Dizzy Spells, med-related?

[newbieguy]

So, I've been getting these irregular bouts of dizziness once a few months ago, that last about 5 days and then went away, and now for the past 4 days or so. It's worse in the morning, when I get up the room spins and I just feel a bit out of sorts. It seems to go away by around noon or so. I have been on Atripla since late 2010, could this be med-related? I had a CT scan and MRI a few years back for a migraine issue, and they found nothing abnormal in my head, so that was good news. I take Atripla at night, so maybe it could be why the dizziness is worse in the mornings, but is it normal to have dizzy spells like that so long after being on it? I am going to tell my doc about this, but just wanted some feedback from you guys. Thanks!

[newt]

Yes it could be Atripla (specifically the efavirenz it contains).

- matt

[newbieguy]

Thanks newt, if it IS the Atripla (sustiva) causing the dizzy spells, is it anything that could be harmful to me? Other than the discomfort? Why would it only be sporadic? Like I have months where I have no spells at all. Then, bam. lol

[newt]

No it's not harmful, and can be episodic. Management is usually 1) changing meds 2) an additional "mind" drug to dull the effects << not dope

But I am told ibuprofen etc sometimes helps, which seems plausible given the likely mechanism for the side effect is cytokine activation (part of your immune system) and the cytokines getting in your brain where they are unwelcome, and ibuprofen etc reduces cytokine activation. << take at same time as meds

- matt

[MarkB]

Thanks for this thread. I've been having a lot of problems with balance and dizziness of late: interesting to know that it might be meds-related.

[newbieguy]

I guess all meds have their pros and cons, I can live with the dizziness as long as it doesn't rear its ugly head too often! Ibuprofen, interesting, I might give that a try! Will ask my doc about it. When I get it, its always in the mornings, so I def think its med related.

[HIVidyas]

For the sake of discussion (and NOT for the sake of scaring Newbieguy) is it possible that the efavirenz is amplifying other dizziness issues, and isn't necessarily the only cause, especially if its something that wasn't an issue during the first few days?

[alberche]

Dear Newby,

Talk to your doctor about switching to another NNRTI instead of Efavirenz contained in Atripla.

Intellence (Etravirine) could be a good option. My first combo was Truvada+Efavirenz (Atripla formulation was not on the market by then) and I had the same side effects you mentioned. I quitted it due to an allergic reaction to Efavirenz and, at that time, my doc prescribed a PI, so my combo changed to  Truvada+Atazanavir+Ritonavir.

Then, 2 years ago, my doc passed me back to NNRTIs, switching Atazanavir+Ritonavir by Intellence. And then, due to I was diagnosed with osteoporosis, my doc also stopped Truvada and switched me to Kivexa (Abacavir + 3TC). So I am now on Kivexa+Intellence.

Intellence does not cause those foggy, depressive or hallucinatory effects of Efavirenz. The only thing I feel (and not sure neither me nor my doc is due to Intellence) is that I feel more tired than some time ago. But I sleep well, and have no particular problems to concentrate, spelling, writting or just doing my work. No digestive or similar side effects, so I feel comfortable taking Intellence (etravirine) so far.

One disadvantage by comparison with Atripla is that taking Intellence+Truvada will mean 5 pills instead of only one.

In the guidelines, Intellence is recommended to be taken twice daily, 2 100gr pills each 12 hours. But, if your viral load has been controlled undetectable and your CD4 counts are good or improving, and you have no resistance to meds, you can take Intellence once a day, the 4 pills altogether (daily dose is 400 gr). That is what I do, I take it with Kivexa, altogether, with breakfast.

Maybe it could be a good option to you meaning not changing a lot the kind of meds you  are taking, which helps to preserve other meds as an option in the future.

Hugs!