• HIV infection (in combination with other antiretroviral agents).

Contraindicated in:

• Hypersensitivity
• Concurrent use of ketoconazole, rifampin, or St. John's wort
• Moderate or severe hepatic impairment
• As part of occupational and nonoccupational postexposure prophylaxis regimens
• Women with CD4+ cell counts >250 cells/mm³ (↑ risk of liver toxicity)
• Lactation: Breastfeeding not recommended in women with HIV.

Use Cautiously in:

• Women (↑ risk of liver toxicity)
• Mild renal impairment
• Mild hepatic impairment
• OB: Use during pregnancy only if potential maternal benefit justifies potential fetal risk
• Pedi: Children <6 yr or with a body surface area (BSA) <1.17 m² (extended-release [ER] nevirapine) and <15 days (IR nevirapine) (safety and effectiveness not established).

Reflects combination therapy

Derm: rash (may progress to toxic epidermal necrolysis), DRUG REACTION WITH EOSINOPHILIA AND SYSTEMIC SYMPTOMS (DRESS), STEVENS-JOHNSON SYNDROME.

GI: ↑liver enzymes, nausea, abdominal pain, diarrhea, hepatitis, HEPATOTOXICITY, ulcerative stomatitis.

GU: ↓fertility (females).

Hemat: granulocytopenia (↑ in children).

MS: myalgia.

Neuro: headache, paresthesia, peripheral neuropathy.
Misc: fever, immune reconstitution syndrome.

Drug-Drug:

• Significantly ↓ levels and effectiveness of ketoconazole; concurrent use contraindicated.
• Rifampin significantly ↓ levels and effectiveness; concurrent use contraindicated.
• May induce methadone withdrawal within 2 wk of starting therapy in patients physically dependent on methadone.
• May ↓ levels and effectiveness of hormonal contraceptives; avoid concurrent use of hormonal contraceptives.
• May ↓ levels and effectiveness of clarithromycin, lopinavir, fosamprenavir, nelfinavir, efavirenz, amiodarone, disopyramide, lidocaine, itraconazole, carbamazepine, clonazepam, ethosuximide, diltiazem, nifedipine, verapamil, cyclosporine, tacrolimus, sirolimus, cyclophosphamide, ergotamine, fentanyl , and rifabutin.
• Fluconazole↑ levels and risk of toxicity.
• May ↑ levels of and risk of bleeding with warfarin.
• Use of prednisone during first 2 wk of therapy may ↑ risk of rash.
• Simultaneously initiating other drugs that often cause rash, including trimethoprim/sulfamethoxazole and abacavir, may ↑ risk of rash.
• Concurrent use with atazanavir may ↓ atazanavir levels and ↑ nevirapine levels; concurrent use not recommended.
• May ↑ levels and risk of toxicity of darunavir/ritonavir and maraviroc.

Drug-Natural Products:

• St. John’s wort may ↓ levels and effectiveness; concurrent use contraindicated.

(Generic available)

• Extended-release tablets: 400 mg;
• Immediate-release tablets: 200 mg;
• Oral suspension: 50 mg/5 mL;

• PO (Adults): IR: 200 mg daily for the first 2 wk, then 200 mg twice daily (in combination with a nucleoside analogue antiretroviral); ER (for patients not currently taking IR nevirapine): 200 mg of IR nevirapine for the first 2 wk (to ↓ risk of rash), then 400 mg of ER nevirapine once daily; ER (for patients currently taking IR nevirapine): switch to 400 mg of extended-release nevirapine once daily.
• PO (Children 15 days): IR: 150 mg/m² once daily for first 2 wk, then 150 mg/m² twice daily.
• PO (Children 6–<18 yr and BSA 1.17 m²): ER: 150 mg/m² of IR nevirapine once daily (max = 200 mg/day) for the first 2 wk (to ↓ risk of rash), then 400 mg of ER nevirapine once daily.

Viramune

• Binds to the enzyme reverse transcriptase, which results in disruption of DNA synthesis.

• Slowed progression of HIV infection and decreased occurrence of sequelae.

Therapeutic Classification: antiretrovirals

Pharmacologic Classification: non nucleoside reverse transcriptase inhibitors

Absorption: >90% absorbed after oral administration.

Distribution: Widely distributed to tissues.

Metabolism/Excretion: Primarily metabolized by the liver via the CYP3A4 isoenzyme; minor amounts excreted unchanged in urine.

Half-life: 25–30 hr (during multiple dosing).

(plasma concentrations)

• Emphasize importance of taking nevirapine as directed, at evenly spaced times throughout day. Instruct patient to read the Medication Guide prior to initiating therapy and with each Rx refill. Do not take more than prescribed amount and do not stop taking without consulting health care professional. Take missed doses as soon as remembered; do not double doses.
• Instruct patient not to share nevirapine with others.
• Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications.
• Inform patient that nevirapine does not cure HIV or prevent associated or opportunistic infections. Nevirapine may ↓ the risk of transmission of HIV to others through sexual contact or blood contamination. Caution patient to use condoms and avoid sharing needles or donating blood to prevent spreading HIV to others.
• Instruct patient to notify health care professional immediately if signs and symptoms of hepatitis (flu-like symptoms, tiredness, nausea, lack of appetite, yellow skin or eyes, dark urine, pale stools, pain or sensitivity to touch on right side below ribs), skin reactions with symptoms (flu-like symptoms, fever, muscle aches, conjunctivitis, blisters, mouth sores, swelling of face, tiredness), or signs of immune reconstitution syndrome (signs and symptoms of an infection) occur. Nevirapine should be discontinued immediately.
• Advise patient taking oral contraceptives to use a nonhormonal method of birth control during nevirapine therapy. If pregnancy is suspected, notify health care professional promptly. Encourage pregnant patients to enroll in the Antiretroviral Pregnancy Registry by calling 1-800-258-4263. Advise patient to avoid breastfeeding during therapy. Nevirapine may ↓ fertility in females.
• Emphasize the importance of regular follow-up exams and blood counts to determine progress and monitor for side effects.

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