Sustiva
Sustiva
- In our pharmacy, you can purchase Sustiva (or generic efavirenz) without a prescription, with worldwide delivery in 5-14 days. Discreet and anonymous packaging available.
- Sustiva (efavirenz) treats HIV infection as part of combination antiretroviral therapy. It works as a non-nucleoside reverse transcriptase inhibitor (NNRTI), blocking HIV replication.
- The usual adult dosage is 600 mg daily, taken orally once per day. Pediatric doses are weight-adjusted (200-600 mg daily).
- Administered orally as tablets (600 mg) or capsules (50 mg, 100 mg, 200 mg). Capsules may be opened for pediatric use.
- Peak plasma concentrations occur within 3-5 hours after dosing, with antiviral effects developing over days to weeks.
- Due to its long half-life (40-55 hours), Sustiva maintains therapeutic effects for approximately 24 hours per dose.
- Avoid alcohol consumption due to increased risk of CNS side effects (dizziness, impaired concentration), hepatotoxicity, and gastrointestinal distress.
- Most common side effects include dizziness, insomnia, vivid dreams/nightmares, rash, fatigue, headache, nausea, and vomiting.
- Would you like to try Sustiva without a prescription today?
Sustiva
Basic Sustiva Information
| Attribute | Details |
|---|---|
| INN (International Nonproprietary Name) | Efavirenz |
| Australian Brand Names | Stocrin® (primary brand) |
| ATC Code | J05AG03 (NNRTI class) |
| Forms & Dosages | Capsules: 50mg, 100mg, 200mg, 600mg Tablets: 600mg |
| Manufacturers | Generic suppliers (Mylan, Cipla) dominate market; originator was Bristol-Myers Squibb |
| Registration Status | TGA-registered |
| Classification | Prescription-only medication |
Efavirenz, marketed in Australia primarily as Stocrin®, belongs to the NNRTI class of antiretroviral drugs. Unlike the discontinued U.S. brand Sustiva, Stocrin remains available through major retailers like Chemist Warehouse and TerryWhite Chemmart across Australian states. You'll find it in capsule or tablet form ranging from 50mg to 600mg strengths. Generic versions approved by Australia's Therapeutic Goods Administration dominate the market, making this WHO Essential Medicine accessible under the Pharmaceutical Benefits Scheme. As prescription HIV medication, efavirenz requires doctor oversight and isn't available over the counter.
How Sustiva Works in Your Body
Sustiva targets HIV by blocking the virus's reverse transcriptase enzyme. This crucial action prevents HIV from replicating its genetic material and spreading through your bloodstream. After swallowing your dose, efavirenz enters your system quickly, peaking in three to five hours. Your liver handles processing the medication mainly through CYP3A4 enzymes, with effects lasting approximately two days due to its 40-55 hour half-life.
Several important interactions require attention:
- Hepatitis C medications like elbasvir/grazoprevir must be avoided completely
- Central nervous system depressants including midazolam heighten dizziness risks
- High-fat meals increase absorption - take on an empty stomach where possible
- Alcohol dangerously amplifies side effects like hallucinations
These NNRTI metabolism considerations mean discussing all medications and supplements with your doctor or pharmacist is essential. Hepatic enzyme interactions can alter drug effectiveness, requiring careful monitoring through Australia's prescribing guidelines.
Medical Uses of Efavirenz in Australia
In Australia, efavirenz treats HIV-1 infection as part of combination antiretroviral therapy. The Therapeutic Goods Administration approves it strictly for use with other HIV medications - never as standalone treatment. Some Australian doctors also prescribe it off-label for post-exposure prophylaxis following potential HIV exposure.
Special considerations apply across different groups:
Children's dosing starts from three months old using weight-based calculations. Pediatric HIV treatment requires careful measurement using smaller 50mg or 100mg capsules.
Pregnancy brings significant concerns, particularly during the first trimester where neural tube defect risks necessitate avoidance. Strict contraception is required for those who could become pregnant.
Elderly patients don't typically need dosage adjustments but require monitoring for neuropsychiatric effects. Regular liver function tests help identify potential hepatotoxicity early.
