED
JE6H2O27P8
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
PRIMARY
ChEMBL
CHEMBL223228
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PRIMARY
EPA CompTox
DTXSID9046029
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PRIMARY
DRUG CENTRAL
989
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
PRIMARY
WHO INTERNATIONAL PHARMACOPEIA
EFAVIRENZ
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
PRIMARY Description: White to slightly pink powder.Solubility: Practically insoluble in water, freely soluble in methanol.Category. Antiretroviral (Non-nucleoside Reverse Transcriptase Inhibitor).Storage. Efavirenz should be kept in a well-closed container, protected from light.Additional information: Efavirenz may exhibit polymorphism.Requirements: Definition: Efavirenz contains not less than 97.0% and not more than 103.0% of C14H9ClF3NO2, calculated with reference to thedried substance.Manufacture: The production method is validated to ensure that the substance is the (4S)-enantiomer.
EVMPD
SUB06463MIG
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PRIMARY
PUBCHEM
64139
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PRIMARY
MESH
C098320
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PRIMARY
RS_ITEM_NUM
1234103
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PRIMARY
RXCUI
195085
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PRIMARY RxNorm
NDF-RT
N0000182141
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
PRIMARY Cytochrome P450 3A4 Inhibitors [MoA]
LACTMED
Efavirenz
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
PRIMARY
MERCK INDEX
m4839
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PRIMARY Merck Index
HSDB
7163
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PRIMARY
CHEBI
119486
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PRIMARY
INN
7718
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PRIMARY
FDA UNII
JE6H2O27P8
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PRIMARY
NCI_THESAURUS
C29027
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PRIMARY
SMS_ID
100000085266
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PRIMARY
WIKIPEDIA
EFAVIRENZ
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
PRIMARY
USAN
II-77
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PRIMARY
NDF-RT
N0000185504
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
PRIMARY Cytochrome P450 2C9 Inhibitors [MoA]
NDF-RT
N0000187064
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
PRIMARY Cytochrome P450 2B6 Inducers [MoA]
CAS
154598-52-4
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PRIMARY
DRUG BANK
DB00625
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PRIMARY
NDF-RT
N0000190118
Created by admin on Fri Dec 15 15:45:38 GMT 2023 , Edited by admin on Fri Dec 15 15:45:38 GMT 2023
PRIMARY Cytochrome P450 3A Inducers [MoA]
NSC
742403
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PRIMARY