Written by Rachel Nall | Published on October 25, 2013
Medically Reviewed by George Krucik, MD, MBA on October 25, 2013

What Is Sustiva?

Brand Name: Sustiva
Generic Name: Efavirenz, EFV

Sustiva is a medication that has been approved by the U.S. Food and Drug Aministration for the treatment of 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 prescribed with other drugs as a part of combination therapy. It is not prescribed on its own.

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.

Sustiva should be taken on an empty stomach without food. Taking it at night can help to reduce side effects (National Institutes of Health, 2013).Take the medication with a full glass of water. The medication can be mixed with water or formula for infants.

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
  • are taking birth control pills, as Sustiva can reduce their effectiveness
  • 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, such as hepatitis B or hepatitis C

What Medications May Interact with Sustiva?

Always tell your physician about any prescription medications or herbal remedies you are taking.

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

Possible Side Effects of Sustiva

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

  • hepatotoxicity, such as hepatomegaly with steatosis, that 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 (National Institutes of Health, 2013).
  • psychiatric symptoms, such as suicidal thoughts, severe depression, strange thoughts or aggression

The following side effects may occur, but do not 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 and/or diarrhea

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.

Sustiva and Rash

Sustiva can cause a rash to form in the first one to two weeks after starting the medication (FDA, 2010). 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, such as 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.

Where Should I Keep Sustiva?

Sustiva should be stored at room temperature—somewhere 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.

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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Article Sources:

●      Efavirenz (Sustiva). (2013, August 23). National Institutes of Health. Retrieved October 22, 2013, from
●      Sustiva. (2010). FDA. Retrieved October 22, 2013, from

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