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CNS side effects of Sustiva

Feb 8, 2003

I started on sustiva (along with combivir) about six months ago. I know the side effects are supposed to stop relatively soon after you start (according to my doctor). But they just haven't for me. I have a lot of trouble sleeping and its driving me crazy.

Is there something I can take to fight this? My viral load is down - should I risk switching to another med at this point?

Response from Dr. Horwath

An excellent treatment for insomnia in persons with HIV infection is trazodone. Trazodone 50 mg at bedtime is very effective and is not likely to cause cognitive impairment, like many other sedatives do. Sometimes higher doses are needed to treat severe insomnia.

Efavirenz(Sustiva) has been associated with central nervous system (CNS) adverse effects in as many as 50% of those who take it. These side effects may include insomnia, confusion, dizziness, nightmares, hallucinations, depressed mood, somnolence, euphoria, and impaired concentration. As your doctor said, for many people these symptoms are transient (less than one or two months). For people who have persistent CNS side effects from efavirenz, they may benefit from switching to nevirapine (Viramune). But this decision requires considering the possible effects on controlling your viral load and disease progression. You should consult your doctor and discuss these options.

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