Efavirenz (Sustiva) and Ketamine Therapy | Tovani Health
Sustiva (Efavirenz) (also: Atripla (component)) — NNRTI (HIV)
Verdict at Tovani Health
Strong CYP3A4 inducer — lowers ketamine levels; plus efavirenz has its own psychiatric side effect profile.
Efavirenz and ketamine are compatible with planning, but there are two KAP-relevant considerations. First (pharmacokinetic): efavirenz is a strong CYP3A4 inducer that accelerates ketamine metabolism and lowers plasma levels — same directionality as phenytoin and rifampin. Standard KAP dosing may be subtherapeutic; we adjust upward with monitoring. Second (pharmacodynamic): efavirenz has a well-documented CNS/psychiatric side effect profile (vivid dreams, mood changes, depression, suicidality in some patients) that's relevant for KAP outcome interpretation — if mood is worsening on efavirenz and you're trying to assess KAP response, we need to separate signal from noise. Many HIV teams now use integrase inhibitor regimens (Biktarvy etc.) as alternatives — that's a conversation with your HIV provider, independent of KAP.
If you take Sustiva regularly and are considering at-home ketamine therapy, the combination is safe with monitoring or modest dose adjustment. This page covers the brief pharmacologic context and what we do at intake.
How Sustiva interacts with ketamine
Efavirenz inhibits HIV reverse transcriptase non-competitively. CYP2B6 substrate. Strong CYP3A4 inducer (and modest 2B6 inducer). Long terminal half-life; induction develops over weeks.
What we do at intake
Disclose chronic efavirenz use and any mood/sleep side effects since starting it. Don't change efavirenz around KAP without your HIV team. We adjust KAP dose to account for accelerated metabolism.
Bottom line
Efavirenz and ketamine are compatible with planning, but there are two KAP-relevant considerations. First (pharmacokinetic): efavirenz is a strong CYP3A4 inducer that accelerates ketamine metabolism and lowers plasma levels — same directionality as phenytoin and rifampin. Standard KAP dosing may be subtherapeutic; we adjust upward with monitoring. Second (pharmacodynamic): efavirenz has a well-documented CNS/psychiatric side effect profile (vivid dreams, mood changes, depression, suicidality in some patients) that's relevant for KAP outcome interpretation — if mood is worsening on efavirenz and you're trying to assess KAP response, we need to separate signal from noise. Many HIV teams now use integrase inhibitor regimens (Biktarvy etc.) as alternatives — that's a conversation with your HIV provider, independent of KAP.
Ready to find out if at-home ketamine fits your situation?
We’ll note that you’re on Sustiva (Efavirenz) at intake. The eligibility check takes 5 minutes and gives you an honest answer about whether at-home ketamine fits your specific situation.
FL and NJ residents only. Benjamin Soffer, DO — Tovani Health.
Sources
The verdict and clinical guidance on this page are based on the following peer-reviewed literature and FDA prescribing information.
- Ketamine: A Review of Clinical Pharmacokinetics and Pharmacodynamics in Anesthetic and Pain Therapy. Peltoniemi MA, Hagelberg NM, Olkkola KT, Saari TI. Clinical Pharmacokinetics. 2016. PMID: 27028535
Clinically reviewed
Reviewed by Benjamin Soffer, DO on May 22, 2026. Dr. Soffer is a board-certified physician (American Board of Internal Medicine) licensed in Florida and New Jersey, prescribing at-home ketamine therapy through Tovani Health.
This page is general information about how this medication interacts with at-home ketamine therapy at Tovani Health. It is not a substitute for medical advice from your prescribing physician about your specific situation. Always discuss medication changes with the doctor who prescribed them.