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sustiva - success with lower dose?
Apr 24, 2006

Hi, My fiance has been using Sustiva for almost three years now (in combination with Combivir for several years). His viral load remains undetectable, and all his lab numbers are great, but the Sustiva CNS side effects are increasing - like the initial 'get acquainted' weeks when he first began his nightly 600 mg dose (unable to sleep, unable to fall back asleep when he wakes up several times a night, nervous system super charged in an electric feeling way...). We are debating the move to another class (Kaletra + Combivir) in order to have better quaility of life, but of course we'd like to preserve this class for later if possible. I've recently found scattered (new) studies indicating lower doses may solve the CNS side effects, while still suppressing the virus. Are any Sustiva users having success with lower doses?

Three days ago he took himself off the Sustiva, while maintaining his Combivir, until he sees his doctor to discuss the possibilities - two days from now. He's already feeling withdrawal side effects. The only other med variable is his recent opiate stop: 10-20 mg three times daily dose of Oxycontin, and before that 25 mg patch per 48 hours Fentanyl to aid his recovery for two ankle transplants (2 years ago) severely deteriorated joints and Hemophilic bleeds. He got tired of jumping through hoops to get a never changing script for these pain meds, and titrated himself off, now three weeks ago. Could the opiates be triggering this adrenaline reaction?

Thanks for your help, and this resource. With multiple viruses and a very complex stressful life, we appreciate your voice. Blessings to you,


Response from Dr. Conway

Dear Colleen:

Thanks so much for taking the time to write, I'm sure your fiance appreciates it. It may well be that the opiate withdrawal is contributing to the symptoms that are occurring, but it sounds as if they were already occurring before the opiates were cut down.

The first thing I would say is that he should NOT stay on 2 drugs alone, as this is a set-up for the development of drug resistance, especially to the lamivudine part of the Combivir. So, it is best to stay on everything OR stop everything until you see the doctor. As for a switch in therapy, changing a single drug at a time is OK if the viral load is undetectable. You could change the efavirenz to either Kaletra or Reyataz, for instance. Doing this, you can always come back to NNRTIs in the future if need be so you are not compromising any future options, so don't worry about this aspect of it. The key here is to STAY ON HAART (not 2 drugs) and not compromise the important gains you have already made.

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