What Is Sustiva?

Brand Name: Sustiva
Generic Name: Efavirenz, EFV

Uses

Sustiva is approved by the FDA to treat HIV in adults and children who are older than three months and who weigh more than 7 pounds, 12 ounces (3.5 kilograms). Sustiva is always prescribed with other drugs as a part of combination therapy.  

Read the FDA description of Sustiva.

What Does Sustiva Do?

Sustiva belongs to a class of medications known as non-nucleoside reverse transcriptase inhibitors (NNRTIs). These medications attach to and block an HIV enzyme called reverse transcriptase that the virus requires to replicate itself. Sustiva is not a cure for HIV but slows its progression.

What Are the Typical Doses?

The adult dose of Sustiva is one 600 milligrams (mg) tablet daily, taken on an empty stomach with a full glass of water. Taking Sustiva at night can help minimize side effects. The dose for children who are at least 3 months old and weight at least 7 pounds, 12 ounces, is calculated according to their weight. The medication can be mixed with water or formula for infants.

If rifampin is given at the same time, an additional 200 mg/day of efavirenz is recommended for patients weighing 50 kg or more.

If voriconazole is given at the same time, the voriconizole dose should be increased to 400 mg every 12 hours and the Sustiva dose should be decreased to 300 mg once daily (using Sustiva capsules since the tablets should not be broken).  

This information is a summary. Before starting this medication, discuss questions with your healthcare provider and make sure you understand dosage instructions.

What Should I Tell My Doctor Before Starting Sustiva?

Tell your doctor if you:

  • have an allergy to Sustiva or other medications
  • are breastfeeding or are planning on breastfeeding
  • are pregnant or are thinking of becoming pregnant. Sustiva may cause birth defects and should not be used by women who are sexually active and could become pregnant.
  • are taking birth control pills, as Sustiva can reduce their effectiveness
  • have a history of seizures
  • have a history of drug or alcohol abuse
  • have been diagnosed with a mental illness
  • have a history of hypersensitive skin reactions, such as Stevens-Johnson syndrome
  • have a history of liver disease, or have hepatitis B or hepatitis C. Sustiva should be used with caution in patients with liver disease. 

What Medications May Interact with Sustiva?

Always tell your physician about any prescription medications or herbal remedies you are taking. Some of the medications that can adversely interact with Sustiva include:

  • efavirenz/emtricitabine/tenofovir disoproxil fumarate (Atripla)
  • benzodiazepines, including midazolam (Dormicum, Hypnovel, and Versed) and triazolam (Apo-Triazo, Halcion, Hypam or Trilam)
  • ergot derivatives used to treat migraines, such as dihydroergotamine (D.H.E. 45, Migranal), ergonovine, ergotamine (Cafergot), methylergonovine (Methergine)
  • GI motility agents, such as cisapride (Prepulsid and Propulsid)
  • neuroleptic medications, such as pimozide (Orap)
  • St. John’s wort

Sustiva may increase the adverse or toxic effects of alcohol.  Avoid consuming alcohol while taking Sustiva.

Possible Side Effects of Sustiva

Possible Adverse and Emergency Side Effects

The following are severe and emergent side effects of Sustiva. Contact your medical provider immediately if you experience any of the following.

  • Psychiatric symptoms, such as suicidal thoughts, severe depression, anxiety, strange thoughts or aggression. Seek immediate medical evaluation if you experience severe psychiatric symptoms. 
  • Nearly half of patients taking Sustiva reported mild to moderate nervous system effects (dizziness, insomnia, poor concentration, sleepiness, abnormal dreams, confusion, memory problems, hallucinations) and symptoms usually resolve within a month.  In controlled clinical trials, about 2 percent of patients taking Sustiva discontinued the drug due to adverse effects. 
  • Hepatotoxicity, such as hepatomegaly with steatosis, affects your liver functioning. Symptoms of this condition include dark urine, decrease in appetite, fatigue, jaundice or yellowing skin, nausea, and tenderness over the liver. This is more likely to occur in people diagnosed with chronic liver disease or other liver-related conditions.

Possible Nonemergency Side Effects

The following side effects may occur but don’t usually represent an emergency. Discuss with your doctor or healthcare professional if they continue or are bothersome.

  • changes in the distribution of body fat, such as an increasing amount of fat on the neck
  • difficulty sleeping
  • dizziness
  • drowsiness
  • hyperlipidemia, a condition that raises the levels of cholesterol and triglycerides in the blood
  • immune reconstitution syndrome, a condition that causes an inflammatory response in viruses in the blood, such as pneumonia or tuberculosis
  • tiredness
  • trouble concentrating
  • upset stomach, vomiting, or diarrhea

Sustiva and Rash

Sustiva can cause a rash to form in the first one to two weeks after starting the medication. An estimated 26 percent of patients will experience a new-onset rash after taking the medication. Most Sustiva-related rashes subside within four weeks. However, Sustiva can cause severe skin reactions like ulcers or blisters. If these skin reactions occur, discontinue the medication and seek emergency medical attention.

Sustiva and Sleep

Sustiva can cause a medical condition known as somnolence in some patients. This condition causes excessive daytime sleepiness. However, at night Sustiva can cause difficulty sleeping and disturbed sleep. For this reason, some patients take Sustiva in the morning to get a better night’s sleep.

This list may not describe all possible side effects. Call your doctor or healthcare provider for advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

Where Should I Keep Sustiva?

Sustiva should be stored at room temperature between 59 and 86 degrees Fahrenheit (15 and 30 degrees Celsius).

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Important FDA Warnings

FDA WARNING: SUSTIVA CARRIES A BLACK BOX WARNING FOR ITS POTENTIALLY DEADLY EFFECTS IN DAMAGING THE LIVER OR CAUSING SEVERE PSYCHIATRIC ISSUES. SEEK EMERGENCY MEDICAL TREATMENT IF YOU EXPERIENCE SYMPTOMS RELATED TO EITHER OF THESE ISSUES. THE DRUG CAN ALSO CAUSE SERIOUS BIRTH DEFECTS WHEN TAKEN BY PREGNANT WOMEN. WOMEN SHOULD NOT BECOME PREGNANT UNTIL AT LEAST 12 WEEKS AFTER STOPPING THE MEDICATION (NATIONAL INSTITUTES OF HEALTH, 2013).

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