nevirapine

ROUTE	ONSET	PEAK	DURATION
PO-immediate release (IR)	rapid	4 hr	12 hr

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.

Route/Dosage ⬆ ⬇

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.

Renal Impairment

PO (Adults and Children ): Dialysis: Give additional 200 mg of IR nevirapine after each dialysis session.

Availability ⬆ ⬇

(Generic available)

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

Assessment ⬆ ⬇

Assess for change in severity of HIV symptoms and for symptoms of opportunistic infections throughout therapy.
Assess for rash.If mild to moderate rash without constitutional symptoms (fever, weight loss, hyperhidrosis) occurs during 2-wk lead-in period,discontinue therapy until rash has resolved. If not resolved ≥28 days, reconsider therapy.If severe rash or any rash with constitutional symptoms occur,discontinue nevirapine immediately.

Lab Test Considerations:

Monitor viral load and CD4 cell count regularly during therapy.
- Monitor liver function at baseline and frequently during the first 18 wk , especially prior to dose ↑ and 2 wk postdose ↑; continue monitoring throughout therapy. May be asymptomatic with ↑ AST and ALT without clinical signs or symptoms, or symptomatic with ↑ liver enzymes and at least one symptom (rash, flu-like symptoms, fever). May progress to liver failure and death. If hepatotoxicity occurs, permanently discontinue nevirapine.
- Assess patient for hepatitis B and C virus.

Implementation ⬆ ⬇

PO: May be administered with or without food. DNC: Swallow ER tablets whole; do not crush, break, or chew.
- Shake oral solution prior to administration. Use an oral dosing syringe for amounts <5 mL. Rinse syringe or cup and readminister to ensure patient receives full dose.
- If therapy is interrupted for >7 days, restart the recommended lead-in dose for the first 14 days; then follow dose recommendations for particular formulation.

Patient/Family Teaching ⬆ ⬇

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.
Rep: 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.

Evaluation/Desired Outcomes ⬆ ⬇

Delayed progression of HIV and decreased opportunistic infections in patients with HIV.
Decrease in viral load and increase in CD4 cell counts.

US Brand Names ⬆ ⬇

Code ⬆

NDC Code

0378- Mylan Pharmaceuticals Inc.
- 0378-4050- Nevirapine
  - 0378-4050-91- 60 TABLET in 1 BOTTLE, PLASTIC (0378-4050-91)

0378- Mylan Pharmaceuticals Inc.
- 0378-4890- Nevirapine
  - 0378-4890-93- 30 TABLET, EXTENDED RELEASE in 1 BOTTLE, PLASTIC (0378-4890-93)

0597- Boehringer Ingelheim Pharmaceuticals Inc.
- 0597-0046- Viramune
  - 0597-0046-60- 60 TABLET in 1 BOTTLE (0597-0046-60)

0597- Boehringer Ingelheim Pharmaceuticals Inc.
- 0597-0047- Viramune
  - 0597-0047-24- 1 BOTTLE, PLASTIC in 1 CARTON (0597-0047-24) > 240 mL in 1 BOTTLE, PLASTIC

0597- Boehringer Ingelheim Pharmaceuticals, Inc.
- 0597-0123- Viramune
  - 0597-0123-30- 30 TABLET, EXTENDED RELEASE in 1 BOTTLE (0597-0123-30)

0781- Sandoz Inc
- 0781-5893- Nevirapine
  - 0781-5893-05- 500 TABLET, EXTENDED RELEASE in 1 BOTTLE (0781-5893-05)

0781- Sandoz Inc
- 0781-5893- Nevirapine
  - 0781-5893-31- 30 TABLET, EXTENDED RELEASE in 1 BOTTLE (0781-5893-31)

31722- Camber Pharmaceuticals, Inc.
- 31722-505- Nevirapine
  - 31722-505-01- 100 TABLET in 1 BOTTLE (31722-505-01)

31722- Camber Pharmaceuticals, Inc.
- 31722-505- Nevirapine
  - 31722-505-05- 500 TABLET in 1 BOTTLE (31722-505-05)

31722- Camber Pharmaceuticals, Inc.
- 31722-505- Nevirapine
  - 31722-505-10- 1000 TABLET in 1 BOTTLE (31722-505-10)

31722- Camber Pharmaceuticals, Inc.
- 31722-505- Nevirapine
  - 31722-505-60- 60 TABLET in 1 BOTTLE (31722-505-60)

33342- Macleods Pharmaceuticals Limited
- 33342-004- Nevirapine
  - 33342-004-09- 60 TABLET in 1 BOTTLE (33342-004-09)

33342- Macleods Pharmaceuticals Limited
- 33342-004- Nevirapine
  - 33342-004-24- 6 BLISTER PACK in 1 CARTON (33342-004-24) > 10 TABLET in 1 BLISTER PACK

33342- Macleods Pharmaceuticals Limited
- 33342-004- Nevirapine
  - 33342-004-25- 12 BLISTER PACK in 1 CARTON (33342-004-25) > 10 TABLET in 1 BLISTER PACK

