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Sustiva your doctor right away if you think you are having these psychiatric symptoms, so your doctor can decide if you should continue to take efavirenz.
Common side effects. Many patients have dizziness, trouble sleeping, drowsiness, trouble concentrating, and/or unusual dreams during treatment with efavirenz. These side effects may be reduced if you take efavirenz at bedtime on an empty stomach. They also tend to go away after you have taken the medicine for a few weeks. If you have these common side effects, such as dizziness, it does not mean that you will also have serious psychiatric problems, such as severe depression, strange thoughts, or angry behavior. Tell your doctor right away if any of these side effects continue or if they bother you. It is possible that these symptoms may be more severe if efavirenz is used with alcohol or mood altering (street) drugs.
If you are dizzy, have trouble concentrating, or are drowsy, avoid activities that may be dangerous, such as driving or operating machinery.
Rash is common. Rashes usually go away without any change in treatment. In a small number of patients, rash may be serious. If you develop a rash, call your doctor right away. Rash may be a serious problem in some children. Tell your child’s doctor right away if you notice rash or any other side effects while your child is taking efavirenz.
Other common side effects include tiredness, upset stomach, vomiting, and diarrhea. Some patients taking efavirenz have experienced increased levels of lipids (cholesterol and triglycerides) in the blood.
Changes in body fat. Changes in body fat develop in some patients taking anti-HIV medicine. These changes may include an increased amount of fat in the upper back and neck (“buffalo hump”), in the breasts, and around the trunk. Loss of fat from the legs, arms, and face may also happen. The cause and long-term health effects of these fat changes are not known.
Liver problems. Some patients taking efavirenz have experienced serious liver problems including liver failure resulting in transplantation or death. Most of these serious side effects occurred in patients with a chronic liver disease such as hepatitis infection, but there have also been a few reports in patients without any existing liver disease.
Tell your doctor or healthcare provider if you notice any side effects while taking efavirenz.
Contact your doctor before stopping efavirenz because of side effects or for any other reason.
This is not a complete list of side effects possible with efavirenz. Ask your doctor or pharmacist for a more complete list of side effects of efavirenz and all the medicines you will take.
Sustiva may change the effect of other medicines, including ones for HIV, and cause serious side effects. Your doctor may change your other medicines or change their doses. Other medicines, including herbal products, may affect efavirenz. For this reason, it is very important to:
Bring all your prescription and nonprescription medicines as well as any herbal remedies that you are taking when you see a doctor, or make a list of their names, how much you take, and how often you take them. This will give your doctor a complete picture of the medicines you use. Then he or she can decide the best approach for your situation.
Taking efavirenz with St. John’s wort (Hypericum perforatum), an herbal product sold as a dietary supplement, or products containing St. John’s wort is not recommended. Talk with your doctor if you are taking or are planning to take St. John’s wort. Taking St. John’s wort may decrease efavirenz levels and lead to increased viral load and possible resistance to efavirenz or cross-resistance to other anti-HIV drugs.
MEDICINES YOU SHOULD NOT TAKE WITH EFAVIRENZ:
The following medicines may cause serious and life-threatening side effects when taken with efavirenz. You should not take any of these medicines while taking efavirenz:
So once resistance develops to efavirenz (for example), your patient just lost the entire NNRTI class as a treatment option.

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  • Sustiva may be used, but dose used depends on the patient’s weight (600 mg daily if weight less than 50 kg; 800 mg daily if weight greater than 50 kg).
  • Vivid dreams and CNS symptoms are common with efavirenz.
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