SUSTIVA

efavirenz (EFV)

Recommended as a component of initial regimen in certain clinical situations (as a component in Atripla, Symfi, or Symfi Lo, or in combination with Descovy or Truvada)

Non-Nucleoside “Non-Nuke”

Sustiva tablet

STANDARD DOSE

One 600 mg tablet once daily, preferably on an empty stomach at bedtime. Must be taken in combination with another antiretroviral(s) which does not contain the medication in this drug or medication from the same drug class.

Approved for adults and children 3 months and older weighing at least 7.7 pounds (3.5 kg). For children weighing less than 88 pounds (40 kg), the dose is based on weight. See the package insert for specific weight-based dosing. For children weighing at least 88 pounds, use the standard adult dose. For those who can’t swallow capsules, administer by capsule sprinkle method. See below or drug label for instructions or watch video at sustiva.com.

Take missed dose as soon as possible, unless it is closer in time to your next dose. Do not double up on your next dose. Also available in 50 mg and 200 mg capsules.

Use with caution in mild liver impairment; not recommended with moderate or severe liver impairment.

MANUFACTURER

Bristol-Myers Squibb
bms.com
sustiva.com
(800) 321-1335

PHARMACY

Drug Mart Pharmacy
shopdrugmart.com
(800) 877-0337

GET STARTED – Request To Fill Your Medication

Central nervous system (CNS) symptoms (dizziness, insomnia, impaired concentration, abnormal or vivid dreams, and hallucinations) are most common at the start of treatment and usually diminish in two to four weeks. Bedtime dosing on an empty stomach can help reduce symptoms. Less common psychiatric symptoms (catatonia, depression, suicidal thoughts or actions, aggression, paranoid/manic reactions) may also occur. A 2014 study reviewed four previously published AIDS Clinical Trials Group (ACTG) studies regarding efavirenz and suicidal ideation and re-emphasized the fact that efavirenz has an association with suicidality (reported suicidal ideation or attempted or completed suicide), and should be used with caution in patients with severe or uncontrolled depression and/or a history of suicidality. It is recommended for anyone on a regimen containing efavirenz to be screened for depression and suicidality. Additional side effects may include rash, nausea, vomiting, diarrhea, and fever. Rash in children is more common and more severe. Efavirenz may raise levels of triglycerides (fat in the blood) and cholesterol. Efavirenz can cause a false positive for marijuana on certain drug tests. A more specific confirmatory test can be done. A link to birth defects in humans has not been supported in meta-analyses. The pregnancy recommendation is that women in their first trimester continue taking efavirenz as long as their viral load remains undetectable; however, efavirenz should only be used if the potential benefit outweighs the potential risk, as when other treatment options are not available. Because of the association with suicidality and neuropsychiatric effects, it is also recommended to screen for antenatal and postpartum depression in women with HIV who are taking a regimen containing efavirenz. Regular monitoring for increased liver enzyme levels is recommended initially and during treatment for people with hepatitis B/C or liver disease.

Tell your provider or pharmacist about all medications, herbals, supplements, and over-the-counter products you are taking or thinking of taking, prescribed or not, as there are other drug interactions not listed here. Do not take with midazolam, pimozide, ergot derivatives, St. John’s wort, or triazolam. May affect warfarin levels. Can decrease levels of buprenorphine and methadone—monitor for withdrawal. Increase Kaletra to two 200/50 mg tablets plus one 100/25 mg tablet twice daily (total 500/125 mg twice daily) with food when taken with Sustiva. Kaletra cannot be taken once daily with Sustiva. When using with Tivicay, increase the Tivicay dose to 50 mg twice daily. Treatment-experienced people should not take Reyataz with Sustiva, but for treatment-naïve people, Reyataz once-daily dose should be 400 mg with Norvir boost. Boost once-daily Lexiva 1,400 mg with 300 mg Norvir. No change in the ritonavir dose is required when efavirenz is administered with Lexiva plus ritonavir twice daily. Increase Selzentry to 600 mg twice daily. Increase the Sustiva dose to 800 mg once daily with rifampin for people weighing 110 pounds (50 kg) or more. Rifabutin can be used as an alternative, but dose adjustment is needed. When taken with carbamazepine, phenobarbital, or phenytoin, periodic monitoring of anticonvulsant and Sustiva levels should be done or alternative anti-seizure drugs, such as levetiracetam, should be considered. Effectiveness of birth control pills may be decreased; consider the use of other contraceptives. Closer monitoring and dose adjustments may be required with posaconazole (avoid unless benefit outweighs potential risk) and itraconazole. The dose of voriconazole should be increased to 400 mg every 12 hours and the Sustiva dose should be decreased to 300 mg once daily using capsules; tablets should not be broken. Monitor effectiveness of clarithromycin or consider using azithromycin instead. Levels of immunosuppressants should be monitored when starting or stopping Sustiva. Cardizem, Lipitor, Pravachol, and Zocor doses may need to be adjusted. Titrate dose of bupropion and sertraline based on clinical response. Should not be taken with other medications that prolong QT interval or medications with a known risk of torsades de pointes. No dose adjustment with Harvoni or Sovaldi. Increase Daklinza dose to 90 mg with Sustiva. Don’t take with Epclusa, Olysio, Viekira Pak, or Zepatier. Tell your provider or pharmacist about all medications, herbals, and supplements you are taking or thinking of taking, prescribed or not, as there are other drug interactions which are not listed here.

