Nevirapine is a Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI) drug, used for the treatment of HIV-1 infection and for perinatal HIV prophylaxis in combination with other antiretroviral drugs. It works by binding to the HIV enzyme reverse transcriptase and blocking its catalytic site, thereby disrupting viral replication. VIRAMUNE should not be used in patients with HIV-2 infection, as HIV-2 is resistant to NNRTIs.
Dosing & Administration
Nevirapine is indicated for the treatment of HIV infection in adults and children of any age, including premature neonates, and for prophylaxis of vertical perinatal HIV transmission (off-label). Nevirapine comes in oral tablet form, an extended-release tablet form, and an oral liquid formulation. It may be taken with or without food. No dosage adjustments are required for patients with mild liver dysfunction, but the drug should not be used in those with moderate or severe liver impairment (Child-Pugh B or C). Nevirapine does not require dosage adjustments for renal impairment not requiring dialysis. Patients receiving dialysis require a dose adjustment. Dosages and administration instructions are detailed in the product monograph.
Nevirapine is contraindicated in patients with hypersensitivity to the drug, patients with moderate or severe liver dysfunction (Child-Pugh Class B or C), and in patients taking the herbal supplement St. John’s wort.
Nevirapine has boxed warnings about hepatotoxicity and skin reactions (see below). Common side effects are nausea/vomiting, abdominal pain, fatigue, and myalgias. A complete list of potential adverse effects is provided in the product monograph.
Nevirapine has a boxed warning due to its associated risk of severe, even life-threatening cases of hepatotoxicity, especially in the first 18 weeks of use. Specific recommendations for initial and ongoing monitoring for hepatic events are detailed in the product monograph.
Nevirapine also comes with a boxed warning about severe, even life-threatening skin toxicity and hypersensitivity reactions, especially during the first 18 weeks of use. Monitoring guidelines are detailed in the product monograph.
All patients who test positive for HIV infection should be screened for comorbid HBV and HCV infection. Co-infected patients should be started on an antiretroviral regimen targeting co-infected viruses, regardless of CD4 counts or viral loads. Current HIV treatment guidelines outline drug regimens and prescribing considerations.
Nevirapine is associated with a large number of drug-drug and herbal interactions. A complete list is provided in the product monograph.
Pregnancy & Lactation
Highly active retroviral combination treatment should be used in all pregnant women. Data from the Antiretroviral Pregnancy Registry (more than 1,200 first trimester exposures) do not show that nevirapine causes major birth defects above baseline. Guidelines should be consulted when treating women in pregnancy. Nevirapine is excreted in breast milk. The CDC recommends that all HIV positive women, treated or untreated, avoid breastfeeding to prevent vertical transmission of the virus.
There is no known antidote for nevirapine overdose, so standard supportive care should be provided.
Alternative Brand Names
Nevirapine is available under the brand names Viramune and Viramune XR.
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