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Sustiva (Efavirenz) Buyer and Patient Handbook in Singapore

What is Sustiva?

Sustiva is an antiretroviral medication containing the active ingredient efavirenz, used to treat HIV-1 infection. It belongs to the non-nucleoside reverse transcriptase inhibitor (NNRTI) class, which blocks a key viral enzyme needed for replication. In Singapore, Sustiva is approved by the Health Sciences Authority (HSA) and is available as a oral tablet (pill).

Who Should Use Sustiva?

• Adults living with HIV-1 who have been assessed as suitable for an NNRTI-based regimen.
• Patients whose viral load monitoring shows benefit from efavirenz-containing therapy.
• Individuals without a history of severe psychiatric illness or seizure disorders (see contraindications).

How Does It Work?

Efavirenz binds directly to the HIV-1 reverse transcriptase enzyme, causing a structural change that prevents the enzyme from copying viral RNA into DNA. Think of the enzyme as a photocopier; efavirenz jams the machine so the virus cannot make copies of itself. By halting viral replication, the drug allows the immune system to recover and reduces the risk of disease progression.

Why Choose Sustaina?

• Generic Advantage: As a generic formulation, Sustiva offers the same clinical efficacy as brand-name options at a lower cost, which is important for long-term HIV management.
• Convenient Dosing: Once-daily oral tablets simplify adherence compared with multiple-dose regimens.
• Off-label uses (e.g., treatment of certain opportunistic infections) should only be considered after specialist consultation.

Dosage, Administration, Lifestyle and Dietary Recommendations

Recommended Dosage

• Standard adult dose: 600 mg (one 600 mg tablet) taken once daily on an empty stomach.
• Dose reduction: 200 mg (one 200 mg tablet) may be prescribed for patients who experience intolerable side effects or who are co-prescribed medications that increase efavirenz exposure.

How to Take

• Swallow the tablet whole with a small amount of water.
• Take at least 1 hour before or 2 hours after a meal to maximize absorption.
• Avoid crushing or chewing the tablet.

Missed Dose

• If you realize a dose is missed within 12 hours, take it as soon as you remember.
• If it is more than 12 hours late, skip the missed dose and resume the regular schedule; do not double-dose.

Overdose

• Seek immediate medical attention or call the Singapore National Poison Centre (180-225-369) .
• Bring the medication packaging so clinicians can identify the amount taken.

Special Populations

• Elderly: No dosage adjustment is required, but monitor for CNS side effects.
• Pregnancy: Efavirenz is classified as Category C in Singapore; discuss risks and benefits with a specialist.
• Renal/Hepatic impairment: No routine dose change, but severe hepatic dysfunction warrants careful monitoring.

Lifestyle & Diet

• Avoid alcohol excess, as it may increase central nervous system (CNS) side effects.
• Grapefruit juice can raise efavirenz levels; limit consumption.
• Smoking induces metabolism of efavirenz, potentially reducing its effectiveness; discuss Smoking Cessation with your care team.

Precautions and Warnings

• Neuropsychiatric effects (e.g., vivid dreams, Depression, Anxiety) are common; report new or worsening symptoms promptly.
• Seizure risk: Avoid use in patients with a history of Seizures.
• Hepatotoxicity: Monitor liver enzymes before initiation and periodically thereafter.
• Teratogenic potential: Women of child-bearing potential must use effective contraception throughout treatment and for at least 12 weeks after stopping the drug.

Drug Interactions

Potential Side Effects

Common Side Effects

• Dizziness
• Headache
• Insomnia or vivid dreams
• Nausea

Less Common Side Effects

• Rash
• Loss of appetite
• Mild Hypertension

Serious Side Effects

• Severe rash or Stevens-Johnson syndrome - stop medication and seek urgent care.
• Depression, suicidal thoughts - contact a mental-health professional immediately.
• Seizures - emergency evaluation required.

Who Should Avoid This Medication?

• History of major depressive disorder with suicidal ideation or uncontrolled psychiatric disease.
• Seizure disorders unless benefits outweigh risks.
• Known hypersensitivity to efavirenz or any tablet excipients.

Storage Instructions

• Keep tablets below 30 °C, away from direct sunlight.
• Store in a dry place, tightly closed, out of reach of children.
• Do not refrigerate or freeze.

Sustiva Alternatives

Frequently Asked Questions

How long does it take for Sustiva to start working?

Efavirenz begins to suppress viral replication within 2-4 weeks, but full virologic response may take up to 12 weeks.

Can I take Sustiva with coffee?

Yes, moderate coffee consumption does not affect efavirenz levels; avoid excessive caffeine if you experience insomnia.

Will Sustiva cause weight gain?

Weight changes are not a typical effect; any noticeable gain or loss should be discussed with your care team.

Is it safe to travel abroad while on Sustiva?

Maintain your dosing schedule across time zones, keep a supply for the entire trip, and carry a copy of your medication record for customs.

Can I switch from another NNRTI to Sustiva?

Switching is possible but should be guided by a specialist to ensure proper sequencing and monitoring.

What should I do if I experience vivid dreams?

These are common; taking the tablet at bedtime may help, or your clinician may adjust the dose.

Does Sustiva interact with antacids?

Antacids do not significantly affect efavirenz absorption, but continue to take the medication on an empty stomach.

Is breastfeeding allowed while on Sustiva?

Efavirenz is excreted in breast milk; Singapore guidelines advise against breastfeeding for mothers on this medication.

Glossary

• NNRTI (Non-nucleoside reverse transcriptase inhibitor): A drug class that blocks the HIV enzyme needed to copy its genetic material.
• Viral load: The amount of HIV RNA in the blood; a key marker of treatment effectiveness.
• CYP450 enzymes: Liver proteins that metabolize many drugs; efavirenz is mainly processed by CYP2B6 and CYP3A4.

Disclaimer

The information provided here is for general educational purposes and does not replace professional medical advice. All therapeutic decisions, including off-label use, should be discussed with a qualified healthcare provider. Our online pharmacy supplies only legally approved medicines; we do not dispense prescriptions. Users are responsible for verifying product availability, suitability, and any regulatory updates in Singapore.