If you can’t sleep, ask your doctor about gradually adjusting the timing of your dose until it’s taken during the day. A rare genetic trait affecting drug metabolism of Sustiva, leading to a higher rate of side effects, occurs more in African Americans. In pediatric HIV guidelines, Sustiva was downgraded in 2017 from “preferred” to an “alternative” component of an initial regimen for children ages 3–12 years. For individuals with HIV-2, commonly found in some other countries, an NNRTI would not be recommended as HIV-2 is inherently resistant to NNRTIs. Efavirenz is found in the single-tablet regimens Atripla, Symfi, and Symfi Lo; see those pages.

Efavirenz is a very potent and long-acting antiviral. Sustiva is the anchor drug of Atripla, the first and most widely used single-tablet regimen for the last 11 years. Sustiva’s central nervous system side effects are challenging. Dizziness, weird dreams, depression, and feeling tired constantly are some of the side effects reported. Some individuals tolerate it well and others manage to overcome them after three months. Other NNRTIs and INSTIs with no CNS side effects, as effective and way more tolerable have been developed.

Karen T.
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"They truly care, I tell everyone to go here. I've been with them since 2008."
Yolanda P.
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"Always helpful to save money on medication and very kind."
Michael A.
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"Helpful and knowledgeable. Can't ask for better service, thank you!"
Patti E.
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"The staff at Drug Mart are exceptionally helpful. The quality of their products are top notch. I recommend Drug Mart to everyone. Am with them for life!!"
Darryl F.
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"This is the best pharmacy I have ever been to. They are caring, helpful and treat you with respect."
Anita H.
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"My daughter was able to get emergency medication after hours within half hour of making the phone call to the 800#. I can't recommend Drug Mart more highly."
Robert T.
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"I've been going here for years since my doctor recommended this pharmacy. They're busier now then when I first started but their service is still top notch. Thanks again for all your help!"
David D.
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"They are most accommodating, courteous, friendly and professional pharmacist I've ever dealt with. I'm so grateful to call this pharmacy my own."
Tonia B.
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"Always very caring when asking a question about your medication they know what they're talking about and they are very knowledgeable I've been going to them for oh my goodness since they opened up wow where did time go anyway my drug store for life thank you!"
Josh P.
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"This pharmacy is one of the best. Pharmacist has lots of knowledge and staff takes time to explain in detail. They do other half of what doctors should do. Also, no waiting like big name pharmacy. I highly recommend this pharmacy. They also deliver and ship to anywhere in USA."
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Drug Mart Pharmacy
5.0
Based on 163 reviews
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Chanice Dorsey
Chanice Dorsey
02:45 12 Mar 20
The staff at Drug Mart are truly an extension of my family. Vik offered me one of the greatest opportunities while in... nursing school, as a graduate, and as a working professional. He continues to encourage young adults to pursue their dreams and provides them with opportunities to be impactful within the community. You can’t get any better than this.read more
langston hannah
langston hannah
12:02 07 Mar 20
I am very pleased with the service that I receive from the pharmacy. The people who serve you are very helpful and... friendly and assist you in any way that they can. The pharmacist are well informed with your prescription needs, if there's a problem with anything you need they will do their best to resolve any issue you have. I recommend everyone to check them out and get their prescriptions filled at Drug Mart. I will always be a customer of Drug Mart because they are so good at what they do.read more
Yolanda Mesa
Yolanda Mesa
15:11 05 Mar 20
The best pharmacy I ever went. Staff is very polite and friendly. Very fast and they also deliver. One time I totally... forget about a medication and they went to my house.read more
tracey evans
tracey evans
16:32 03 Mar 20
Drug Mart is my family, I’ve been with them since day 1. I moved away for a few years to another state, I’ve been... back i NJ. a little over 5 years and I’m still a happy customer. They’re very friendly, knowledgeable and very helpful and understanding, prices are better then most..read more
