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Sustiva (EFV) and Combivir (AZT/3TC) Timing
May 8, 2004

This question may sound silly but I must admit that I am all about convenience.... and I dont think there's a better regimen than the one Im on... A NRTI and NNRTI - Thank God I dont have to deal with the side effects of Protease Inhibitors.

Anyway, my question comes to you with my sleeping habits... Im under the impression that Sustvia (efavirenz) remains in the system for 24 hours while Combivir (AZT/3TC) is in the system for 12 hours... Is this correct? I ask because I generally go to bed around 1am (when I take my night dosage Sust/Comb) and wake up at about 9am (when I take my morning dosage comb)

Are these times too close together? I think it may have a role in why I feel like crap during the day up until about 2pm

Perhaps I should take my night dosage a little earlier... I just hate the SPACED out feeling I get on Sustiva... and am not up for going to bed at 10pm... What do you think?

I was diagnosed in July of 2003 with a viral load of 1.5million and CD4 of 300 now Im undetectable with CD4 count of 400 if that has any relevance. Thanks for your help!

Mark

Response from Dr. Sherer

I would suggest that you take the CBV later in the day, i.e. around lunch (1pm), to avoid the chance that the morning symptoms are related to higher blood levels of AZT, and leave the evening dose alone (i.e. 1am). AZT toxicity includes nausea, headache, and malaise, and can affect some people strongly.

Another alternative would be a switch to a once-daily nucleoside combination, such as tenofovir and 3TC, which are better tolerated in the short term, while continuing Sustiva, in which case you would only need one dose per day. I would only suggest this if the above does not work, as you have had an excellent response, and I am reluctant to suggest changes when the viral load and CD4 response is very good.

Sustiva has a long half-life - 41 hours - and combivir shorter, as you suggest, but there is ample clinical evidence that CBV can be taken twice daily, i.e. every 12 hours.

As always, I advise that you do NOT follow this advice without first talking to your doctor and making a plan with him or her, as there may be important information that I am not aware of.


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