Nevirapine Tablet: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Nevirapine Tablet (nevirapine) is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used together with other antiretroviral medicines to treat HIV-1 infection. It is used in adults, adolescents, and children, and may also help prevent mother-to-child transmission of HIV. It is not a cure for HIV and does not prevent transmission of HIV to others. It works by blocking an enzyme HIV needs to multiply, helping to reduce viral load and support CD4 cell counts.

What is Nevirapine Tablet

Nevirapine is a prescription antiretroviral medicine used together with other HIV medicines to treat HIV-1 infection. It belongs to a group of anti-HIV medicines called non-nucleoside reverse transcriptase inhibitors (NNRTIs). It is not a cure for HIV and does not stop you from passing HIV to others.

Nevirapine Tablet uses

• Treatment of HIV-1 infection in adults, adolescents, and children, always used in combination with other antiretroviral medicines
• May be used to help prevent mother-to-child (perinatal) transmission of HIV
• Treats HIV-1 infection
• Helps reduce HIV viral load
• Helps maintain or improve CD4 cell counts

Benefits of Nevirapine Tablet

• Helps lower the amount of HIV in the blood (viral load) when combined with other antiretroviral medicines
• Can help increase CD4 cell counts, supporting the immune system
• Reduces HIV viral load
• Helps increase or maintain CD4 cell counts
• Supports the immune system
• Helps slow HIV disease progression

How Nevirapine Tablet works

Nevirapine blocks an HIV enzyme called reverse transcriptase that the virus needs to multiply, which helps control the infection.

Nevirapine Tablet dosage

Nevirapine must always be taken together with at least two other antiretroviral medicines, never on its own. For the first 14 days, take the lower once-daily dose (the "lead-in" period), which has been shown to lower the risk of skin rash. After 14 days, move to the twice-daily dosing schedule, unless you have a rash, in which case do not increase the dose until it resolves.

Tablets should be swallowed with liquid and should not be crushed or chewed. Extended-release tablets should not be broken or chewed. Nevirapine can be taken with or without food. Oral suspension should be shaken gently before use and measured with an oral dosing syringe or cup.

If you miss a dose within 8 hours of when it was due, take it as soon as possible; if more than 8 hours late, skip it and take the next dose at the usual time. If you stop taking nevirapine for more than 7 days, you will need to restart with the 14-day lead-in dosing period before returning to the regular schedule. Elderly patients have not been specifically studied, so dosing should be approached cautiously.

Available forms and strengths

• Immediate-release tablets (200 mg)
• Extended-release tablets (400 mg)
• Oral suspension (50 mg/5 mL)

Side effects of Nevirapine Tablet

Common

• Rash
• Headache
• Nausea
• Vomiting
• Abdominal pain
• Diarrhoea
• Fatigue
• Fever
• Granulocytopenia (low white blood cell count)
• Hypersensitivity reactions
• Abnormal liver function test results

Serious

• Severe and life-threatening skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis
• Severe and life-threatening liver damage, including fulminant hepatitis and liver failure
• Hypersensitivity (allergic) reactions with rash, fever, and organ involvement (such as hepatitis, eosinophilia, granulocytopenia, and kidney problems)
• Anaphylactic reaction, angioedema
• Jaundice
• Rhabdomyolysis (in patients with skin or liver reactions)

Warnings and precautions

• The first 18 weeks of treatment are a critical period requiring close monitoring for severe and potentially life-threatening skin reactions and liver problems. The highest risk period is the first 6 weeks.
• Nevirapine must never be used alone; it should always be taken with at least two other antiretroviral medicines because using it alone leads to drug resistance. Patients who have had to stop nevirapine in the past due to severe rash, hypersensitivity reaction, or liver problems should never take it again.
• St John's Wort must not be taken with nevirapine because it can reduce nevirapine levels and reduce its effectiveness.
• Women with higher CD4 counts and detectable viral load, and men with higher CD4 counts and detectable viral load, are at greater risk of serious liver problems when starting nevirapine.
• Hormonal birth control methods other than DMPA injections should not be used as the only method of contraception, since nevirapine may lower their effectiveness; barrier methods like condoms are recommended.
• Prednisone should not be used to try to prevent or treat nevirapine-related rash, as it may actually increase the risk and severity of rash.
• There are no adequate, well-controlled studies in pregnant women. Nevirapine should be used with caution in pregnancy, and the same liver-risk warnings for CD4 counts apply, including to pregnant women.
• Nevirapine passes into breast milk, and mothers with HIV are advised not to breastfeed while taking this medicine to avoid passing HIV to the infant.
• Patients with kidney dysfunction requiring dialysis need an extra dose after each dialysis session. Those with a creatinine clearance of 20 mL/min or more do not need a dose change.
• Nevirapine must not be used in people with severe liver impairment, and caution is needed in those with moderate liver impairment. Liver problems are a major risk of this medicine and require close monitoring, especially in the first 18 weeks of treatment.
• This medicine can cause fatigue, so caution is advised when driving or operating machinery, and hazardous tasks should be avoided if you feel tired.

Storage

• This medicinal product does not require any special storage conditions.
• Keep out of the sight and reach of children.
• Do not use this medicine after the expiry date which is stated on the carton and on the blister after EXP.
• Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use.

When to see a doctor

• Stop taking nevirapine and seek medical help immediately if you develop a severe rash or a rash with fever, blistering, mouth sores, eye inflammation, facial swelling, general swelling, muscle or joint aches, or feeling generally unwell.
• Stop taking nevirapine and contact your doctor right away if you notice signs of liver damage such as loss of appetite, nausea, vomiting, yellowing of the skin or eyes, or abdominal pain.
• Never restart nevirapine if you have previously had to stop it due to severe liver, skin, or hypersensitivity reactions.
• Tell your doctor immediately if you notice any signs of infection or symptoms like muscle weakness, weakness starting in the hands and feet, palpitations, tremor, or hyperactivity, as these may indicate an immune or autoimmune reaction.
• Seek medical advice if you develop joint stiffness, aches, or pain, or difficulty moving, as these could be signs of a bone condition called osteonecrosis.

Alternatives

• Dolutegravir-based regimens
• Bictegravir-based regimens
• Raltegravir-based regimens