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Generic Name: efavirenz (e FAV ir enz)
Brand Names: Sustiva

What is Sustiva?

Sustiva (efavirenz) is an antiviral medicine that prevents human immunodeficiency virus (HIV) from multiplying in your body.

Sustiva is used to treat HIV, the virus that can cause acquired immunodeficiency syndrome (AIDS).

Sustiva is for adults and children who are at least 3 months old and weigh at least 8 pounds. This medicine is not a cure for HIV or AIDS.

Important information

Do not take Sustiva together with Atripla (combination efavirenz, emtricitabine, and tenofovir), unless your doctor tells you to.

Do not take Sustiva with cisapride (Propulsid), pimozide (Orap), midazolam (Versed), triazolam (Halcion), or ergot medicines such as dihydroergotamine (D.H.E. 45), ergonovine (Ergotrate), ergotamine (Ergomar, Cafergot, Wigraine), or methylergonovine (Methergine). These drugs can cause life-threatening side effects if you use them while you are taking efavirenz.

Sustiva may cause serious psychiatric symptoms including confusion, severe depression, suicidal thoughts, aggression, extreme fear, hallucinations, or unusual behavior. Contact your doctor at once if you have any of these side effects, even if you have had them before.

Do not use Sustiva without telling your doctor if you are pregnant. It could harm the unborn baby. Use two forms of birth control, including a barrier form (such as a condom or diaphragm with spermicide gel) while you are taking this medicine, and for at least 12 weeks after your treatment ends. Tell your doctor if you become pregnant during treatment.

Taking Sustiva will not prevent you from passing HIV to other people. Talk with your doctor about safe methods of preventing HIV transmission during sex. Sharing drug or medicine needles is never safe, even for a healthy person.

Before taking this medicine

You should not use Sustiva if you have ever had a severe allergic reaction to efavirenz. Do not take this medicine together with Atripla (combination efavirenz, emtricitabine, and tenofovir), unless your doctor tells you to.

To make sure Sustiva is safe for you, tell your doctor if you have:

  • liver disease (including hepatitis B or C);

  • seizures or epilepsy;

  • a history of mental illness, injection drug use, or taking an anti-psychotic medicine;

  • heart disease or long QT syndrome;

  • high cholesterol or triglycerides; or

  • if you have ever taken delavirdine (Rescriptor) or nevirapine (Viramune) and they were not effective in treating your condition.

Do not use Sustiva if you are pregnant. It could harm the unborn baby. Use two forms of birth control, including a barrier form (such as a condom or diaphragm with spermicide gel) while you are taking Sustiva, and for at least 12 weeks after your last dose. Tell your doctor if you become pregnant during treatment.

Hormonal contraception (birth control pills, injections, implants, skin patches, and vaginal rings) may not be effective enough to prevent pregnancy during your treatment.

If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of Sustiva on the baby. HIV can be passed to your baby if you are not properly treated during pregnancy. Take all of your HIV medicines as directed to control your infection.

Women with HIV or AIDS should not breast-feed a baby. Even if your baby is born without HIV, the virus may be passed to the baby in your breast milk.

How should I take Sustiva?

Take Sustiva exactly as prescribed by your doctor. Follow all directions on your prescription label. Do not take this medicine in larger or smaller amounts or for longer than recommended.

Sustiva must be given in combination with other antiviral medications and it should not be used alone. Your disease may become resistant to efavirenz if you do not take it in combination with other HIV medicines your doctor has prescribed.

Take Sustiva on an empty stomach at bedtime.

To make swallowing easier, you may open a capsule and sprinkle the medicine into a spoonful of applesauce, yogurt, or grape jelly. You may also mix the medicine with infant formula if you are giving the medicine to a baby. Swallow the mixture right away. Do not save it for later use.

After taking Sustiva using the sprinkle method, do not eat for the next 2 hours. Sustiva mixed with infant formula should be given to the baby right away. But do not feed the baby any more formula for at least 2 hours afterward.

Sustiva comes with instructions for mixing the capsule contents with soft food or infant formula. Follow these directions carefully. Ask your pharmacist if you have any questions.

Do not crush, chew, or break a tablet. Swallow it whole with liquid.

While using Sustiva, you may need frequent blood tests.

Sustiva can cause you to have a false positive drug screening test. If you provide a urine sample for drug screening, tell the laboratory staff that you are taking this medicine.

If a child is using this medicine, tell your doctor if the child has any changes in weight. Sustiva doses are based on weight in children, and any changes may affect your child's dose.

Take Sustiva regularly to get the most benefit. Get your prescriptions refilled before you run out of medicine completely. Skipping doses may increase the risk of your virus becoming resistant to antiviral medicine.

Store at room temperature away from moisture and heat.

Read the medication guide provided with all your medications. Do not change your doses or medication schedule without your doctor's advice. Every person with HIV or AIDS should remain under the care of a doctor.

