Generic Name: Nevirapine Brand Name(s): Generics only. No brands available.

Uses

What is Nevirapine used for?

Nevirapine is used with other HIV medications to help control HIV infection. It helps to decrease the amount of HIV in your body so your immune system can work better. This lowers your chance of getting HIV complications (such as new infections, cancer) and improves your quality of life. Nevirapine belongs to a class of drugs known as non-nucleoside reverse transcriptase inhibitors (NNRTIs).

Nevirapine is not a cure for HIV infection. To decrease your risk of spreading HIV disease to others, do all of the following: (1) continue to take all HIV medications exactly as prescribed by your doctor, (2) always use an effective barrier method (latex or polyurethane condoms/dental dams) during all sexual activity, and (3) do not share personal items (such as needles/syringes, toothbrushes, and razors) that may have contacted blood or other body fluids. Consult your doctor or pharmacist for more details.

Nevirapine should not be used to prevent HIV infection after accidental exposure (such as needle sticks, blood/bodily fluid contact). Different HIV medications are used to prevent infection after exposure.

How should I take Nevirapine?

Take this medication by mouth with or without food, usually once daily for the first 14 days when you start treatment, then twice daily or as directed by your doctor.

If liver problems or skin/allergic reactions occur while you are taking this medication once daily, seek immediate medical attention and do not increase the dose to twice daily.

If you are using the liquid suspension form of this medication, shake the bottle gently before each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. If you are using a dosing cup, rinse the cup with water after taking the medication and drink all of the rinse water to make sure you take the full dose.

The dosage is based on your medical condition and response to treatment. In children, the dosage is also based on body size.

Do not stay on the once-daily dosing schedule for more than 28 days. If you approach that period of time, your doctor should consider switching you to another medication. Consult your doctor for more details.

If you stop taking this medication for more than 7 days for reasons other than the serious reactions described in the Warning section, ask your doctor for directions on how to restart treatment. You may need to take this medication once daily again for the first 14 days to decrease the risk of serious side effects.

It is very important to continue taking this medication (and other HIV medications) exactly as prescribed by your doctor. Do not skip any doses. Do not increase your dose, take this drug more often than prescribed, or stop taking it (or other HIV medicines) even for a short time unless directed to do so by your doctor. Skipping or changing your dose without approval from your doctor may cause the amount of virus to increase, make the infection more difficult to treat (resistant), or worsen side effects.

This medication works best when the amount of drug in your body is kept at a constant level. Therefore, take this drug at evenly spaced intervals. To help you remember, take it at the same times each day.

How do I store Nevirapine?

Nevirapine is best stored at room temperature away from direct light and moisture. To prevent drug damage, you should not store Nevirapine in the bathroom or the freezer. There may be different brands of Nevirapine that may have different storage needs. It is important to always check the product package for instructions on storage, or ask your pharmacist. For safety, you should keep all medicines away from children and pets.

You should not flush Nevirapine down the toilet or pour them into a drain unless instructed to do so. It is important to properly discard this product when it is expired or no longer needed. Consult your pharmacist for more details about how to safely discard your product.

Precautions & warnings

What should I know before using Nevirapine?

Before taking nevirapine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver problems (such as hepatitis B or C, cirrhosis), kidney dialysis, galactose or lactose intolerance.

This drug may rarely make you drowsy. Alcohol or marijuana can make you more drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana.

During pregnancy, this medication should be used only when clearly needed. Treatment can lower the risk of passing HIV infection to your baby, and nevirapine may be part of that treatment. Discuss the risks and benefits with your doctor.

Nevirapine passes into breast milk. Because breast milk can transmit HIV, do not breast-feed.

Is it safe during pregnancy or breast-feeding?

There are no adequate studies in women for determining risk when using this Nevirapine during pregnancy or while breastfeeding. Please always consult with your doctor to weigh the potential benefits and risks before taking Nevirapine. Nevirapine is pregnancy risk category B according to the US Food and Drug Administration (FDA).

FDA pregnancy risk category reference below:

  • A=No risk,
  • B=No risk in some studies,
  • C=There may be some risk,
  • D=Positive evidence of risk,
  • X=Contraindicated,
  • N=Unknown

Interactions

What drugs may interact with Nevirapine?

Some products that may interact with this drug include: orlistat, rifabutin, warfarin.

Other medications can affect the removal of nevirapine from your body, which may affect how nevirapine works. Examples include rifamycins (such as rifampin), St. John’s wort, among others.

Nevirapine can speed up the removal of many other medications from your body, which may affect how they work. Examples of affected drugs include antiarrhythmics (such as amiodarone), asunaprevir, boceprevir, cobicistat, elvitegravir, some drugs used to treat seizures (such as clonazepam), azole antifungals (such as itraconazole, ketoconazole), macrolide antibiotics (such as clarithromycin), methadone, telaprevir, among others.

