Meds, Mind, Body & Benefits > Questions About Treatment & Side Effects

Efavirenz 400mg vs 600mg - as good as, less CNS side effects

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Ann:

--- Quote from: SteveS on July 05, 2013, 04:49:18 AM ---
I would be interested in Ann's perspective. She seems quite knowledgable.

What might this mean for those of us on Atripla?

I am fine with 2 or 3 pills, as long as they can be taken at the same time each day. Might they retool the levels in Atripla? Or is another combination available to me? Sorry - I am VERY new to all of this...


--- End quote ---

Steve, I've discussed this twice recently, so rather than type it all out again, I've quoted the relevant posts below. You can go into the thread where they were originally posted by clicking on the "Quote from: Ann [etc]" link at the top of the quote box.


--- Quote from: Ann on February 07, 2013, 07:48:26 AM ---
And just a little Sustiva aside that you might be interested in hearing - when my partner was first put on Sustiva (and Combivir* as was usual back in the early 2000s), he had really bad nightmares every freaking night. I mean waking-up-the-whole-house-and-neighbours-too screaming nightmares.

He'd been an aide worker in South Sudan during the 90s and every night he relived every horrible thing and all the human suffering he saw there - but even more gruesome and horrifying than in real life.

Back in those days (early 2000s), Sustiva was considered the freakin' bee's knees. Instead of switching him for something else (fewer choices available then), they did something called Therapeutic Drug Monitoring (TDM) on him and discovered that he always had much, much higher concentrations of Sustiva in his blood than he should have had.

The usual dose is 600mgs. At first they dropped him down to 400mgs, but he was still having nightmares more often than not and TDM still showed too-high levels. Then they dropped him down to 200mgs (practically unheard of!) and the nightmares stopped for the most part.

He remained UD on this low dose for around nine/ten years (aside from the occasional blip), until they switched him to Intelence late last summer. (still UD) While he no longer has the nightmares, and no longer talks in his sleep, he's still having trouble getting a good night's sleep.

*They switched the Combivir out for Truvada ... around 2007, IIRC.

--- End quote ---


--- Quote from: Ann on June 12, 2013, 07:04:52 AM ---
My partner started out on the usual 600mgs of Sustiva (back in the days before Atripla) and his Sustiva-induced side-effects were through the roof. They cut him back to 400mgs - using TDM as a guide - and eventually cut him back to 200mgs, also using TDM as a guide.

He still had side-effects, but they were more manageable. He did NOT cut down on his other two meds (AZT and lamivudine - aka Combivir) as they were NOT at too-high levels. They were just right.

During the last few years of being on Sustiva 200mgs, they switched him from Combivir to Truvada. No change in side-effects. He is now on Intelence (etravirine) and Truvada and feels much better for it.

For the record, my partner is pretty much the same size as you - slightly taller height, slightly lower weight. Having optimal drug levels in your body has much more to do with your body's metabolism, liver function and kidney function than it does your height and/or weight.


--- End quote ---

I'm happy someone has finally done a study on a reduced Sustiva dosage. However, I don't think the makers of Atripla will be very happy about it - or am I being cynical? ;)

JMMich:
This should make the Atripla manufacturers happy, at least in theory. They can make a version #2 of the pill with the 400mg dose, then charge probably about the same amount for it but with a (presumably) larger profit margin since they don't have to put as much efavirenz into manufacturing it. And, as an added bonus, their PR flacks can tout it as "the latest cutting edge treatment for HIV" even if in reality all it is, is tweaking an already-existing product.

Then again, this is big business we're talking about...Ann is probably right, they're unlikely to be too pleased.

SteveS:
Thanks - I understand more now. Thankfully, though my dreams are much more vivid, it is not bothering me much.

I do hope however that someone comes up with one pill with the lower dose. To me, the less medicine the better.

Ann:

--- Quote from: SteveS on July 05, 2013, 11:49:24 AM ---
I do hope however that someone comes up with one pill with the lower dose. To me, the less medicine the better.


--- End quote ---

The less medicine the better? You'd be taking the same amount of meds whether it was one pill (Atripla) or three (two 200mgs Sustiva + one Truvada).

I really don't get the allure of taking one pill as opposed to two or three or four. They can all go down in one either way.

I take three pills at once (one Prezista, one Norvir, one Truvada) and that's recently down from four (two Prezista, one Norvir, one Truvada - Prezista went from 2x400mg to 1x800mg) and one less pill hasn't made the slightest difference. They all go down the hatch in one gulp.

In fact, I take nine pills (non-hiv meds) in the morning and they also go down in one. Swallowing a handful of pills is no different to swallowing food when you're eating.

I totally get wanting a once-a-day combo, because it can be too easy to forget to take meds twice a day, but I really, really don't get the big deal about only having to take one pill once a day as opposed to two, three or four (or nine!) once-a-day.

darryaz:

--- Quote from: Ann on July 05, 2013, 11:08:34 AM ---However, I don't think the makers of Atripla will be very happy about it - or am I being cynical? ;)

--- End quote ---

If they want to make lemonade from this news they will come out with a NEW product..... Atripla Lite or something like that.

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