Sustiva is an anti-HIV
medication. It is in a category of HIV medicines
reverse transcriptase inhibitors (NNRTIs).
Sustiva prevents HIV from entering the nucleus
of healthy T-cells. This prevents the cells
from producing new virus and decreases the amount
of virus in the body.
Sustiva was approved
by the U.S. Food and Drug Administration for
the treatment of HIV in 1998. It was originally
produced by DuPont Pharmaceuticals and is now
manufactured by Bristol-Myers Squibb for sale
in the United States. In Europe and many other
parts of the world, Sustiva has a different
brand name: Stocrin. Stocrin is manufactured
by by Merck Sharp and Dohme. Stocrin and Sustiva
are the same drug.
Sustiva must be used
in combination with other drugs to treat HIV.
It is usually combined with two nucleoside
reverse transcriptase inhibitors (NRTIs).
about drug interactions?
Sustiva is broken down
(metabolized) by the liver, like many medications
used to treat HIV and AIDS. This means that
Sustiva can interact with other medications.
Sustiva can lower or raise the levels of other
medications in the body. Similarly, other medications
can lower or raise the levels of Sustiva in
the body. While many interactions are not a
problem, some can cause your medications to
be less effective or increase the risk of side
The following medications
should not be taken while you are being treated
Antifungals: Standard doses of Vfend (voriconazole)
Antihistamines: Hismanal (astemizole)
Antipsychotics: Orap (pimozide)
Acid reflux/heartburn medications: Propulsid
Heart medications: Vascor (bepridil)
Sedatives: Versed (midazolam) and Halcion
Antimigraine medications: Wigraine and Cafergot
All of the available
nucleoside reverse transcriptase inhibitors
can be combined safely with Sustiva.
Sustiva can reduce the
amount of various protease inhibitors in the
bloodstream, including Reyataz (atazanavir),
Invirase (saquinavir), Crixivan (indinavir),
Kaletra (lopinavir/ritonavir), and Agenerase
and and Lexiva (amprenavir/fosamprenavir). Sustiva
can increase the amount of Viracept (nelfinavir)
and Norvir (ritonavir) in the bloodstream. And
when Sustiva and Norvir are combined, Sustiva
levels also increase in the bloodstream. If
Sustiva is taken with Reyataz, Invirase, Kaletra,
Crixivan, Agenerase, or Lexiva, their doses
may need to be increased or they may need to
be combined with a low dose of Norvir (e.g.,
100 mg) to help maintain necessary drug levels
in the bloodstream.
Sustiva can interact
with some medications used to treat TB, MAC
and other bacterial infections. Rifadin (rifampin)
can decrease Sustiva levels (Sustiva dose should
be increased to 800 mg). Sustiva can decrease
Mycobutin (rifabutin) levels (Mycobutin dose
should be increased). Sustiva can also decrease
Biaxin (clarithromycin) levels; an alternative
to clarithromycin is recommended.
Sustiva can interact
with some medications used to treat various
fungal infections, including candidiasis and
cryptococcal meningitis. If Sustiva is combined
with Vfend (voriconazole), the Vfend dose should
be increased to 400mg every 12 hours and the
Sustiva dose should be decreased to 300mg once
daily using the older capsule formulation. Sustiva
can also decrease levels of Sporanox (itraconazole);
it is recommended that a Sporanox alternative
be used instead. Nizoral (ketoconazole) levels
can decrease as well; no dosing recommendations
have been made.
Sustiva can decrease
blood levels of calcium channel blockers (used
to control blood pressure, regulate heart beats,
and manage chest pain). Examples include Cardizem
(diltiazem), Plendil (felodipine), Cardene (nicardipine),
Procardia (nifedipine), Calan (verapamil). Increasing
the doses of these medications may be necessary.
Sustiva can interact
with oral contraceptives/birth control pills
(ethinyl estradiol). Sustiva increases the amount
of ethinyl estradiol in the bloodstream. No
alternative has been recommended.
is known about side effects?
Many patients have dizziness,
trouble sleeping, drowsiness, trouble concentrating,
and/or unusual dreams a few hours after starting
treatment with Sustiva. These feeling may be
less noticeable if you take Sustiva at bedtime.
