Email 95: Switching Back to Nevirapine?

Posted by Pozziepinoy on 8:01 AM
Hello.

I used to take Nevirapine and Lamiduvine/Stavudine but had rashes and fever. So, I stopped taking it. 

 Now, my doctor gave me Efavirenz and Lamiduvine/Stavudine and had rashes and dizziness while taking it but I still continued until the side effects are now minimal. 


What I don't like about taking effivarenz is that I have vivid dreams that seem so real and I don't feel having enough sleep. My question now is if can I still go back to Nevirapine since my body is stronger now as this medicine does not have vivid dreams as side effects?

XXX


POZZIEPINOY'S REPSONSE

Hi XXX.

Thank you for your email.

The protocol for most hubs is giving nevirapine first and if the PLHIV develops rashes, which nevirapine is very notorious for, nevirapine will be stopped and be switched to efavirenz. That means that if you have allergic reactions already to nevirapine and or it may be hazardous to your liver and other vital organs, thus the switch to efavirenz. Efavirenz has very minimal development of rashes, however patients complain of dizziness and vivid dreams from it.

I haven't heard of anyone who is already in efavirenz and will be made to switch back to nevirapine for the simple reason that one doesn't like the vivid dreams and apparent lack of sleep. For one, those side effects are very minimal, unless the side effects are becoming harmful to your body organs, that they may opt for another alternative, the next switch of which is already second line regimen. Second, as I have said before, the doctors in our treatment hubs have control over our medicines because all medicines are free in the Philippines and ARV's are not available for sale in pharmacies here which means that we can't chose what we like to take. "Beggars can't be chosers" as I would say. Unlike in other countries wherein you can buy your own ARV's, however, ARV's are so expensive and one will have to spend from $2,000 to $3,000 per month for your cocktail.

The best way advice that I can give you is to try to minimize the side effects of efavirenz, taking it on an empty stomach so it won't be absorbed in the stomach but in your small intestines. To do this, you can try what I am doing. Try to take it 4 hours after your last meal. For more than a year now, the schedule of my last meal is at 6pm and I take my efavirenz at 10pm. I don't have vivid dreams, no dizziness, no body heat and no itchiness. There are times when I eat at 7pm or 8pm however, I experience body warmth and itchiness. You can play with the timing of your last meals to know when side effects occur the least.

 Still, you can talk to your doctor about your concerns on your next visit. But if I were you, be happy that you don't have worse side effects and that you are still in first line regimen. 

 I hope I was able to answer your question. Feel free to email me again if you have other concerns.
Stay healthy,
Pozziepinoy


"WE ARE ALL IN THIS TOGETHER.
NO PLHIV is alone with his or her struggle with HIV!"

-Pozziepinoy-


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