Efavirenz Side Effects: What You Need to Know Before Taking It
When you're prescribed efavirenz, a cornerstone antiretroviral drug used to treat HIV infection. Also known as Sustiva, it's been a go-to option for decades because it keeps the virus under control—but it doesn't come without trade-offs. Many people start efavirenz without knowing what to expect beyond "it helps with HIV." But the real story is in the details: dizziness, vivid dreams, nausea, and even mood changes aren't rare. In fact, up to half of users report some form of central nervous system effect in the first few weeks. This isn't just a footnote—it's something you need to plan for.
What makes efavirenz tricky is how it interacts with your brain chemistry. It doesn't just target the virus; it crosses the blood-brain barrier, which is why sleep disturbances and anxiety show up so often. These aren't "all in your head"—they're pharmacological. Studies show that people with a history of depression or anxiety are more likely to have trouble, and some end up switching drugs within months. You also need to watch for liver stress, especially if you're taking other meds like statins or herbal supplements. And don't forget the long-term stuff: skin rashes, high cholesterol, and even bone thinning over time. It's not a drug you take and forget—it's one you monitor.
Then there's the timing. Taking efavirenz on an empty stomach can make side effects worse. Most people feel better if they take it at bedtime, which helps them sleep through the worst of the dizziness and weird dreams. But if those dreams turn into nightmares that last for weeks, or if you start feeling hopeless, it's not normal—it's a signal. You're not weak for struggling. You're just human. And there are alternatives. Drugs like rilpivirine or dolutegravir offer similar virus control with fewer brain-related side effects. If efavirenz is making your life harder, you have options.
Below, you'll find real-world experiences and practical advice from people who've walked this path. We've pulled together guides on managing side effects, comparing efavirenz to other HIV meds, and spotting when it's time to switch. No fluff. No marketing. Just what works—and what doesn't.