Some other drugs to treat HIV infection (including protease inhibitors such as atazanavir, ritonavir) may also interact with nevirapine. Your doctor will adjust your medications and monitor your treatment to reduce the risk of side effects.

Do not use prednisone to prevent a rash because it can actually increase the risk of a rash during the first 6 weeks of nevirapine treatment. Ask your doctor for more details.

This medication may decrease the effectiveness of hormonal birth control such as pills, patch, or ring. This could cause pregnancy. Talk to your doctor about additional or alternative reliable forms of birth control, and always use an effective barrier method (latex or polyurethane condoms/dental dams) during all sexual activity to decrease the risk of spreading HIV to others. Tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your hormonal birth control is not working well.

Nevirapine may interact with other drugs that you are currently taking, which can change how your drug works or increase your risk for serious side effects. To avoid any potential drug interactions, you should keep a list of all the drugs you are using (including prescription drugs, nonprescription drugs and herbal products) and share it with your doctor and pharmacist. For your safety, do not start, stop, or change the dosage of any drugs without your doctor’s approval.

Does food or alcohol interact with Nevirapine?

Nevirapine may interact with food or alcohol by altering the way the drug works or increase the risk for serious side effects. Please discuss with your doctor or pharmacist any potential food or alcohol interactions before using this drug.

What health conditions may interact with Nevirapine?

Nevirapine may interact with your health condition. This interaction may worsen your health condition or alter the way the drug works. It is important to always let your doctor and pharmacist know all the health conditions you currently have.

Dosage

The information provided is not a substitute for any medical advice. You should ALWAYS consult with your doctor or pharmacist before using this Nevirapine.

What is the dose of Nevirapine for an adult?

Usual Adult Dose for HIV Infection

Initial Dose (lead-in dosing period):

-Immediate-release formulation: 200 mg orally once a day for 14 days

Maintenance Dose (after lead-in dosing period):

-Immediate-release formulation: 200 mg orally twice a day

-Extended-release formulation: 400 mg orally once a day

Use: In combination with other antiretroviral agents, for the treatment of HIV-1 infection

Renal Dose Adjustments

CrCl at least 20 mL/min (and not requiring dialysis): No adjustment recommended.

CrCl less than 20 mL/min: Data not available

Comments:

-The extended-release formulation has not been studied in patients with renal dysfunction.

Liver Dose Adjustments

Moderate or severe liver dysfunction (Child-Pugh B or C): Contraindicated

Comments:

-The extended-release formulation has not been assessed in patients with liver dysfunction.

Dose Adjustments

Patients with Dose Interruption:

-If this drug is interrupted for more than 7 days, it should be restarted at the lower lead-in dose (using the immediate-release formulation) for the first 14 days.

Patients with Hepatic Events:

-This drug should be permanently discontinued if a clinical (symptomatic) hepatic event occurs.

-This drug must not be restarted after recovery.

Patients with Rash:

-This drug should be discontinued if a severe rash or any rash accompanied by constitutional findings develops.

-If patient has mild to moderate rash without constitutional symptoms during the 14-day lead-in period with the immediate-release formulation:

—The dose of the immediate-release formulation should not be increased OR therapy with the extended-release formulation should not be started until rash has resolved.

—The total duration of the lead-in dosing period should not exceed 28 days, at which point another regimen should be used.

Dialysis

Hemodialysis:

-Immediate-release formulation: A supplemental 200 mg dose should be administered after each dialysis session.

-Extended-release formulation: Data not available

Comments:

-Metabolites of this drug may accumulate in patients on dialysis; clinical significance not established.

Other Comments

Administration advice:

-Due to serious and life-threatening hepatotoxicity seen in trials, do not start this drug (unless benefits outweigh risks) in adult females with CD4+ cell counts greater than 250 cells/mm3 or adult males with CD4+ cell counts greater than 400 cells/mm3.

-Do not use as a single agent to treat HIV-1 or add to a failing regimen as a single agent.

-May administer without regard to food

-If the oral suspension is used, shake gently before each use and use an oral syringe to measure an accurate dose.

-Swallow the extended-release tablets whole and do not chew, crush, or divide; consider ability to swallow tablets before prescribing the extended-release formulation.

-Do not administer the immediate-release and extended-release formulations concurrently.

Monitoring:

-General: Clinical and laboratory (baseline and during first 18 weeks of therapy [the manufacturer product information should be consulted]); drug-induced toxicity in patients with hepatic fibrosis or cirrhosis

-Hepatic: Liver enzymes (baseline and during first 18 weeks of therapy [the manufacturer product information should be consulted])

Patient advice:

-Read the US FDA-approved patient labeling (Medication Guide).

-Stop this drug and seek medical attention (including laboratory monitoring) at once if signs/symptoms of liver disease or severe skin reactions develop.

-Stop this drug and seek medical attention at once if signs/symptoms of hepatitis occur.

