Nevirapine
Antiviral, Systemic · Non-nucleoside reverse transcriptase inhibitor
Indications
Use in combination with at least 2 additional antiretroviral agents for the treatment of HIV-1 infection. Prevention of mother to child transmission of HIV-1 in pregnant women who are not taking antiretroviral therapy at the time of labour.
Dosage
Tab: Adults: 200 mg daily for 1st 14 days followed by 200 mg twice daily, in combination with at least 2 additional antiretroviral agents. Children: >8 yr: 4 mg/kg once daily for 2 wk followed by 4 mg/kg b.i.d thereafter, 2 mth-8 yr: 4 mg/kg once daily for 2 wk followed by 7 mg/kg twice daily thereafter. Max for any patient: 400 mg/day. Prevention of mother to child HIV transmission: Administer to pregnant mother in labour: 200 mg as a single dose, followed by 2 mg/kg as a single dose to neonate within 72 hr of birth. Susp: Adults: Over 16 yr, 20 mL once daily for first 14 days, then 20 mL twice daily. Children: By body surface area: =8 yr; 150 mg/m2 once daily for two wk, then 150 mg/m2 twice daily. Alternatively, by wt: =8 yr; 4 mg/kg once daily for two wk, then 7 mg/kg twice daily; 8-16 yr; 4 mg/kg once daily for two wk, then 4 mg/kg twice daily. Max 400 mg daily.
Adverse Effects
Severe & life-threatening skin reactions including Stevens-Johnson syndrome & toxic epidermal necrolysis. Severe or life-threatening hepatotoxicity e.g. fatal fulminant hepatitis. Abnormal liver function tests, jaundice, hepatitis, nausea, fatigue, fever, headache, somnolence, vomiting, diarrhoea, abdominal pain, myalgia, granulocytopenia (paed), GI upset, rash, rhabdomyolysis, hypophosphataemia, increased BP.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Readministration to patient with history of hypersensitivity to drug. Severe hepatic impairment. Precautions: 1st 8 week of therapy. Patients experiencing rash during the 14 day lead-in period should not have their dose increased until rash has resolved. Vigilant monitoring of liver function. Renal impairment, hepatitis B or C. Risk of wt gain and raised blood lipids and glucose. Severe immune deficiency; risk of immune reconstitution inflammatory syndrome and autoimmune disorders. Risk of osteonecrosis; monitor for signs of joint pain or immobility. Elderly >65 years.
Interactions
Drugs metabolized by hepatic enzymes, ketoconazole, oral contraceptive, methadone, protease inhibitors, elvitegravir, cobicistat, other NNRTIs, azole antifungals, macrolides, rifampicin, rifabutin, warfarin, St John's wort.
Advice to Patient
Take with or without meals. If it is difficult for you to swallow whole tablet, dissolve it in water or add it in food and crush it. Before use, shake suspension well. For volumes 5 mL or less than 5 mL, use oral syringe. Before using dosing cup, rinse it well with water then use. If you miss a dose, take it as soon as you remember unless it is time for the next dose. Do not take double dose. Discontinue medication and inform prescriber immediately if rash occurs. Contact prescriber if there is muscle pain, joint pain, facial edema, blisters, fever, difficulty in breathing, malaise, constant diarrhoea, nausea, pain or irritation in eyes. If therapy is for a long period of time, frequent blood tests are required.
Pharmacokinetics
Absorption: Rapid and readily absorbed. Immediate release: >90%. Metabolism: Extensively hepatic. Bioavailability: 93% (immediate release tab); approx. 75% (extended release tab[relative to immediate release]); 91% (oral soln). Half-life elimination: Decreases over 2- to 4-week time with chronic dosing due to autoinduction (i.e., half-life=45 hrs initially [single dose] and decreases to 25 to 30 hrs [multiple dosing]). Time to peak, serum: Immediate release: 4 hrs. Extended release: Approx. 24 hrs. Excretion: Urine (approx. 81%). Faeces (approx. 10%).
Brands with this active ingredient
Compiled by Healify Pharmacy from published drug references. How we compile it →
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