Efavirenz for HIV (Sustiva)

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Efavirenz slows the progress of HIV infection. It is one of a number of medicines that you will need to take regularly.

Take one dose daily, preferably at bedtime.

Efavirenz has been associated with some side-effects, most commonly a rash. Your doctor will discuss this with you before you start treatment.
Type of medicineA non-nucleoside reverse transcriptase inhibitor antiretroviral medicine
Used forHuman immunodeficiency virus (HIV) infection (in adults and in children over 3 years of age)
Also calledSustiva®; there is also a combination tablet called Atripla® which contains efavirenz with two other antiretroviral medicines called tenofovir and emtricitabine
Available asCapsules and tablets

Efavirenz is an antiretroviral medicine. It is used for human immunodeficiency virus (HIV) infection. It slows the progress of HIV infection, but it is not a cure. HIV destroys cells in the body, called CD4 T cells. These cells are a type of white blood cell and are important because they are involved in protecting your body from infection. If left untreated, the HIV infection weakens your immune system so that your body cannot defend itself against bacteria, viruses and other germs. Efavirenz slows down the progress of HIV infection by reducing the amount of virus in your body. It does this by stopping the virus from copying (replicating) itself.

Efavirenz will be prescribed for you in a hospital clinic by a doctor who is a specialist. It belongs to a group of antiretroviral medicines known as non-nucleoside reverse transcriptase inhibitors. It is given alongside a number of other antiretroviral medicines, as part of a combination therapy. Taking three or more antiretroviral medicines at the same time is more effective than taking one alone. Taking a combination of different medicines also reduces the risk that the virus will become resistant to any individual medicine. It is vital to take them exactly as prescribed to maintain success and to help to prevent the virus from becoming resistant to the medicines. These medicines are usually taken for life.

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking efavirenz it is important that your doctor knows:

  • If you are pregnant, trying for a baby or breast-feeding.
  • If you have any problems with the way your liver works, or if you have any problems with the way your kidneys work.
  • If you have ever had any mental health problems.
  • If you have ever had a fit (seizure).
  • If you have a rare inherited blood disorder called porphyria.
  • If you are taking any other medicines. This includes any medicines which are available to buy without a prescription, as well as herbal and complementary medicines.
  • If you have ever had an allergic reaction to a medicine.
  • Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about efavirenz, and it will also provide you with a full list of the side-effects which you could experience from taking it.
  • Take efavirenz exactly as your doctor tells you to. The usual dose for an adult is one tablet (600 mg) daily. If your child has been given capsules to take, your doctor will advise you about how many should be taken for each dose. The dose will also be printed on the label of the pack to remind you about what the doctor said.
  • Efavirenz should be taken when your stomach is empty, which means taking it one hour before a meal, or waiting until two hours after you've eaten. This is because your body absorbs more efavirenz after a meal, which makes side-effects much more likely.
  • Try to take efavirenz at the same time of day each day, as this will help you to remember to take efavirenz regularly. Your doctor is likely to recommend you take your doses at bedtime.
  • Do not drink grapefruit juice while you are on efavirenz. This is because a chemical in grapefruit juice is thought to increase the amount of efavirenz in your bloodstream, making side-effects more likely.
  • If you forget to take a dose, do not 'double-up' on the following day to make up for the missed dose. Leave out the forgotten dose from the previous day and take the dose that is due as normal.
  • Keep your regular appointments with your doctor so that your progress can be monitored. You will need to have regular blood tests.
  • It is important that you continue to take efavirenz and your other antiretroviral treatment regularly. This will help to prevent the HIV from becoming resistant to the medicines you are taking. Even if you miss only a small number of doses, the virus can become resistant to treatment.
  • If you develop an infection soon after you start the treatment, let your doctor know. As a result of taking efavirenz, your immune system may start fighting an infection which was present before you started the treatment, but which you may not have been aware of.
  • Follow carefully any advice your doctor gives to you about making lifestyle changes to reduce any risk of damage to your heart and blood vessels. These can include stopping smoking, eating healthily and taking regular exercise.
  • Although treatment with antiretroviral medicines may reduce the risk of you passing HIV to others through sexual contact, it does not stop it. It is important that you use condoms.
  • It is not uncommon for people with HIV to feel low or even depressed, especially soon after the diagnosis has been made and treatment has been started. If you have any feelings of depression, or any distressing thoughts about harming yourself then you should speak with your doctor straightaway.
  • Some people who have taken antiretroviral medicines (particularly over a long time) have developed a condition called osteonecrosis. This is a bone disease where bone tissue dies because there is a reduced blood supply to it. It leads to joint pains and stiffness, and can cause difficulties in movement. If you notice any of these symptoms, speak with your doctor.
  • If you buy any medicines, supplements or herbal remedies 'over the counter', check with a pharmacist that they are suitable to take with efavirenz and your other medicines. This is because some medicines interfere with antiretrovirals and can stop them from working properly. In particular, do not take St John's wort.
  • Some people taking antiretroviral medicines develop changes to the way body fat is distributed in the body. This can result in changes to body image. Your doctor will discuss the possibility of this with you.
  • If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.
  • Treatment for HIV is usually lifelong. Continue to take efavirenz regularly, even if you feel well. This is to keep your immune system healthy.

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with efavirenz. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Common efavirenz side-effectsWhat can I do if I experience this?
Itchy rash (usually within the first week or so)If this is severe, such as if blisters develop or if you also have a high temperature (fever), let your doctor know about it straightaway
DiarrhoeaDrink plenty of water to replace lost fluids
Feeling or being sick, tummy (abdominal) painStick to simple meals - avoid fatty or spicy food. If it continues, speak with your doctor
HeadacheAsk your doctor to recommend a suitable painkiller
Feeling dizzy or tiredDo not drive and do not use tools or machines while affected
Feeling anxious or depressedLet your doctor know about this
Problems sleeping, lack of concentration or coordinationThese usually improve after a few weeks
Changes to some blood tests (such as raised cholesterol levels)Your doctor will check for this

If you experience any other symptoms which you think may be due to efavirenz, speak with your doctor or pharmacist for further advice.

  • Keep all medicines out of the reach and sight of children.
  • Store in a cool, dry place, away from direct heat and light. 

Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital at once. Take the container with you, even if it is empty.

This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.

Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.

If you have any questions about this medicine ask your pharmacist.

Further reading & references

Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. EMIS has used all reasonable care in compiling the information but make no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details see our conditions.

Original Author:
Helen Allen
Current Version:
Peer Reviewer:
Prof Cathy Jackson
Document ID:
28515 (v2)
Last Checked:
Next Review:
The Information Standard - certified member

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