33342- Macleods Pharmaceuticals Limited
- 33342-238- NEVIRAPINE
  - 33342-238-07- 30 TABLET, EXTENDED RELEASE in 1 BOTTLE (33342-238-07)

33342- Macleods Pharmaceuticals Limited
- 33342-238- NEVIRAPINE
  - 33342-238-12- 10 BLISTER PACK in 1 CARTON (33342-238-12) > 10 TABLET, EXTENDED RELEASE in 1 BLISTER PACK

42571- Micro Labs Limited
- 42571-131- NEVIRAPINE
  - 42571-131-29- 6 BLISTER PACK in 1 CARTON (42571-131-29) > 10 TABLET in 1 BLISTER PACK

42571- Micro Labs Limited
- 42571-131- NEVIRAPINE
  - 42571-131-60- 60 TABLET in 1 BOTTLE (42571-131-60)

47781- Alvogen Inc.
- 47781-317- Nevirapine Extended Release
  - 47781-317-30- 30 TABLET in 1 BOTTLE (47781-317-30)

51991- Breckenridge Pharmaceutical, Inc.
- 51991-331- Nevirapine
  - 51991-331-06- 60 TABLET in 1 BOTTLE (51991-331-06)

53104- Cipla Ltd.
- 53104-0166- nevirapine
  - 53104-0166-2- 60 TABLET in 1 BOTTLE (53104-0166-2)

53104- Cipla Ltd.
- 53104-0166- nevirapine
  - 53104-0166-6- 1000 TABLET in 1 BOTTLE (53104-0166-6)

53808- State of Florida DOH Central Pharmacy
- 53808-0680- Nevirapine
  - 53808-0680-1- 30 TABLET in 1 BLISTER PACK (53808-0680-1)

64380- Strides Pharma Science Limited
- 64380-709- Nevirapine
  - 64380-709-03- 60 TABLET in 1 BOTTLE, PLASTIC (64380-709-03)

65162- Amneal Pharmaceuticals of New York, LLC
- 65162-209- Nevirapine
  - 65162-209-06- 60 TABLET in 1 BOTTLE (65162-209-06)

65862- Aurobindo Pharma Limited
- 65862-027- Nevirapine
  - 65862-027-10- 6 BLISTER PACK in 1 CARTON (65862-027-10) > 10 TABLET in 1 BLISTER PACK

65862- Aurobindo Pharma Limited
- 65862-027- Nevirapine
  - 65862-027-60- 60 TABLET in 1 BOTTLE (65862-027-60)

65862- Aurobindo Pharma Limited
- 65862-057- Nevirapine
  - 65862-057-11- 100 mL in 1 BOTTLE (65862-057-11)

65862- Aurobindo Pharma Limited
- 65862-057- Nevirapine
  - 65862-057-24- 240 mL in 1 BOTTLE (65862-057-24)

65862- Aurobindo Pharma Limited
- 65862-932- NEVIRAPINE
  - 65862-932-05- 500 TABLET, EXTENDED RELEASE in 1 BOTTLE (65862-932-05)

65862- Aurobindo Pharma Limited
- 65862-932- NEVIRAPINE
  - 65862-932-90- 90 TABLET, EXTENDED RELEASE in 1 BOTTLE (65862-932-90)

65862- Aurobindo Pharma Limited
- 65862-932- NEVIRAPINE
  - 65862-932-99- 1000 TABLET, EXTENDED RELEASE in 1 BOTTLE (65862-932-99)

65862- Aurobindo Pharma Limited
- 65862-933- NEVIRAPINE
  - 65862-933-05- 500 TABLET, EXTENDED RELEASE in 1 BOTTLE (65862-933-05)

65862- Aurobindo Pharma Limited
- 65862-933- NEVIRAPINE
  - 65862-933-30- 30 TABLET, EXTENDED RELEASE in 1 BOTTLE (65862-933-30)

65862- Aurobindo Pharma Limited
- 65862-933- NEVIRAPINE
  - 65862-933-90- 90 TABLET, EXTENDED RELEASE in 1 BOTTLE (65862-933-90)

65862- Aurobindo Pharma Limited
- 65862-933- NEVIRAPINE
  - 65862-933-99- 1000 TABLET, EXTENDED RELEASE in 1 BOTTLE (65862-933-99)

69097- Cipla USA Inc.
- 69097-233- nevirapine
  - 69097-233-44- 100 mL in 1 BOTTLE (69097-233-44)

69097- Cipla USA Inc.
- 69097-233- nevirapine
  - 69097-233-46- 240 mL in 1 BOTTLE (69097-233-46)

69097- Cipla USA Inc.
- 69097-403- NEVIRAPINE
  - 69097-403-02- 30 TABLET, EXTENDED RELEASE in 1 BOTTLE (69097-403-02)

69097- Cipla USA Inc.
- 69097-403- NEVIRAPINE
  - 69097-403-11- 480 TABLET, EXTENDED RELEASE in 1 BOTTLE (69097-403-11)

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Pronunciation ⬇

Classifications ⬆ ⬇

Indications ⬆ ⬇

Action ⬆ ⬇

Pharmacokinetics ⬆ ⬇

Time/Action Profile ⬆ ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