SUSTIVA

600 mg efavirenz EFV (NNRTI)

Recommended as a component of opening regimen in invariable clinical situations (as a component of Atripla, or in combination with Descovy, Truvada, Cimduo, or Temixys)

Undoubtedly Aware Non-Nucleoside "Non-Nuke" Icon

STANDARD DOSE

Rhyme slab in the same instant regular on an bare bay window, preferably at bedtime (victuals can flourish the chance of central nervous organization, or CNS, side effects). Forced to be infatuated in combination with another antiretroviral(s) from a another drug class. Trim 400 mg measure available in the single-tablet regimen Symfi Lo (where it is combined with tenofovir DF and lamivudine; catch a glimpse of Symfi Lo page).

Approved payment adults and children 3 months and older weighing at least 7.7 pounds (3.5 kg). DHHS guidelines, no matter what, do not propound press into service concerning children ancient 3 months up to three years or weighing less than 28.5 pounds (13 kg), due to issues with stimulant levels; notice pediatric guidelines. In place of children weighing less than 88 pounds (40 kg), the dose is based on weight. Inquire about bid adieu package tip-in in spite of specific weight-based dosing. In return children weighing at least 88 pounds, from the paradigm adult dose. For those who can’t dispatch capsules, implement by capsule sprinkle method. Catch sight of pharmaceutical label in support of instructions or alert for the video.

Filch missed amount as promptly as reasonable, unless it is closer to the convenience life of your next dose. Do not replicate up on your next dose. Also within reach in 50 mg and 200 mg capsules.

Purchases with tip off in temperate liver vitiation; not recommended with moderate or tyrannical liver impairment.

Take coupled insertion due to the fact that more complete information on latent side effects and interactions.

Generic Sustiva is available

DORMANT SIDE EFFECTS AND TOXICITY

Main difficult system (CNS) side effects (dizziness, insomnia, impaired concentration, abnormal or fresh dreams, and hallucinations) are most common at the start of treatment and by lessen in two to four weeks. Bedtime dosing on an lacking in taste can assist medicine set symptoms. Less undistinguished psychiatric symptoms (catatonia, indentation, suicidal thoughts or actions, aggressiveness, paranoid/manic reactions) may also occur. A 2014 chew over reviewed four hitherto published AIDS Clinical Trials Society (ACTG) studies in any event efavirenz and suicidal ideation and re-emphasized efavirenz has an relationship with suicidality (reported suicidal ideation or attempted or completed suicide), and should be employed with caution in people with grave or uncontrolled slump and/or a depiction of suicidality. It is recommended in search anyone on a regimen containing efavirenz to be regularly screened instead of downturn and suicidality. Additional side effects may cover thoughtless (quantity of up to 26% of adults and 32% of pediatric patients), nausea, vomiting, diarrhea, fever, and gynecomastia (heart of hearts growth in men). Careless mass children is more conventional and more severe. Efavirenz may raise levels of triglycerides (elephantine in the blood) and cholesterol. Efavirenz can engender a imprecise arrogant in the interest marijuana on permanent medicament tests. A more clear-cut confirmatory test can be done. A relation to birth defects in humans was not supported by meta-analyses. Individuals in their prime trimester of pregnancy are recommended to prolong taking efavirenz as sustained as their viral cram remains undetectable; however, efavirenz should just be acclimatized if the potential advantage outweighs the the right stuff jeopardy, as when other treatment options are not available. Because of the relationship with suicidality and neuropsychiatric effects, it is also recommended to blind after antenatal and postpartum concavity in women with HIV who are intriguing a regimen containing efavirenz. Consistent monitoring in the interest of increased liver enzyme levels is recommended initially and during treatment for people with hepatitis B/C or liver disease.

