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Ask the Experts about General Treatment Strategies
Is my sustiva dose too high? /CNS effects
Aug 30, 2000
I have been taking sustiva for 9months in combo with epivir and zerit... the results have been good numbers wise.. undetectable viral load and cd4s fluctuating btwn 600-800. However, I have night after night of dreams, depressed moods, and have strong emotional responses during the night mostly negative, and have to remind myself that I am fine that the drugs are causing this reaction at night. It is becoming exhausting? I am 6' 190lbs and built solid not fat. I started this routine when my vload went to 34k. and cd4s were at 500. Is it time for a drug vacation..? I am beginning to wonder
Response from Dr. Stryker
Sustiva certainly causes effects like you are having, in many people, though often the side effects improve with time. The effect is not very dose-related, and you should not attempt to take less Sustiva. That would just lead to resistance, probably quickly.
In early clinical trials, splitting the dose between morning and evening was tried, but this did not help with the central nervous system/brain effects you are having. When you take Sustiva, it should be in a single daily dose as you are doing now.
Your situation is complicated, and should be discussed with your doc in detail if you haven't already. The vivid dreams aren't likely to go away on their own at this point, so changing to a new combination may be a good option. For instance, replacing Sustiva with nevirapine, another drug in the same class, may be a good choice if your viral load is still undetectable. Also, be sure that any underlying depression or mood disturbance that doesn't seem drug-related is addressed. It is great that your numbers have responded so well, but I worry when patients describe side effects as "exhausting"; it will be hard to keep putting up with the symptoms, and you may start missing doses to avoid them.
Time for an adjustment, I would guess. Good Luck! RAS
Rick Stryker, M.D., M.P.H.
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