We want to dedicate our article to the question of taking it and possible strategies to improve its tolerability. So, Sustiva drug is used only in combination with other drugs to treat HIV infection. Among the side effects that this drug may cause are mood changes, anxiety, depression, sleep problems and frightening dreams, which can make a person who takes it feel tired during the day. The good news is that a few weeks after the start of the admission in most people, those effects usually become less pronounced. However, if you are not among the lucky ones, below you will find some useful tips that can help improve the quality of life during treatment with Sustiva:
- Take it in the evening, before going to bed. The concentration of the drug in the blood will be maximal while you sleep.
- Take it on an empty stomach or with some low-fat food. It will not rise above the required level.
- Unequivocally you cannot take it along with fatty foods. Do at least a 2-hour break between taking fatty foods and Sustiva. Otherwise, the concentration in the blood will rise by almost 60% above the level required to suppress the virus.
If the side effects persist for several months:
- Ask your doctor to replace Sustiva with another drug.
- Even if your doctor says that it effectively reduces the viral load and increases CD4, there are other drugs that are no less effective.
- If your doctor does not want to change it for another drug, ask him to change it for one month. It's safe and you can compare your feelings. It should be noted that the change of Sustiva can be carried out only under the supervision of a doctor, since the drug is excreted from the body for several days. If canceling the drug and replacing it with another will result in a significant improvement in your well-being, you can tell your doctor that you would like to stay on this new drug.
- If the reception causes depression and suicidal thoughts, you must tell your doctor about it. This is a very serious effect and the doctor is obligated to change therapy schedule for you.
Despite the fact that Sustiva is not the newest drug it is still very widely used in the treatment of HIV infection around the world.
This is partly because it effectively reduces the viral load, but also because its cost is significantly lower compared to alternative drugs. For example, it is much cheaper than protease inhibitors (atazanavir and darunavir), integrase inhibitors (raltegravir, elvitegravir and dolutegravir) or other NNRTIs (rilpivirin).
Even in countries that can afford to use more advanced drugs to treat HIV, health systems are under the pressure of a very low price of Efavirenz (main ingredient) and continue to use it.
All clinical protocols in all developed countries include a recommendation to change therapy if patient notice any bad manifestations.
The scheme should be selected individually for each patient, taking into account a number of factors, including possible side effects of the drugs, the convenience of the therapy scheme (that is, the number of tablets taken per day, the frequency of taking medications, attachment to meals, requirements for food composition and fluid intake). A selectable treatment regimen should ensure long-term treatment effectiveness and maximum tolerability. Current research to improve the tolerability of Sustiva is focused on two strategies: Use of a reduced dose of Sustiva (400 mg instead of 600 mg). The results of the study suggest that reducing the dosage to 400 mg reduces the number of undesirable effects while maintaining efficacy. There are also several studies on the use of efavirenz/emtricitabine/efavirenz in patients with undetectable viral load not every day. The study shows that the growth of viral load was not observed when taking in the regime of "five days yes, two days no" (reception during the working week, but not on weekends).
Both strategies are quite interesting, but it is necessary to continue studying this issue. It is worth noting that there is no data on whether there was a significant difference in side effects.
As is known, the first-line treatment regimen for HIV infection is the combination of Sustiva with other antiretroviral drugs. With zidovudine and lamivudine it has shown high efficiency. Another advantage of this mode is the possibility of reducing the number of tablets for daily intake, since there is a drug Combivir, which is a combination of zidovudine and lamivudine in a standard dose (300 mg 150 mg). The newly developed combination drug Truvada can also be used in conjunction with Sustiva.
The aim of the study was a comparative evaluation of the effectiveness of the combining with tenofovir and emtricitabine and zidovudine and lamivudine in the therapy of people who had not previously received treatment. Thus, both combinations tested showed high efficacy at the initial stages of therapy, however, with zidovudine and lamivudine had more pronounced toxicity (mainly due to zidovudine), which was the reason for excluding a number of patients who received it from the study.