Healthcare providers follow Australian recommendations to prescribe efavirenz when viral load reduction is needed and safer alternatives aren't suitable. This HIV medication requires ongoing viral load testing to confirm effectiveness.
Dosage and Administration
Sustiva (efavirenz) dosing varies by age and weight, with strict adherence to daily schedules being critical. Adults typically take one 600mg tablet orally at bedtime to minimise central nervous system side effects. For paediatric patients, weight determines the capsule strength:
| Weight Range | Dosage Form | Daily Dose |
|---|---|---|
| 3.5-5 kg | 50mg capsule | 1 capsule |
| 10-15 kg | 200mg capsule | 1 capsule |
| >40 kg | 600mg tablet | 1 tablet |
Administration requires an empty stomach—dose 2 hours post-meal or before breakfast. Modified protocols apply for hepatic impairment: avoid entirely in severe liver dysfunction (Child-Pugh C). No renal dosage adjustments are necessary. Store capsules/tablets below 30°C in original light-resistant containers. If a dose is missed, skip it unless recalled within 3 hours of scheduled time.
Safety and Warnings
Sustiva carries severe safety restrictions requiring vigilant monitoring. Absolute contraindications include hypersensitivity reactions or concurrent use of certain CYP3A4 inducers like rifampicin. Neuropsychiatric complications demand immediate attention:
- Black Box Warnings (TGA-listed): Suicidal ideation (2.5% of users), major depression, and teratogenic risks
- Severe Reactions: Hepatitis (monitor LFTs quarterly), Stevens-Johnson syndrome (discontinue immediately)
Initiate therapy cautiously in patients with seizure disorders or psychiatric history. Routine liver function tests are mandatory pre-treatment and annually. Driving is prohibited during initial weeks due to dizziness affecting 40% of users. Concomitant alcohol exacerbates CNS depression—strict avoidance recommended.
Patient Experience
Real-world data reveals nuanced outcomes with Sustiva therapy. Viral suppression occurs in 78-85% of adherent patients within 12 weeks, though tolerability challenges persist. Common adaptation patterns include:
New starters report vivid nightmares diminishing after 2-4 weeks when taken at bedtime. Persistent fatigue affects elderly users longer than younger demographics—dose timing adjustment often helps. Mood fluctuations concern 22% of young adults according to Australian HIV forums. Practical adherence strategies involve phone alarms and weekly pill organisers. Missed doses trigger anxiety spikes despite low resistance risk with occasional lapses.
Alternatives and Comparison
Sustiva alternatives vary significantly in cost and tolerability within Australia's Pharmaceutical Benefits Scheme (PBS):
| Drug | Price (PBS/month) | Key Advantage | Major Limitation |
|---|---|---|---|
| Efavirenz (Sustiva) | $38.50 | Lowest-cost NNRTI | CNS disturbances |
| Dolutegravir (Tivicay) | $927 | High efficacy | Restricted PBS access |
| Rilpivirine (Edurant) | $58.30 | Food-flexible dosing | Strict meal requirements |
Australian prescriber guidelines prioritise dolutegravir-based regimens as first-line due to superior safety profiles. Sustiva remains preferred where PBS subsidies apply or integrase inhibitors are contraindicated. Therapy switches occur predominantly for neuropsychiatric intolerance or pregnancy planning.
Sustiva Market Availability and Access in Australia
Getting Sustiva (efavirenz) in Australia is streamlined through the Pharmaceutical Benefits Scheme (PBS). This vital HIV medication is readily stocked by national pharmacy chains like TerryWhite Chemmart and Chemist Warehouse. Access requires a valid prescription from your doctor.
The out-of-pocket cost reflects PBS subsidies. For eligible patients holding a Medicare card and a current PBS prescription, the price sits at $41.50 for a standard pack containing thirty 600mg tablets. Concession cardholders pay only $6.80.
You'll typically receive Sustiva in two packaging formats depending on the pharmacy and supplier: foil-backed blister packs, convenient for storage and travel, or amber plastic bottles containing either thirty or ninety tablets. Generic efavirenz brands dominate the market, with versions from manufacturers like Cipla and Viatris being most common following patent expiry.