Sustiva dosing information

Usual Adult Dose for HIV Infection:

600 mg orally once a day

Comments:
-This drug should be used with a protease inhibitor and/or NRTIs.

Use: In combination with other antiretroviral agents, for the treatment of HIV-1 infection

Usual Adult Dose for Nonoccupational Exposure:

US CDC recommendations: 600 mg orally once a day
Duration of therapy: 28 days

Comments:
-This drug should be used with (lamivudine or emtricitabine) plus (zidovudine or tenofovir); recommended as the preferred NNRTI-based regimen for nonoccupational postexposure prophylaxis of HIV infection.
-Prophylaxis should be started as soon as possible, within 72 hours of exposure.
-Not approved by US FDA.

Usual Adult Dose for Occupational Exposure:

US Public Health Service working group recommendations: 600 mg orally once a day
Duration of therapy: 28 days, if tolerated

Comments:
-An alternative antiretroviral agent for use as HIV postexposure prophylaxis only with expert consultation
-Prophylaxis should be started as soon as possible, preferably within hours after exposure.
-The optimal duration of prophylaxis is unknown and may differ based on institution protocol.
-The most current therapeutic guidelines should be consulted for more information.
-Not approved by US FDA.

Usual Pediatric Dose for HIV Infection:

3 months or older:
3.5 to less than 5 kg: 100 mg orally once a day
5 to less than 7.5 kg: 150 mg orally once a day
7.5 to less than 15 kg: 200 mg orally once a day
15 to less than 20 kg: 250 mg orally once a day
20 to less than 25 kg: 300 mg orally once a day
25 to less than 32.5 kg: 350 mg orally once a day
32.5 to less than 40 kg: 400 mg orally once a day
40 kg or more: 600 mg orally once a day

Use: In combination with other antiretroviral agents, for the treatment of HIV-1 infection

See also: Dosage Information (in more detail)

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking Sustiva?

Sustiva may impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert.

Drinking alcohol can increase certain side effects of efavirenz.

Taking this medication will not prevent you from passing HIV to other people. Do not have unprotected sex or share razors or toothbrushes. Talk with your doctor about safe ways to prevent HIV transmission during sex. Sharing drug or medicine needles is never safe, even for a healthy person.

Sustiva side effects

Get emergency medical help if you have signs of an allergic reaction to Sustiva: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Call your doctor at once if you have:

  • a seizure (convulsions);

  • liver problems - nausea, upper stomach pain, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes); or

  • severe skin reaction - fever, sore throat, swelling in your face or tongue, redness or burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Sustiva may cause serious psychiatric symptoms including confusion, severe depression (feeling sad or hopeless), suicidal thoughts, anxiety, paranoia, hallucinations, trouble speaking or moving, or unusual behavior. Contact your doctor at once if you have any of these side effects, even if you have had them before.

Sustiva may increase your risk of certain infections or autoimmune disorders by changing the way your immune system works. Symptoms may occur weeks or months after you start treatment with Sustiva. Tell your doctor if you have:

  • signs of a new infection - fever, night sweats, swollen glands, mouth sores, diarrhea, stomach pain, weight loss;

  • chest pain (especially when you breathe), dry cough, wheezing, feeling short of breath;

  • cold sores, sores on your genital or anal area;

  • rapid heart rate, feeling anxious or irritable, weakness or prickly feeling, problems with balance or eye movement;

  • trouble speaking or swallowing, severe lower back pain, loss of bladder or bowel control; or

  • swelling in your neck or throat (enlarged thyroid), menstrual changes, impotence, loss of interest in sex.

Common Sustiva side effects may include:

  • nausea, vomiting;

  • dizziness, drowsiness, trouble concentrating;

  • mild skin rash;

  • headache, tired feeling;

  • sleep problems (insomnia), strange dreams; or

  • changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist).

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

What other drugs will affect Sustiva?

Sustiva may cause a serious heart problem if you use certain medicines at the same time, including antibiotics, antidepressants, antipsychotic medicines, stomach acid reducers, heart rhythm medicine, and medicines to treat cancer, or malaria. Tell your doctor about all medicines you use, and those you start or stop using during your treatment.

Many drugs can interact with efavirenz. Not all possible interactions are listed here. Tell your doctor about all your current medicines and any you start or stop using, especially:

  • any other HIV or AIDS medications;

  • an antibiotic or antifungal medicine;

  • anti-malaria medicine;

  • cholesterol-lowering medicine;

  • heart or blood pressure medicine;

  • hepatitis C medication;

  • medicine to prevent organ transplant rejection; or

  • seizure medicine.

This list is not complete and many other drugs can interact with efavirenz. This includes prescription and over-the-counter medicines, vitamins, and herbal products. Give a list of all your medicines to any healthcare provider who treats you.

Where can I get more information?

  • Your pharmacist can provide more information about Sustiva.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Sustiva only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2017 Cerner Multum, Inc. Version: 16.07.

Date modified: March 02, 2017
Last reviewed: February 14, 2017

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