Indications  

Sustiva is a prescribed medication used in conjunction with other antiretroviral drugs to manage human immunodeficiency virus (HIV) type 1 infection in adult and pediatric patients aged 3 months and above, weighing a minimum of 3.5 kg. 

As a non-nucleoside reverse transcriptase inhibitor (NNRTI), Sustiva works by reducing HIV levels in the bloodstream. While not curative, it may lower the risk of acquiring acquired immunodeficiency syndrome (AIDS) and related conditions like severe infections or cancer. 

Uses and Dosage 

Before taking Sustiva and with every prescription refill, carefully review its medication guide and patient information leaflet. Consult your healthcare provider or pharmacist for any inquiries or concerns. 

The dosage of this medication is determined based on the patient’s medical condition, treatment response, and concurrent medications. 

Typically, Sustiva is taken once daily as prescribed by the doctor, with ample water, and on an empty stomach (at least 1 hour before or 2 hours after eating). 

Sustiva tablet and capsule should be ingested whole, without splitting, chewing, or crushing. 

If swallowing the whole medication is challenging, the capsule form may be opened, and mix its contents with a small portion (1 to 2 teaspoons) of soft food like applesauce, grape jelly, or yogurt. After taking the mixture, add 2 more teaspoons of food to the empty container, then swallow the rest of the mixture to guarantee the complete dosage is taken. Consume within 30 minutes of mixing and refrain from eating for 2 hours following medication intake. 

For infants unable to consume solids, mix the capsule’s contents with 2 teaspoons of infant formula and administer via an oral syringe. Refrain from nursing them for 2 hours following medication intake. 

Adhere strictly to your doctor’s prescription for Sustiva (and other HIV medications). Avoid missing doses, altering the dosage, exceeding the recommended frequency, or discontinuing the medication (including other HIV treatments) without consulting your doctor. 

Altering or omitting doses of your medications without medical consent could lead to elevated virus levels, increased treatment complexity (resistance), or exacerbate side effects. 

Side Effects 

Listed below are the potential adverse effects of Sustiva. Inform your doctor promptly if any of them persist or worsen. 

Common Side Effects 

• Nausea, vomiting 
• Dizziness, drowsiness, difficulty concentrating 
• Rash 
• Headache, fatigue 
• Sleep disturbances (insomnia), unusual dreams 

• Alterations in body fat distribution or shape (particularly in arms, legs, face, neck, breasts, and waist) 

Serious Side Effects 

• Seizure 
• Hallucinations, difficulty concentrating, impaired speech or movement (possible after months or years of taking Sustiva) 
• Indication of nervous system problem: 
  • Dizziness 
  • Drowsiness 
  • Confusion 
  • Unusual dreams 
  • Insomnia 
  • Speech problems 
  • Balance or muscle control problems 
• Signs of severe psychiatric symptoms: 
  • Anxiety 
  • Paranoia 
  • Abnormal behavior 
  • Feelings of sadness or hopelessness 
  • Hallucinations 
  • Suicidal thoughts 
• Signs of liver problems: 
  • Nausea 
  • Abdominal pain 
  • Appetite loss 
  • Dark urine 
  • Pale stools 
  • Jaundice (yellowing of skin or eyes) 

Contact your doctor if any of the serious side effects above are experienced. 

Treatment with Sustiva can lead to severe psychiatric symptoms such as: 

• Confusion 
• Feelings of sadness or hopelessness 
• Suicidal thoughts 
• Anxiety 
• Paranoia 
• Hallucinations 
• Difficulty speaking or moving 
• Abnormal behavior 

If any of the above-listed side effects occur, even if you have experienced them previously, promptly consult your doctor. 

Sustiva impacts your immune system, potentially leading to specific side effects that can manifest even weeks or months after starting the medication. Inform your doctor if you experience: 

• Indicators of a new infection: 
  • Fever 
  • Night sweats 
  • Swollen glands 
  • Cold sores 
  • Cough 
  • Wheezing 
  • Diarrhea 
  • Weight loss 
• Challenges with speech or swallowing, balance or eye movement issues, weakness, or tingling sensations 
• Swelling in the neck or throat (enlarged thyroid), alterations in menstrual patterns, or impotence 

Seek immediate medical assistance if you experience symptoms of a severe skin reaction such as: 

• Fever 
• Sore throat 
• Burning eyes 
• Skin pain 
• A red or purple rash with blistering and peeling 

Allergic Reactions 

Although rare, a severe allergic reaction to Sustiva may occur. Seek immediate medical assistance in case of any signs of an allergic reaction, such as: 

• Hives 
• Swelling of the face or throat  
• Difficulty breathing 

Not all side effects of Sustiva are included in this list. Tell your doctor if any unlisted effects occur. 