Demand for Sustiva and its generics remains steady, primarily driven by Australians managing chronic HIV infection requiring long-term NNRTI-based therapy. Pharmacists report consistent supply levels; no significant shortages linked to events like COVID-19 disruptions have been noted recently. You'll find reliable stock available through local community pharmacies.
Recent Developments and Research for Efavirenz
The clinical landscape for NNRTIs like Sustiva (efavirenz) is evolving. A significant shift occurred in the 2023 WHO HIV Treatment Guidelines, where efavirenz-based regimens were moved to second-line treatment options. Dolutegravir-containing combinations are now recommended first due to better tolerability and higher resistance barriers.
With efavirenz patents now expired, the Australian HIV drug market features numerous generic versions. Over sixteen generic brands are available in Australia, supplied by international pharmaceutical companies such as Cipla, Viatris, Lupin, and Apotex. This competition helps ensure affordability under the PBS.
Research efforts are actively exploring ways to improve Sustiva's profile. Phase II trials investigating combinations of efavirenz (EFV) with tenofovir alafenamide (TAF) aim to reduce toxicity associated with older backbones. Results are anticipated in 2024.
Resistance remains a key consideration. The K103N mutation significantly impacts responsiveness to efavirenz and related NNRTIs. Studies suggest it emerges in approximately 5-15% of cases where adherence is inconsistent, potentially compromising Sustiva’s effectiveness. Therapeutic drug monitoring (TDM) can sometimes assist in optimizing individual dosing.
Common Questions About Using Sustiva
Answering medication questions is part of everyday pharmacy practice. Here are common queries Australians have about Sustiva, based on pharmacy consultations and health forums:
Q: Can I drink alcohol while taking Sustiva?
A: It's strongly advised to avoid alcohol. Combining alcohol with Sustiva significantly worsens central nervous system side effects like dizziness or drowsiness and increases the risk of more severe problems like hallucinations.
Q: What if I forget my morning Sustiva dose? Can I take two at night?
A: No, never take a double dose. If you realise you missed it and your next scheduled dose is more than 12 hours away, take the single missed tablet immediately. If your next dose is due in less than 12 hours, skip the missed one completely.
Q: Is Sustiva safe to take during pregnancy?
A: Sustiva carries a high risk of causing serious birth defects, particularly if taken during the first trimester. Effective contraception, usually using two methods (e.g., condoms and hormonal contraception), is essential throughout treatment and for several weeks after stopping.
Q: Does Sustiva (or Stocrin) interact with St. John’s Wort?
A: Yes, definitely avoid St. John’s Wort. This herbal supplement significantly reduces the blood levels and effectiveness of Sustiva, potentially leading to treatment failure and HIV drug resistance.
Q: How much does Sustiva cost without the PBS subsidy?
A> The private market price is substantial, estimated around $850 per month for the branded medication. This highlights the vital importance of PBS access. If you face high prescription costs throughout the year, ask your pharmacist about registering for the Medicare PBS Safety Net.
Using Sustiva Safely and Effectively
Taking Sustiva correctly maximizes its benefits while managing potential side effects. Follow these key Australian guidelines:
Taking Your Dose: Take Sustiva exactly as prescribed, once daily. To minimize common side effects like dizziness or vivid dreams, take it at bedtime, preferably on an empty stomach or with a light meal (avoiding high-fat meals which can increase absorption unpredictably). Swallow tablets whole; do not crush or chew.
Avoid Interactions: Steer clear of alcohol and grapefruit/grapefruit juice, as they can worsen side effects. Do not start any new herbal remedies (especially St. John’s Wort) or OTC medicines without consulting your pharmacist or doctor.
Safety Precautions: Because Sustiva can cause drowsiness or dizziness initially, avoid driving, operating machinery, or performing hazardous tasks until you understand how the medication affects you.
Storage: Keep Sustiva tightly closed in its original pharmacy packaging (bottle or blister) at room temperature (20-25°C is ideal), away from direct light and moisture. Do not transfer to alternative containers.
Critical Points: Consistency is key. Take your dose at the same time daily to maintain effective drug levels and prevent HIV resistance. Never stop taking Sustiva without consulting your doctor. Report any new or worsening mood changes, depression, suicidal thoughts, or unusual skin reactions to your healthcare team urgently.
