Basic
Informations
Sustiva is an HIV medication.
It is in a category of HIV medicines called non-nucleoside reverse
transcriptase inhibitors (NNRTIs). Sustiva prevents HIV from
entering the nucleus of healthy CD4 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, Canada, and certain countries of the
European Union. In Europe and many other parts of the world, Sustiva
has a different brand name: Stocrin. Stocrin is manufactured 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).
Atripla, a combination tablet containing Sustiva and the NRTIs
Viread (tenofovir) and Emtriva (emtricitabine), was approved for use
in the United States in July 2006. Sustiva can still be purchased
separately for use in combination with HIV drugs other than Viread,
Emtriva, or Truvada (tenofovir and emtricitabine combined).
Drugs
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 effects.
Tell your doctors and pharmacists about all medicines you take. This
includes those you buy over-the-counter and herbal or natural
remedies, such as St. John’s Wort. Bring all your medicines when you
see a doctor, or make a list of their names, how much you take, and
how often you take them. Your doctor can then tell you if you need
to change the dosages of any of your medications.
The following medications
should not be taken while you are being treated with Sustiva:
-
Antibiotics: Priftin (rifapentine)
-
Antifungals: Standard
doses of Vfend (voriconazole)
-
Antihistamines: Hismanal (astemizole)
or Seldane (terfenadine)
-
Antipsychotics: Orap (pimozide)
-
Acid reflux/heartburn
medications: Propulsid (cisapride)
-
Heart medications: Vascor
(bepridil)
-
Sedatives: Versed (midazolam)
and Halcion (triazolam)
-
Antimigraine medications:
Wigraine and Cafergot (ergot medications).
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, Agenerase and Lexiva (fosamprenavir).
Sustiva can increase the amount of Kaletra (lopinavir/ritonavir),
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 Invirase, Kaletra,
Crixivan, 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. Because of
reduced Reyataz blood levels when combined with Sustiva, people who
are treatment experienced should not combine the two drugs. People
who are new to antiretroviral treatment may combine the drugs,
provided that they take 400 mg of Reyataz along with 100 mg of
Norvir.
Sustiva should not be combined with the NNRTI Intelence (etravirine).
Sustiva decreases the amount of Intelence in the blood and dosing
for either drug has not yet been determined.
Sustiva can significantly decrease the dose of the entry inhibitor
Selzentry (maraviroc). If the two are combined, the dose of
Selzentry must be increased to 600 mg twice daily.
Sustiva can interact with some medications used to treat TB, MAC and
other bacterial infections. Rifadin (rifampin) can decrease Sustiva
levels. 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 (one 200 mg and
two 50 mg Sustiva capsules once a day). 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 also decrease blood levels of Noxafil (posaconazole), and the
two should not be combined.
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. Women should use a
reliable form of barrier contraception, such as a condom or
diaphragm, even if they also use other methods of birth control.
If you take methadone, Sustiva can decrease the amount of it in your
blood. This might cause you to experience withdrawal symptoms and
may require that your doctor or your rehabilitation program increase
your dose of methadone.
Blood levels of Viagra (sildenafil) and Levitra (vardenafil), two
drugs used for erectile dysfunction, can decrease if they are
combined with Sustiva. In turn, it may be necessary to increase the
dose of Viagra or Levitra to achieve the desired effect.
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.
Check out our lesson on Tips & Tricks on Taking Sustiva to learn
more.
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 Sustiva.
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 as possible.
Other possible side effects include tiredness, upset stomach,
vomiting, and diarrhea.
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.
Drug-induced hepatitis (liver injury) and liver failure has been
reported in people taking Sustiva. This usually occurred in people
who were taking other drugs known to effect the liver and in those
who were also infected with hepatitis B virus (HBV) and/or hepatitis
C virus (HCV). People taking Sustiva who are coinfected with HBV or
HCV, or who have a history of liver damage, should have their liver
function closely monitored by their healthcare providers. Stopping
Sustiva treatment may be necessary, in consultation with a
healthcare provider, in the case of abnormal liver enzymes or
symptoms of liver damage (i.e. fatigue, nausea, yellow eyes and
skin, dark urine and liver tenderness).
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 Sustiva.
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