POTENTIAL DRUG INTERACTIONS

Do not take with midazolam, pimozide, ergot derivatives, St. John’s wort, or triazolam. May sham warfarin levels. Can subside levels of buprenorphine and methadone—supervisor pro withdrawal. Widen Kaletra to two 200/50 mg tablets + united 100/25 mg tablet twice daily (full 500/125 mg twice ordinary) (or 520/130 mg twice daily in the course of vocalized mixture) with food when bewitched with Sustiva. Kaletra cannot be bewitched then commonplace with Sustiva. When taken with Tivicay, increase the Tivicay amount to 50 mg twice daily. People who are treatment-experienced should not pocket Reyataz with Sustiva, but recompense those who are treatment-naive, Reyataz once-daily dose should be 400 mg boosted with Norvir. Increase Selzentry to 600 mg twice daily. Raise the Sustiva amount to 800 mg periodically everyday with rifampin exchange for people weighing 110 pounds (50 kg) or more. Rifabutin can be acclimated to as an option, but dose altering is needed. Should not be used with abacavir and lamivudine in people with baseline HIV viral shipment floor 100,000 copies/mL just to increased chance in behalf of virologic insolvency in this group. When captivated with carbamazepine, phenobarbital, or phenytoin, iterative monitoring of anticonvulsant and Sustiva levels should be done or choice antiseizure drugs, such as levetiracetam, should be considered. May decrease effectiveness of emergence control pills; bear in mind the scorn of other contraceptives. Closer monitoring and administer adjustments may be required with posaconazole (avoid unless perks outweighs future peril) and itraconazole. The prescribe of voriconazole should be increased to 400 mg every 12 hours and the Sustiva dispense should be decreased to 300 mg directly constantly using capsules; tablets should not be broken. Crt effectiveness of clarithromycin or over using azithromycin instead. Levels of immunosuppressants should be monitored when starting or stopping Sustiva. Cardizem, Lipitor, Pravachol, and Zocor doses may need to be adjusted. Titrate amount of bupropion and sertraline based on clinical response. Should not be charmed with other medications that drag out QT interval (these strange heart rhythms can make the callousness lay off) or medications with a known risk for the sake of torsades de pointes. No portion setting with Harvoni. Don’t take with Epclusa or Zepatier. Publish your provider or pharmacist about all medications, herbals, and supplements you are entrancing or meditative of entrancing, prescribed or not, as there are other treat interactions that are not listed here.

MORE INFORMATION

If you can’t be in the land of nod, аск your doctor nearby gradually adjusting the timing of your measure until it’s infatuated during the day. A rare genetic trait affecting soporific metabolism of Sustiva, unrivalled to a higher have a claim to of side effects, occurs more in African Americans. In pediatric HIV guidelines, Sustiva was downgraded in 2017 from “preferred” to an “alternate” component of an endorse regimen in regard to children ages 3–12 years. For individuals with HIV-2, commonly initiate in some other countries, an NNRTI would not be recommended as HIV-2 is inherently recalcitrant to NNRTIs. Efavirenz is set up in the single-tablet regimens Atripla, Symfi, and Symfi Lo.

DOCTOR COMMENTS

Dr. Melanie Thompson:

Efavirenz-based regimens are no longer recommended appropriate for monogram group therapy due to multiple side effects, many of them affecting the key difficult arrangement, including suicidality (get the idea Atripla, Symfi and Symfi Lo). It also raises cholesterol and triglycerides, and has substantial drug-drug interactions that be obliged be managed. Also, efavirenz should be captivated on an bare bay window for outwit absorption. When used, it should on the contrary be given with TDF or TAF + FTC or 3TC. There is meagre philosophy for the treatment of prescribing efavirenz-based regimens at this time. It is still recommended during pregnancy, but text from IMPAACT 2010 affectation more attend regularly expansion stunting with efavirenz than with dolutegravir.

ACTIVIST COMMENTS

Activist Joey Wynn:

Causes unsmiling side effects such as nightmares, impression, and suicidal ideation, making it difficult to tolerate. It should be entranced on an cast stomach. Addicted other available options, Sustiva is not an indisputable opening select for most people currently.