-If any rash occurs during the 2-week lead-in period, do not escalate the immediate-release formulation dose or start the extended-release formulation; stop this drug and consult physician if severe rash or hypersensitivity reactions develop.

-Consult healthcare provider immediately regarding any signs/symptoms of infection.

What is the dose of Nevirapine for a child?

Usual Pediatric Dose for HIV Infection

Initial Dose (lead-in dosing period):

Immediate-release formulation:

-Age 15 days or older: 150 mg/m2 orally once a day for 14 days

Maximum initial dose: 200 mg/day

Maintenance Dose (after lead-in dosing period):

Immediate-release formulation:

-Age 15 days or older: 150 mg/m2 orally twice a day

Extended-release formulation:

-Age 6 years or older:

—BSA 0.58 to 0.83 m2: 200 mg orally once a day

—BSA 0.84 to 1.16 m2: 300 mg orally once a day

—BSA at least 1.17 m2: 400 mg orally once a day

Maximum maintenance dose: 400 mg/day

Use: In combination with other antiretroviral agents, for the treatment of HIV-1 infection

Panel on Antiretroviral Therapy and Medical Management of Children Infected with HIV Recommendations:

Immediate-release formulation:

-Gestational age 34 to less than 37 weeks, less than 1 month of age: 4 mg/kg orally twice a day for the first week followed by 6 mg/kg orally twice a day

-Gestational age at least 37 weeks, less than 1 month of age: 6 mg/kg orally twice a day

-Age 1 month to less than 8 years:

—Initial dose (lead-in dosing): 200 mg/m2 orally once a day for 14 days

—Maintenance dose: 200 mg/m2 orally twice a day

-Age 8 years or older:

—Initial dose (lead-in dosing): 120 to 150 mg/m2 orally once a day for 14 days

—Maintenance dose: 120 to 150 mg/m2 orally twice a day

Maximum dose: 200 mg/dose

Extended-release formulation:

-Age 6 years or older (maintenance dose):

—BSA 0.58 to 0.83 m2: 200 mg orally once a day

—BSA 0.84 to 1.16 m2: 300 mg orally once a day

—BSA at least 1.17 m2: 400 mg orally once a day

Comments:

-In children up to 2 years of age, some experts start this drug without lead-in dosing.

-As long as there are no side effects, the mg dose does not need to be decreased when the child reaches 8 years; the mg dose is left the same to achieve the appropriate mg/m2 dosage as the child grows larger.

-The total daily dose should not exceed 400 mg.

-Current guidelines should be consulted for additional information.

Usual Pediatric Dose for Reduction of Perinatal Transmission of HIV

Panel on Treatment of Pregnant Women with HIV Infection and Prevention of Perinatal Transmission Recommendations:

Prophylaxis dose:

-Birth weight 1.5 to 2 kg: 8 mg orally once a day for 3 doses

-Birth weight greater than 2 kg: 12 mg orally once a day for 3 doses

Treatment dose:

-Gestational age 34 to less than 37 weeks at birth, up to 1 week of age: 4 mg/kg orally twice a day

-Gestational age 34 to less than 37 weeks at birth, 1 to 6 weeks of age: 6 mg/kg orally twice a day

-Gestational age at least 37 weeks at birth, up to 6 weeks of age: 6 mg/kg orally twice a day

Comments:

-Immediate-release formulation recommended.

-Combination antiretroviral prophylaxis with 3 doses of this drug (using prophylaxis dose) plus 6 weeks of zidovudine OR empiric HIV therapy using this drug (using treatment dose) plus zidovudine and lamivudine recommended for higher risk of perinatal HIV transmission and presumed neonate HIV exposure

-This drug (using treatment dose) plus zidovudine and lamivudine recommended for neonates with confirmed HIV

-Optimum duration of empiric HIV therapy in neonates at higher risk of perinatal HIV transmission is unknown; many experts use 6 weeks of combination therapy while others stop this drug and/or lamivudine after newborn testing returns negative.

-Therapy should be started as close to time of birth as possible, preferably within 6 to 12 hours of delivery.

-Current guidelines should be consulted for additional information.

Precautions

Safety and efficacy of the extended-release formulation have not been established in patients younger than 6 years.

How is Nevirapine available?

Nevirapine is available in the following dosage forms and strengths:

  • Oral suspension,
  • Oral tablet,
  • Oral tablet, extended release.

What should I do in case of an emergency or overdose?

In case of an emergency or an overdose, call your local emergency services or go to your nearest emergency room.

What should I do if I miss a dose?

If you miss a dose of Nevirapine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and take your regular dose as scheduled. Do not take a double dose.

 

Hello Health Group does not provide medical advice, diagnosis or treatment.

Review Date: April 5, 2018 | Last Modified: April 5, 2018

Want to live your best life?
Get the Hello Doktor Daily newsletter for health tips, wellness updates and more.