Cassandra Hemby
Cassandra Hemby
21:33 28 Feb 20
I so appreciate the dear people @Drug Mart! I am recovering from cancer and one day while in Chemotherapy I was told I... would need a certain cream right away, but I wouldn't be able to pick it up that day.however there is this very courteous and sweet young lady named Michele that assured me it would be delivered to me in at my daughter's home in Woodbridge, NJ, because that is where I go after having treatment.The kind of caring and compassion received there have made the staff endearing to me and has restored my faith in customer service again.read more
Denise Eady
Denise Eady
20:38 24 Feb 20
I love this place. Best pharmacy around!!!. I have been using this pharmacy since it opened. Whenever I walk in,... everyone is very cordial and always pleasant and with a smile, and they always greet me by nmy name. Vic and the other Pharmacists are very knowledgeable, and the staff takes the time to explain any new medications in detail. If you are not able to pick up your prescriptions, they do HOME delivery which is great. I transferred from Walgreens pharmacy and I am so glad I did!!!read more
Jay Bhatt
Jay Bhatt
21:05 22 Feb 20
The quality of service provided by the pharmacist and the staff is excellent! I wouldn't go to any other pharmacy. They... truly care.read more
Cindy Hall
Cindy Hall
15:21 20 Feb 20
I never have to wait. This is the best pharmacy I ever went to. I highly recommend them to everyone!
Maisha Bryant
Maisha Bryant
00:32 20 Feb 20
I have known Vik and his family since they opened. They have bright back what it means to have a home town family... operated pharmacy. He remembers you, that you have had a baby etc. He is compassionate and always goes above and beyond. He trains his staff to pursue their own dreams. Some have gone on to school. My prayer is that God gives him a long healthy life and that his business continues to prosper. Oh and BTW if you move he does mail order so he can continue to be your pharmacist no need to switch!read more
Sharel E. Gordon-Love
Sharel E. Gordon-Love
19:46 19 Feb 20
My family has been with Drug Mart since they first open and we’ve received top notch service every single time. Vic... and the staff are very friendly, and we are greeted with a smileread more
Tammy Nichols
Tammy Nichols
23:23 18 Feb 20
I used to get my prescriptions at Cvs. But when Drug Mart open close to my house i figured I give then a try and have... not looked back. The staff is always kind, helpful, and considerate. LOVE THIS PLACE.❤read more
Yolanda Parker
Yolanda Parker
20:50 17 Feb 20
I enjoyed the customer service I experience when I go into this store the friendly atmosphere the warm welcome you get... upon entering and exitingread more
Mike Webb
Mike Webb
16:48 06 Feb 20
Great being able to pick up my meds at this pharmacy. They are the best!
Janet Bynum
Janet Bynum
18:21 28 Jan 20
Leaving his experience I had with Drug Mart it's coming there getting my medication and then delivering it to me very... happy who had Drug Mart in my life far as my medications is concerned I don't have to call for refills they deliver them to me I've been the drug mart play my medications concern about 7 years or more appreciate the people they appreciate me I'm happy with Drug Mart this is my the best pharmacist that I know thank youread more
james hunter
james hunter
21:25 24 Jan 20
Always ready to help! Any way possible thank you for all your years of service!
Michelle Reyes
Michelle Reyes
21:03 24 Jan 20
Awesome staff always willing to help out 🙂
cindy ortega
cindy ortega
20:41 24 Jan 20
I love this pharmacy. Everyone makes you feel like your family. Any issues with prescription they try to resolve it... asap. I recommend this pharmacy to everyone.read more
jacqueline wells
jacqueline wells
19:33 31 Dec 19
Drug mart has the most pleasant employees and the service is swift I can't say enough good things about this pharmacy... Thanks for your years of dedication and service in our communityread more
Chris Hanington
Chris Hanington
13:47 18 Jul 19
These people take great care of THEIR people. Impressive!
R Turner
R Turner
21:57 01 Jun 19
I've been going here for years since my doctor recommended this pharmacy. They're busier now then when I first started... but their service is still top notch. Thanks again for all your help!read more
John Aleksandrowicz
John Aleksandrowicz
22:21 14 Apr 19
Great pharmacy with great customer service. Vik is great. He obviously cares about people and understands the needs of... each. Thank you!read more
Karen T
Karen T
18:54 06 Jan 19
This pharmacy is the best! I left Walgreens and very glad I did. They take the time to explain my medicines and know me... by name. I recommended them to all my family and friends.read more
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