What is Sustiva (Efavirenz)?
Sustiva is a synthetic non-nucleoside reverse transcriptase inhibitor (NNRTI) drug, which reduces the HIV viral load, slows damage to the immune system, and reduces the risk of progression to AIDS when used as part of a three-drug treatment plan in combination with other antiretroviral drugs for HIV-1.
Dosage and administration
Sustiva comes in tablet form, which cannot be scored, crushed or chewed, and as oral capsules, which may be opened and sprinkled. Sustiva should be taken on an empty stomach. Dosing and administration instructions are given in the product monograph.
This medication only needs to be taken once daily, and can be prescribed to adults, children, and infants three months and older who at least 3.5 kg. Despite FDA approval, it is generally not recommended for children under three years. For Sustiva in patients with mild liver dysfunction, no dosage modifications are necessary, but the medication should not be used in moderate to severe liver impairment. Dosage adjustments are not likely necessary in renal-impaired patients.
Sustiva Side effects
Most patients using Sustiva report CNS side effects, thus patients should be careful when driving, using heavy machinery, or other potentially dangerous activities requiring attentiveness.
Other side effects include, but are not limited to:
- psychiatric effects
All potential side effects are provided in the product monograph and should be consulted.
As current HIV treatment guidelines recommend all HIV-positive patients should be screened for HBV and HCV at the time of diagnosis, any co-infection with HIV and HBV or HCV should be treated with antiretroviral therapy targeting both viruses. Treatment should continue indefinitely to achieve optimal suppression of HIV and prevention of HBV or HCV exacerbation. Regimens and considerations are outlined in the appropriate treatment guidelines.
Pregnancy and lactation
Women taking Sustiva should use two forms of contraception during treatment and continuing for 12 weeks after. Treatment guidelines and the product monograph outline recommendations for women who are inadvertently exposed to Sustiva while pregnant. Active retroviral combination treatment should be used in all pregnant women, regardless of viral load and CD4 count. Avoid Efavirenz in the first trimester of pregnancy, as it may be teratogenic. If your patient has been exposed to Sustiva before or during pregnancy, report this to the Antiretroviral Pregnancy Registry to assist in data collection.
The CDC recommends that all HIV-positive women, treated or untreated, avoid breastfeeding to prevent vertical transmission of the virus, as Sustiva is excreted in the breast milk.
A complete list of potential drug interactions is provided in the product monograph and should be consulted.
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