I have adult ADD (non-attentive type, without hyperactivity) and take Ritalin for it. I may soon have to start treatment and would ideally like once-a-day Sustiva/Epzicom. I'm concerned, however, that Sustiva may increase ADD symptoms, specifically my inherent difficulty with concentration. I can probably live with a month or two of decreased concentration while adjusting to Sustiva. Also, I have my ups and downs which are directly related to some challangeing issues in my life, but I don't have a history of clinical depression or anything like that.

Would you recommend starting with Sustiva? Or, am I better off avoiding potential CNS issues with something like Viramune?

If Sustiva is causing me problems two months out, I could just switch to Viramune, right?

Thanks for your post.

Newer combinations like the Epzicom and Sustiva that you mention are usually very well tolerated and can be very simple to take. I've had patients with ADD tolerate this regimen without significant side effects, but some patients (with and without ADD) do experience neuro-psychological side effects from Sustiva that persist. As such, I'd be tuned in to how your body is reacting to the new medication regimen.

Should you have bothersome symptoms from Sustiva, a switch to another medication should be fine. Viramune (nevirapine) would be one alternative, though one should use this medication with caution if you have active hepatitis or if you have a higher CD4 cell count (because of increased risk of liver toxicity). Another simmple alternative that has gained a lot of use in our clinic are the Norvir-boosted PIs, Lexiva (fosamprenavir) and Reyataz (atazanavir). Each offer low pill count, once-daily options too.

Good luck, thanks for reading. BY