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Sustiva
Sustiva (generic name: efavirenz) is an antiretroviral medication used in combination with other drugs to treat HIV-1 infection. Efavirenz belongs to the class of drugs known as non-nucleoside reverse transcriptase inhibitors (NNRTIs), which help control HIV infection by reducing the amount of virus in the body, allowing the immune system to work more effectively. Sustiva is not a cure for HIV, but it helps to manage the condition and reduces the risk of developing complications such as AIDS.
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Frequently Asked Questions
How long does it take for Sustiva to start working?
Sustiva begins working to suppress the HIV virus within a few days, but it may take several weeks for the viral load to decrease significantly. Regular blood tests will monitor your progress.
Can I take Sustiva with food?
It is recommended to take Sustiva on an empty stomach, as taking it with food (especially high-fat meals) can increase the levels of efavirenz in your blood, leading to more pronounced side effects like dizziness and drowsiness.
What should I do if I miss a dose of Sustiva?
If you miss a dose, take it as soon as you remember, unless it is close to your next scheduled dose. Do not double up on doses to make up for a missed one. Missing doses increases the risk of HIV developing resistance to the medication.
Can Sustiva be taken during pregnancy?
Sustiva is not recommended during pregnancy, especially in the first trimester, due to the risk of birth defects. Women of childbearing age should use effective contraception while taking Sustiva and consult their healthcare provider if planning to become pregnant.
Does Sustiva cure HIV?
No, Sustiva does not cure HIV. It helps to manage the virus, reducing the viral load and improving immune function, but lifelong treatment is necessary to control the infection.
Comprehensive Drug Guide
How Does Sustiva Work?
Efavirenz works by binding to reverse transcriptase, an enzyme that is critical for the replication of the HIV virus. By inhibiting this enzyme, efavirenz prevents HIV from replicating and spreading in the body, reducing the viral load and helping to maintain immune function.
Common Dosages
- 600 mg tablets
- 200 mg and 50 mg capsules
Typical Dosing
- For adults and children (weighing at least 40 kg): The recommended dose is 600 mg once daily, preferably taken on an empty stomach at bedtime to minimize side effects such as dizziness or drowsiness.
Typical Dosing
FDA Approved Indications
- Treatment of HIV-1 infection in combination with other antiretroviral agents in adults and children.
Who Shouldn't Take Sustiva?
- Severe liver impairment.
- Known hypersensitivity to efavirenz or any components of the drug.
- Concurrent use of certain medications, such as St. John’s Wort, which can reduce the effectiveness of efavirenz.
Advice From The Pharmacist
- Take Sustiva on an empty stomach, preferably at bedtime, as taking it with food can increase the risk of side effects like dizziness and drowsiness.
- Avoid alcohol while taking Sustiva, as it can increase the risk of central nervous system (CNS) side effects such as dizziness, confusion, or impaired judgment.
- Do not miss doses, as missing doses can lead to drug resistance and reduce the effectiveness of the treatment.
- Monitor for mood changes, including depression, anxiety, or unusual thoughts, and report any such symptoms to your healthcare provider immediately.
- Regular blood tests are necessary to monitor liver and kidney function while on Sustiva.
Side Effects of Sustiva
Common Side Effects
- Dizziness
- Drowsiness
- Vivid dreams or nightmares
- Rash
- Headache
- Nausea
- Fatigue
Uncommon/Severe Side Effects
- Severe liver damage: Signs include jaundice (yellowing of the skin or eyes), dark urine, or upper abdominal pain.
- Severe skin reactions: Stevens-Johnson syndrome or toxic epidermal necrolysis, characterized by rash, blistering, or peeling of the skin.
- Mood changes: Depression, anxiety, or suicidal thoughts.
- Seizures: In patients with a history of seizure disorders, efavirenz may increase the risk of seizures.
- Lactic acidosis: A rare but serious condition that can cause muscle pain, weakness, trouble breathing, and fatigue.
Risks and Warnings of Sustiva
- CNS Side Effects: Efavirenz can cause central nervous system side effects, including dizziness, drowsiness, vivid dreams, or confusion. Taking the medication at bedtime and on an empty stomach can help minimize these effects.
- Liver Toxicity: Sustiva may cause liver damage, especially in patients with pre-existing liver conditions, such as hepatitis B or C. Regular liver function tests are recommended.
- Mood Changes: Sustiva has been associated with mood disturbances, including depression, anxiety, and suicidal thoughts. Patients should be monitored for these symptoms, especially if they have a history of mental health conditions.
- Pregnancy: Efavirenz can cause birth defects if taken during pregnancy, especially in the first trimester. Women of childbearing potential should use effective contraception while taking Sustiva.
Interactions with Sustiva
Common Drug Interactions
- St. John’s Wort: This herbal supplement can decrease the levels of efavirenz in the body, making Sustiva less effective. Avoid using St. John’s Wort while on Sustiva.
- Rifampin: This medication can reduce efavirenz levels, leading to decreased effectiveness. Dose adjustments may be necessary.
- Anticonvulsants: Medications like phenytoin and carbamazepine can lower efavirenz levels, reducing its effectiveness.
- Oral contraceptives: Efavirenz may reduce the effectiveness of hormonal contraceptives. Use a backup method of contraception, such as condoms.
Alternatives to Sustiva
- Atripla (Efavirenz/Emtricitabine/Tenofovir): A combination tablet that includes efavirenz and two other antiretroviral drugs, used as a once-daily regimen for treating HIV.
- Rilpivirine (Edurant): Another NNRTI used to treat HIV in combination with other antiretroviral agents.
- Biktarvy (Bictegravir/Emtricitabine/Tenofovir alafenamide): A single-tablet regimen for HIV-1 treatment that is often used as a first-line treatment option.
- Triumeq (Dolutegravir/Abacavir/Lamivudine): A combination tablet for treating HIV, often used in patients who are intolerant of efavirenz or cannot take Sustiva.
