What is Nevirapine (Viramune)?
Nevirapine is an NNRTI (Non-Nucleoside Reverse Transcriptase Inhibitor) that is used to treat HIV-1 infection and for perinatal HIV prophylaxis in combination with other antiretroviral drugs. This drug disrupts viral replication by binding to the HIV enzyme reverse transcriptase and blocking its catalytic site. HIV-2 is resistant to NNRTIs, so VIRAMUNE should not be used in patients with HIV-2 infection.
Dosing & Administration
Nevirapine is used in adults and children of any age, including premature infants, and for prophylaxis of off-label vertical perinatal HIV transmission. The drug comes in an oral liquid formulation, an oral tablet form, and an extended-release tablet form. This drug may be taken with or without food. For patients with mild liver dysfunction, no dosage adjustments are required. However, the drug should not be used in patients with moderate or severe liver impairment (Child-Pugh B or C). For renal impairment that does not require dialysis, Nevirapine does not require dosage adjustments, however, a dosage adjustment is required in patients receiving dialysis. Further details are available in the package insert.
Nevirapine is contraindicated in patients with patients with moderate or severe liver dysfunction (Child-Pugh Class B or C), those with hypersensitivity to the drug, and in patients taking the herbal supplement “St. John’s wort.”
Nevirapine Side Effects
Nevirapine has warnings about skin reactions and hepatotoxicity.
Some common side effects are:
- abdominal pain,
A complete list of side effects is provided in the package insert.
Nevirapine has a warning because of its risk of severe, even life-threatening, cases of hepatotoxicity, especially in the first 18 weeks of using the drug. More details about initial and ongoing monitoring for hepatic events are included in the package insert.
For those patients who test positive for HIV infection, they should be screened for comorbid HCV and HBV infections. Patients who are determined to be co-infected should be started on an antiretroviral regimen that will target co-infected viruses, regardless of viral loads or CD4 counts. Prescribing conditions and drug regimens are outlined in the HIV treatment guidelines.
Nevirapine is associated with herbal and drug-to-drug interactions. Further details are included in the package insert.
Pregnancy & Lactation
Women who are pregnant and who test positive for HIV should be using highly active retroviral combination treatment. Current data from the Antiretroviral Pregnancy Registry (more than 1,200 first trimester exposures) do not show major birth defects linked to nevirapine. However, further guidelines should be consulted when treating pregnant women. The CDC recommends that all HIV positive women, treated or untreated, avoid breastfeeding, as nevirapine is excreted in breast milk.
There is no known antidote for an nevirapine overdose, so standard supportive care should be provided if an overdose is suspected.
Alternative Brand Names
Nevirapine is available under the brand names Viramune XR and Viramune.
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