Adult: In combination with other antiretroviral agents: Initially, 200 mg once daily for 14 days. Maintenance: As conventional tab: 200 mg bid. As extended release tab: 400 mg once daily. Child: As conventional tablet or suspension in combination with other antiretroviral agents: Initially, 150 mg/m2 once daily for 14 days. Maintenance: 150 mg/m2 bid or as extended-release tab 400 mg once daily. ≥16 years or weighing ≥50 kg or with BSA >1.25 m2: Same as adult dose.
Renal Impairment
Patient on haemodialysis: An additional 200 mg should be given after dialysis treatment.
Hepatic Impairment
Moderate to severe (Child Pugh class B or C): Contraindicated.
Administration
May be taken with or without food.
Contraindications
Hypersensitivity. History of severe rash or rash accompanied by constitutional symptoms or clinical hepatitis caused by nevirapine. Use in postexposure prophylaxis (PEP) regimens. Moderate to severe hepatic impairment (Child Pugh class B or C). Lactation. Concomitant use with St. John’s wort.
Special Precautions
Patient with high CD4+ counts (>250 cells/mm3 in females or >400 cell/mm3 in males, chronic hepatitis B or C. Mild hepatic impairment (Child-Pugh class A). Pregnancy.
Adverse Reactions
Significant: Immune reconstitution syndrome, fat redistribution (e.g. central obesity, buffalo hump, peripheral wasting, facial wasting, breast enlargement, cushingoid appearance), rhabdomyolysis, elevated transaminase. Blood and lymphatic system disorders: Granulocytopenia, neutropenia. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, abdominal pain. General disorders and administration site conditions: Fever, fatigue. Hepatobiliary disorders: Hepatitis. Investigations: Increased serum cholesterol, LDL cholesterol, serum alanine aminotransferase, serum aspartate aminotransferase, amylase. Musculoskeletal and connective tissue disorders: Arthralgia, myalgia. Nervous system disorders: Headache. Potentially Fatal: Stevens-Johnson syndrome, toxic epidermal necrolysis, hypersensitivity reactions with rash and organ dysfunction, hepatotoxicity.
This drug may cause fatigue, if affected, do not drive or operate machinery.
Monitoring Parameters
Monitor for signs of adverse skin reactions and hepatotoxicity for the first 18 weeks of treatment, particularly in the first 6 weeks. Monitor CBC, viral load; liver function at baseline then prior and after 2 weeks of dose escalation. Immediately evaluate transaminases level in patients with rash.
Drug Interactions
Increased risk of toxicity with efavirenz. May decrease serum concentration of atazanavir and lopinavir, boceprevir, telaprevir, clarithromycin, and methadone. Increased exposure with fluconazole.
Food Interaction
Reduced plasma concentrations with St. John’s wort.
Action
Description: Mechanism of Action: Nevirapine, a non-nucleoside reverse transcriptase inhibitor which binds directly to reverse transcriptase which inhibits the RNA-dependent and DNA-dependent DNA polymerase activities including HIV-1 replication. Pharmacokinetics: Absorption: Readily absorbed from the gastrointestinal tract. Bioavailability: 93% (conventional tab); approx 75% (extended release tab); 91% (oral solution). Time to peak plasma concentration: 4 hours (conventional tab/oral solution); approx 24 hours (extended release tab). Distribution: Crosses placenta, enters breast milk and distributed in the CSF. Volume of distribution: 1.2 L/kg. Plasma protein binding: Approx 60%. Metabolism: Extensively metabolised in the liver by CYP3A4 and CYP2B6 into several hydroxylated metabolites; undergoes enterohepatic recycling. Excretion: Mainly via urine (approx 81% as metabolites; <3% as unchanged drug); faeces (approx 10%). Elimination half-life: 45 hours as single dose; decreases to 25-30 hours after multiple doses.
Chemical Structure
Nevirapine Source: National Center for Biotechnology Information. PubChem Compound Summary for CID 4463, Nevirapine. https://pubchem.ncbi.nlm.nih.gov/compound/Nevirapine. Accessed Apr. 28, 2021.
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