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However, many current and
potential users of Sustiva are concerned about its potential
for side effects affecting the central nervous system (CNS).
These side effects primarily involve various sleep disturbances
and changes in mood or mental outlook. Below is a list of
the most common CNS side effects, and some of the medical
and lifestyle steps that patients, with the help of their
health care providers, can take to manage them.
Most studies of Sustiva have
shown that the drug’s side effects for most users are
mild to moderate and either disappear or become much less
serious during or after the first few weeks of use. For others,
the side effects persist. Most people taking Sustiva should
take it on an empty stomach. Food can cause your body to absorb
more Sustiva, making side effects more frequent or more serious.
How often and for how
long?
Clinical study data show
that about 53% of patients taking Sustiva have some kind of
CNS symptoms, as opposed to about one-quarter of those in
control groups. For 33% of patients, the symptoms were mild.
Another 17% experienced symptoms described as moderate, and
2% had severe symptoms. Reports of how long CNS side effects
may last vary widely, depending on the kind and size of study
and the ways the data are analyzed and reported. As just one
example, however, in one study, about 65% of participants
reported dizziness at one month on Sustiva treatment, with
about 11% reporting dizziness at six months. Similarly, 35%
reported insomnia at one month, with some 8% reporting it
at six months. The CNS side effects associated with Sustiva
generally come under one of five general categories: sleep
disturbances (insomnia, unusual dreams—which people sometimes
like, or drowsiness); dizziness; impaired or reduced ability
to concentrate; nervousness, anxiety, or agitation; and depression.
Watch for pre-existing conditions,
such as anxiety or depression, and treat them. Sustiva might
worsen the symptoms. If you were already experiencing difficulty
falling asleep or staying asleep before you began to take
Sustiva, be sure to tell your physician. That could mean that
some other medical or emotional problem is at the root of
your sleep problems, and it should get its own diagnosis and
treatment. A final caution about using Sustiva: Some doctors
also believe that Sustiva should not be used by people who
work in certain potentially hazardous occupations where complete
concentration is needed at all times—for example, pilots
and operators of heavy machinery.
Insomnia
- Avoid substances that can disrupt
sleep, such as drinks containing caffeine (regular coffee,
tea, and cola); alcohol; nicotine; and chocolate. This applies
especially during the evening.
- Take Sustiva in the morning,
rather than at night, as is usually suggested.
- Try to exercise during the earlier
parts of the day.
- Try to eliminate recreational
drugs like methamphetamine (crystal) or cocaine that stimulate
the nervous system.
- Some herbal products, like ephedra
and ginseng, can also have stimulating effects.
- Practice relaxation techniques
such as yoga, meditation, breathing exercises, or others
which may help limit sleep disturbances.
- Practice what is called good
sleep hygiene, a frequent recommendation for anyone experiencing
sleep disturbances. Sleep hygiene includes measures like
going to bed at the same time each night; getting up at
the same time each morning; not watching television in bed;
having a bedroom that is comfortable, quiet, and cool; and
using your bed only for sleep and sexual activity.
- Those having trouble falling
asleep may require a prescription for a relatively short-acting
sedative like Ambien or Ativan.
- For those waking up during the
night or too early in the morning, your doctor may want
to prescribe a longer-acting sedative like Desyrel or Restoril.
Unusual dreams
- Maintaining regular sleep habits,
as suggested above, may help.
- Try to relax or enjoy pleasant
activities before going to bed—for example, listening
to soft music or watching an enjoyable movie.
- Avoid disturbing TV programs,
movies, or reading material before bedtime.
- Taking your Sustiva dose during
the day, if possible, may also help.
- A sedative like Ativan or a low
dose of Desyrel could be tried.
- In more rare cases, a physician
may prescribe a more powerful tranquilizer or antipsychotic
drug like Haldol or Zyprexa.
Daytime drowsiness
- Take the drug in the evening
or at bedtime, if you’re not doing that already.
- Time your dose of Sustiva to
12–15 hours before you need to start work.
- Caffeine may help you get past
short-term drowsiness.
- If the problem is chronic, your
doctor may suggest a prescription for a drug like the CNS
stimulants Ritalin or Cylert.
Dizziness
- Take Sustiva at bedtime, which
is the standard advice for beginning therapy. Take your
dose 12–15 hours before you need to start work.
- Avoid driving.
- Clear obstacles that may contribute
to a fall, such as clothes on the floor.
- Some practitioners will also
urge you to drink more water and to stop using the supplements
ephedra and ginseng.
- Pharmaceutical treatments may
include Antivert or Dramamine, antihistamines that also
work against nausea and dizziness.
Impaired or reduced concentration
- Use appointment books, calendars,
or notes to keep track of things you need to do.
- Drinks that contain caffeine—like
coffee, tea, or cola—may help improve your mental alertness.
- Some doctors may suggest a prescription
for a drug like Ritalin or Cylert.
Nervousness, anxiety,
or agitation
- Limit or cut consumption of stimulants,
such as caffeine, prescription or non-prescription medicines
that can cause stimulation, and recreational drugs.
- Try stress-reducing activities
like most forms of exercise, yoga, meditation, or breathing
exercises, which can also relieve symptoms of nervousness,
anxiety, or agitation.
- Medications include tranquilizing
drugs (called anxiolytics) such as Ativan, Klonopin, or
one of the benzodiazepines (Valium, Xanax).
- For more severe symptoms, like
mild agitation, Zyprexa, Haldol, or Risperdal may be tried—but
generally only after a more formal psychiatric evaluation.
Depression
Depression occurs in 22–45%
of all people with HIV, and it is diagnosed and treated less
than it should be. If you have any signs of or history of
depression, be sure to tell your doctor. In addition to a
more formal psychiatric evaluation, you may possibly start
therapy with an antidepressant before beginning to use Sustiva.
- Avoid alcohol and recreational
drugs.
- Use relaxation and stress reduction
techniques.
- Maintain an exercise program.
- Brighten your surroundings and
get out into the fresh air and sunshine.
- Keep a journal that lets you notice
things that affect your mood.
- Antidepressant medications of
first resort are the selective serotonin reuptake inhibitors
(SSRIs), which include Prozac, Paxil, Zoloft, and several
others.
- For severe symptoms, an anxiolytic
or a sedative may be prescribed.
- St. John’s Wort can have
potentially serious interactions with Sustiva, and you should
not take it.
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