They also tend to go away after you've taken
the medicine for a few weeks. If you have these
side effects, such as dizziness, it does not
mean that you will also have severe depression,
strange thoughts or angry behavior. Tell your
doctor promptly if any of these side effects
continue or if they bother you. There is the
possibility that these symptoms may be more
severe if Sustiva is used with alcohol or mood-altering
(recreational) drugs. You should also avoid
driving or operating machinery if you are having
these side effects.
A small number of patients
have had severe depression, strange thoughts,
or angry behavior while taking Sustiva. Some
patients have had thoughts of suicide and a
few patients have actually committed suicide.
These problems tend to occur more often in patients
with a history of mental illness. You should
contact your doctor immediately if you think
you are having these symptoms, so your doctor
can decide whether you should continue to take
Rash is another common
side effect of Sustiva. These rashes usually
go away without any change in treatment. In
a small number of patients, rash may be serious.
If you develop rash, call your doctor as soon
Other possible side
effects include tiredness, upset stomach, vomiting,
Sustiva can cause someone
to test positive for marijuana as a result of
testing for elicit drug use. If you are asked
to submit urine for a drug test, you may want
to tell the person collecting the sample that
you take Sustiva. This way, the laboratory conducting
the test will know to use a more sensitive test
to prevent false-positive results.
Rash may be a serious
problem in some children. Tell your child's
doctor right away if you notice rash or any
other side effects while your child is taking
Do not take SUSTIVA
if you are taking the following medicines because
serious and life-threatening side effects may
occur when taken together:
(astemizole), Vascor® (bepridil), Propulsid®
(cisapride), Versed® (midazolam), Orap®
(pimozide), Halcion® (triazolam), or ergot
medicines (for example, Wigraine® and
In addition, SUSTIVA
should not be taken with:
(voriconazole) since it may lose its effect
or may increase the chance of having side
effects from SUSTIVA. Some doses of voriconazole
can be taken at the same time as a lower dose
of SUSTIVA, but you must check with your doctor
SUSTIVA should not be
taken with ATRIPLA (efavirenz 600 mg/emtricitabine
200 mg/ tenofovir disoproxil fumarate 300 mg)
because it contains efavirenz, the active ingredient
(saquinavir mesylate) should not be used as
the only protease inhibitor in combination with
Taking SUSTIVA with
St. John's wort (Hypericum perforatum) is not
recommended as it may cause decreased levels
of SUSTIVA, increased viral load, and possible
resistance to SUSTIVA or cross-resistance to
other anti-HIV drugs.
Tell your healthcare
provider right away if you have any side effects
or conditions, including the following:
depression, strange thoughts, or angry behavior
have been reported by a small number of patients
taking SUSTIVA (efavirenz). Some patients
have had thoughts of suicide and a few have
actually committed suicide. These problems
may occur more often in patients who have
had mental illness.
trouble sleeping or concentrating, drowsiness,
unusual dreams, and/or hallucinations are
common, and tend to go away after taking SUSTIVA
for a few weeks. Symptoms were severe in a
few patients and some patients discontinued
therapy. These symptoms may become more severe
with the use of alcohol and/or mood-altering
(street) drugs. If you are dizzy, have trouble
concentrating, and/or are drowsy, avoid activities
that may be dangerous, such as driving or
you have ever had mental illness or are using
drugs or alcohol.
Women should not become pregnant while taking
SUSTIVA. Serious birth defects have been seen
in children of women treated with SUSTIVA during
pregnancy. Women must use a reliable form of
barrier contraception, such as a condom or diaphragm,
even if they also use other methods of birth
Women with HIV should not breast-feed because
they can pass HIV through their milk to the
baby. Also, SUSTIVA may pass through breast
milk and cause serious harm to the baby.
Rash is a common side
effect that usually goes away without any change
in your medicines, but may be serious in a small
number of patients. Rash may be a serious problem
in some children.
If you have liver disease,
your healthcare provider may want to do tests
to check your liver.
Seizures have occurred
in patients taking SUSTIVA, usually in those
with a history of seizures. If you have ever
had seizures, or take medicines for seizures,
your healthcare provider may want to switch
you to another medicine or monitor you.
Changes in body fat
have been seen in some patients taking anti-HIV
medicines. The cause and long-term health effects
are not known.