Question

How long should I give Sustiva (efavirenz) side effects?

24 November 2012. Related: All topics, Side effects.

I have recently started (one week) on a Sustiva (efavirenz) and Kivexa (abacavir/3TC) combo taken at 10pm on an empty stomach. I don’t eat after 8pm and avoid a fatty meal. Generally I will feel ok on waking but when I get up my head is buzzing and I can be dizzy. This can last for some hours.

My job is demanding (lawyer) so I have to be on the ball but I’m finding it difficult to concentrate and this has led to worry and upset over whether I can keep going.

One suggestion is to take the meds earlier (8pm) but then if on an empty stomach that would mean stop eating at 6pm when either I’m still at work or on way home.

It’s early days I know but how long should I continue with this regime before considering switching from Sustiva to something which doesn’t produce impaired concentration for me and is there anything else I could be doing meantime to help ? Is there any point in taking say paracetamol to try to clear my head and would that be advisable in any event ? Thanks

Answer

Answer: Simon Collins

The side effects you are describing are very common with efavirenz. Nearly everyone feels something like this when they start. The mechanism for why this happens has still not been explained, but most people find this more manageable within a week or two. Either the side effects reduce or your body adjusts.

HIV treatment is individual though. When you write “I’m finding it difficult to concentrate and this has led to worry and upset over whether I can keep going” I worry that you may having a particularly rough time. A small percentage of people are unlucky in having a more severe and sometimes they switch within the first week because they decide that they have tried it and had enough.

Switching is easy. There are many other options that do not have these side effects. Although most hospitals in the UK suggest people wait for a few weeks to see if they improve, they will all switch you earlier if you say that this is what you want.

Many people do not use efavirenz because of their jobs, especially if they work shifts or operate machinery. If this is affecting your work, one option is to take a few days off, perhaps a week, to see whether this improves. Lots of people take time off when starting efavirenz. If this is not an option for you now, then it sounds like you may be one of the people who would be better using another medicine.

Because the range of responses experienced by different people is so wide though, you need to be the person who decides whether you want to switch and when you want to do this. Does anyone else know you have started treatment? Sometimes a friend or family member may have noticed that your behaviour is different and that you are more anxious.

Also, sometimes efavirenz can cause extreme psychosis and paranoia, including wanting to commit suicide. In these cases it is better to contact your clinic immediately to stop treatment. Even though this is the weekend, if you are this worried, this would be better than continuing efavirenz. You could continue the Kivexa over the weekend and visit your clinic on Monday morning to arrange a replacement so do not get resistance.

Within a few days of stopping efavirenz, most people feel much better again. Severe side effects can be very disturbing and luckily only affect a few percent of people.

Whatever you decide, take everything very gently over the weekend and contact your clinic if you need to.

For more information see the efavirenz information in the i-Base side effect guide.