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

ADHD & choice of 1st combo

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My ADHD makes it hard for me to concentrate and Ritalin helps me a lot.  Now it's finally time for meds (after 9 years med free) and my doc seems to prefer Sustiva (it's the preferred backbone drug at Victoria Clinic, London).  I'm not keen on taking something that could exacerbate my concentration probs and generally make me loopy/cranky.  (Hey, I'm bad 'nuff already!)  Also, I don't get why Sustiva is preferred over Viramune given all the CNS probs with it.  But with Viramune, it seems pretty clear cut -- either ya have the allergic reaction and/or kidney probs, or ya don't.  You know within six weeks, and if you make it through sans serious probs, well then you're home free with a pretty benign and effective regime (including Truvada).   Seems simpler and less risky to me to just start with Viramune, skipping all the CNS wackiness.  My VL is 120,000 and my CD4s are 275 at 12%

Any comments or feedback would be appreciated!

Hey hello in England

Viramune - about 5% of people get a rash bad enough to stop/change, only 0.5% get a very serious reaction. Other than this, it'smuch nicer to the brain but perhaps a bit harder on the liver.  Viramune can be done once a day if necessary (strictly speaking this is off-label), but possible if it helps with adherence, maybe an idea to start on 2 x day). Sustiva is gd if you are prone to forgetting cos it's so forgiving on timing. And truthfully, while many people get a bit trippy on the orange bomb, so it has a bit of a reputation, many people also find it okay, especially after the first few weeks.

Truvada (tenofovir/FTC) is the nukes they usually use with these drugs to start. If your kidneys are fine before you start it usually causes no probs (the tenofovir).

If 1 x day is important, another 1 x day drug worth looking at is Reyataz, which is the "nice" PI that don't raise your blood lipids, though I reckon starting on a PI at the Victoria will be a hard sell cos it's kinda not what the docs there like (this is a personal not a science thing, if another doc at Victoria says Sustiva is the best drug I's gonna shove 6 down his face, there's lots of equally effective drugs).

- matt (brighton)

Hey Matt,

Thanks for responding.  Wondering - is Viramune harder on the liver permanently, or just at the start and /or you have the bad reaction?  If always, that may be an argument for giving la bombe orange a go.  I guess I'd like to avoid even two weeks of being a nutter, if poss.  Twice daily dosing is fine as I take vitas three times a day and Ritalin goes down like 4-5 times daily.  Guess the ADHD thang has me well primed for being max meds compliant...   :)


Hello Andy,

As Matt has stated, some people can have a bad reaction to Viramune. I was started on it, back in October of 2003, and still on it today, along with Epzicom and Viread. So far so good. Never had a problem after starting, and certainly didn't have any of the dreams that one might get with Sustiva. I currently take mine, one pill, every 12 hours.( although I have taken both pills together) One at 8.00 am and one at 8:00 pm. I still manage to get an 8 hour sleep daily, with no problem. I work full time, and I don't seem to have too much of a problem, at least with the job i am doing daily. Of course, every once in a while a little edgy, but hey 21 years plus into this...

My doctor does liver function test, every three months. ( I also do not drink) Haven't for over 7 years, except for the holidays.

Also want to state, that I am on no other medication, except for the HIV meds, and Zocor.

Also from the this site in reference to Viramune ;

"Researchers have found that Viramune passes easily into the brain. This is very important because HIV can infect brain cells. Anti-HIV drugs that pass through the brain's protective barrier called the "blood-brain barrier" may help prevent and/or treat conditions like AIDS-related dementia."

Good luck, Let us know what you decide-------Ray

Well Sustiva can be hard on the liver sometimes, and Viramune is considered a little more likely to be hard than Sustiva, so it's a matter of degree of probability.  It depends  a lot on your physical make up. Some people's livers just react different to these kind of drugs, and end up with high levels of them in their body.  But not most people. It's just a watch point really, like kidneys are for tenofovir and blood fats for PIs.

- matt


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