Cautions 

Before starting treatment with Sustiva, inform your doctor if you have any known allergies, particularly to efavirenz and other medicines. 

Consult your pharmacist for more information about Sustiva, as it may contain inactive ingredients that may cause allergic reactions or other complications. 

To ensure Sustiva is safe for you, disclose to your physician your medical background, especially if you have a history of: 

• Mental or mood disorders (e.g., depression, suicidal thoughts, psychosis) 
• Liver issues (e.g., hepatitis B or C, cirrhosis) 
• Substance abuse or alcohol misuse 
• Seizures 
• Elevated cholesterol or triglyceride levels 

Inform all your healthcare providers of any current or recently started or stopped medications, including prescription/nonprescription drugs, vitamins, and herbal supplements, to reduce the risk of drug interaction with Sustiva. 

Some of the medications that may interact with Sustiva include: 

• Certain combination therapy for chronic hepatitis C (ombitasvir/paritaprevir/ritonavir/dasabuvir) 
• Orlistat 

Refrain from taking Sustiva with other products containing efavirenz unless explicitly instructed by your doctor. 

Certain medications can influence the elimination of Sustiva from the body, potentially impacting its efficacy. This includes certain antiepileptic drugs like carbamazepine, phenobarbital, and phenytoin. 

Sustiva can accelerate the elimination of various medications from the body, potentially impacting their efficacy. Drugs affected include: 

• Atovaquone/proguanil 
• Azole antifungals (e.g., itraconazole, ketoconazole)  
• Bedaquiline 
• Cobicistat 
• Elbasvir/grazoprevir  
• Macrolide antibiotics (such as clarithromycin)  
• Methadone 
• Rifabutin 
• Sertraline  
• Specific cholesterol-lowering statins (atorvastatin, pravastatin, simvastatin) 
• Warfarin 

Some HIV treatment medications (such as elvitegravir and other NNRTIs like etravirine, nevirapine, and rilpivirine) have the potential to engage in interactions with Sustiva. Additional medication (ritonavir) might be required when taking atazanavir alongside this medication. 

Ensure to review the packaging of all your medications, including allergy and cough-and-cold remedies, as they might contain sleep-inducing components. Consult your pharmacist for guidance on the proper usage of such products. 

Moreover, inform your doctor or pharmacist about the use of other products inducing drowsiness, including: 

• Alcohol 
• Marijuana (cannabis) 
• Antihistamines (e.g., cetirizine, diphenhydramine) 
• Sleep or anxiety medications (such as diazepam, zolpidem) 
• Muscle relaxants 
• Opioid pain relievers (like codeine) 

Inform laboratory personnel and all medical professionals about your usage of Sustiva, as it has the potential to interfere with specific lab tests, such as urine cannabinoid tests, resulting in misleading outcomes. 

Sustiva can induce drowsiness, dizziness, or hindered concentration. Refrain from driving or operating machinery until you understand the impact of this medication on you. 

During HIV treatment, your immune system might become more robust and target existing infections or trigger the emergence of other conditions. This could lead to symptoms of those infections or conditions. Promptly inform your doctor if you experience new or exacerbated symptoms while on Sustiva treatment.  

Children taking Sustiva may experience a higher incidence and severity of rashes. Promptly notify the doctor if any rash occurs. The doctor may recommend administering an antihistamine to your child prior to starting this medication. 

Before taking Sustiva, ensure you inform your doctor if you are pregnant, as it may pose risks to the unborn child.  

Employ dual contraception methods for the duration of treatment with Sustva and for a minimum of 12 weeks after its completion, as this medication can reduce the efficacy of hormonal birth control methods like pills, patches, or rings, potentially leading to pregnancy. In the event of pregnancy during treatment, notify your doctor. 

Inform your doctor if you experience any new spotting or breakthrough bleeding, as these could indicate inadequate functioning of your hormonal birth control.  

Consult your doctor regarding alternative and reliable forms of contraception and employ a reliable barrier method (such as latex or polyurethane condoms or dental dams) during sexual activity to minimize the risk of transmitting HIV.  

Women diagnosed with HIV or AIDS should refrain from breastfeeding. Despite the absence of HIV transmission to the newborn, breast milk could convey the virus to the infant.