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sustiva withdrawal
May 3, 2002

Hi, I want to switch sustiva to viramune because of the sustiva side effects,but because I've been on it for almost 3 years, will I experience withdrawal like with benzo's?I'm afraid I won't know if any ill feelings are from stopping sustiva or starting viramune? lastly, should you stop the drugs today and start the new regimen tommorrow (with no lapse)or do a predetemined washout of all drugs?(current v.l. less than 50)Thank you

Response from Dr. Boyle

3 years of success with a regimen is pretty good! There should be no withdrawal associated with stopping Sustiva since it does not lead to dependence like benzodiazepines do. Since your viral load is <50, you should be able to simply switch the Viramune for the Sustiva, using the appropriate lead in dose of Viramune. I would not interrupt therapy since this may lead to a bump in your viral load and make it somewhat more likely that you may fail therapy after the switch. You may even consider overlapping the drugs to make sure that the Viramune is fully therapeutic before the Sustiva is stopped (since in some studies low Viramune levels early in therapy are predictive of virologic failure), but this may increase the risk of side effects (e.g., rash). Of course, discuss these issues with your doctor and agree on a plan. Good luck.

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