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Sustiva, Combivir, Xanax, Ambien and ANXIETY!
Dec 28, 2001

I recently began combination therapy of Sustiva and Combivir. Shortly after starting, I began having bouts of anxiety, mild depression and panic attacks. While I have recently begun seeing a therapist, I have been prescribed Xanax to help with the panic and Ambien to help sleep. I have seen conflicting information regarding the drug interactions of Xanax and Ambien with Sustiva and combivir. Am I in danger with combining these drugs? Also, I have been on the Sustiva/Combivir for 8 weeks but was taken off of them due to a rash. The rash did not go away after a week so I am back on the medication. Will my anxiety ever decrease? Most literature says 2 to 4 weeks but mine is not improving. Please help.

Response from Dr. Boyle

The sympotoms you're describing may be related to taking efavirenz (Sustiva/Stocrin) or to other factors, such as starting therapy, having to take pills everyday, and other factors. In the vast majority of patients the side effects associated with efavirenz remit after a few days or weeks of therapy, but in some patients this may occur a little later or not at all. Continuing on the therapy has to be a decision you make with your doctor and would involve a discussion of many things, but certainly how severe the side effects are, how well you are responding to the therapy, and what other treatment options you have. Due to the efavirenz interaction with the cytochrome p450 enzymes, drug metabolism can be affected. The drugs you are on (ambien and Xanax) are metabolized by the these enzymes and while not contraindicated, but should be used with caution and adjusted as needed.

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