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The following safety and warning information is crucial for anyone prescribed efavirenz (Sustiva). It is important to discuss any concerns with your healthcare provider to ensure safe usage of this medication.

• Heart Rhythm Disturbances (QT Prolongation): Efavirenz (Sustiva) may cause serious heart rhythm issues, which can be life-threatening. The risk is elevated if you have existing heart conditions or are taking other medications that affect heart rhythms, such as amiodarone. Symptoms like a pounding heart, difficulty breathing, chest pain, or feeling faint require immediate medical attention by calling 911.

• Neurological and Mental Health Effects: Rarely, this medication can increase the risk of seizures, dizziness, vivid dreams, hallucinations, and sleep disturbances. These symptoms may appear within the first couple of days of treatment and typically subside within 2-4 weeks. Individuals with a history of seizures, nerve damage, or mental health issues should be cautious. Inform your healthcare provider of any mental health medications or other substances that might heighten seizure risks.

• Pregnancy Risks: Efavirenz (Sustiva) can increase the risk of neural tube defects in unborn babies when taken during early pregnancy. It is advised to avoid pregnancy during treatment and for three months after stopping the medication.

• Severe Skin and Allergic Reactions: This medication can cause rashes or severe skin reactions, usually within the first two weeks of treatment. If a rash appears, continue taking the medication but inform your provider. For severe rashes accompanied by fever, discomfort, joint pain, or facial swelling, discontinue use immediately and seek medical help.

• Liver Complications: Efavirenz (Sustiva) may lead to severe liver issues. Regular blood tests will be conducted to monitor liver health. Be alert for symptoms such as excessive fatigue, nausea, loss of appetite, jaundice, or dark urine, and notify your healthcare provider if these occur.

• Elevated Cholesterol Levels: This medication can increase cholesterol and triglyceride levels, raising the risk of heart attacks or strokes. Cholesterol levels will be monitored, and additional medications may be necessary to manage them. Inform your provider about all medications you are taking, as some cholesterol drugs may be less effective when used with efavirenz.

• Changes in Body Fat: Some individuals may experience alterations in body fat distribution, including fat accumulation or loss in certain areas. Report any noticeable changes to your healthcare provider.

• Overactive Immune Response: Efavirenz (Sustiva) can cause immune reconstitution syndrome, where the immune system becomes overly active, potentially attacking normal cells. New symptoms like fever, pain, or sweating should be reported to your provider immediately.

• Drug Interactions: Efavirenz (Sustiva) can interact with other medications, affecting its efficacy and increasing side effects. Ensure your healthcare provider is aware of all drugs you are taking.

Contraindications:

• Efavirenz (Sustiva) should not be used concurrently with Zepatier (elbasvir / grazoprevir) due to potential health risks. Always consult your healthcare provider if you are on this or any other medication before starting efavirenz (Sustiva).

Efavirenz may cause a range of side effects, some common and mild, while others are rare and serious. Often, side effects like dizziness, trouble sleeping, drowsiness, unusual dreams, and trouble concentrating may occur, especially in the first few days of treatment. These effects usually diminish within 2-4 weeks and can be minimized by taking the medication on an empty stomach at bedtime. Tiredness, headache, nausea, vomiting, and diarrhea are other common side effects that generally improve over time.

A common rash may appear within the first few weeks of treatment. While usually not serious, any rash should be monitored closely, as it could indicate a severe reaction. Less frequently, patients may experience changes in body fat distribution, such as increased fat in the upper back and stomach areas and decreased fat in the arms and legs. The implications of these changes are not fully understood.

Serious side effects, though rare, require immediate medical attention. These include severe allergic reactions characterized by rash, blisters, peeling skin, fever, and swelling of the face, tongue, or throat. Liver problems may present as persistent nausea, vomiting, abdominal pain, yellowing of the skin or eyes, and dark urine. Mood changes, such as depression, anxiety, confusion, or hallucinations, should also be promptly addressed. In very rare cases, symptoms like unexplained weight loss, severe tiredness, or muscle aches may indicate an overactive immune response.

Always contact your healthcare provider if you experience significant side effects or if common side effects persist or worsen.

Efavirenz, often referred to by its brand name Sustiva, can interact with a variety of medications and supplements. It is important to inform your healthcare provider about all medications you're currently taking, including prescription, over-the-counter, vitamins, and herbal products.

Certain drugs should not be used with efavirenz due to potential adverse interactions. Your doctor might choose to adjust your treatment plan if you're using medications like bepridil, carbamazepine, cisapride, dasabuvir, dronedarone, elbasvir, grazoprevir, maraviroc, mesoridazine, paritaprevir, pimozide, piperaquine, ritonavir, saquinavir, sparfloxacin, St John's Wort, terfenadine, thioridazine, voriconazole, or ziprasidone.

In some situations, using efavirenz with other medications might be necessary, but it is typically discouraged. If this is the case, your healthcare provider may adjust dosages or modify how often you take these medications. Such drugs include abametapir, alfentanil, alfuzosin, amiodarone, amisulpride, amitriptyline, amprenavir, anagrelide, apomorphine, aripiprazole, arsenic trioxide, and others. Atazanavir, for instance, may require a concurrent prescription of ritonavir.

Efavirenz can accelerate the removal of certain drugs from your body, potentially altering their effectiveness. This includes medications like atovaquone, azole antifungals, bedaquiline, macrolide antibiotics, methadone, rifabutin, sertraline, statins, and warfarin.

It's also worth noting that efavirenz could reduce the efficacy of hormonal contraceptives, increasing the risk of unintended pregnancy. Discuss reliable backup methods with your doctor and report any unexpected bleeding.

Additionally, efavirenz may cause increased drowsiness when used with other sedating agents like alcohol, marijuana, antihistamines, sleep or anxiety medications, muscle relaxants, and opioids. Always check medication labels for drowsiness warnings and consult your pharmacist for safe use.

Lastly, efavirenz might interfere with certain laboratory tests, including urine cannabinoid tests, potentially leading to inaccurate results. Ensure all healthcare professionals involved in your care are aware of your efavirenz use.