Nevirapin Hormosan (Nevirapine)

Nevirapine is an antiretroviral medication that targets the HIV-1 replication pathway.

• HIV-1 infection (adults): reduces viral load and helps restore immune function in infected individuals.
• HIV-1 infection (children): contributes to viral suppression and immune recovery when used in pediatric combination therapy.
• Prevention of mother-to-child transmission: lowers the risk of vertical transmission when administered to pregnant women living with HIV.

• Nevirapine binds to a non‑nucleoside site on the HIV‑1 reverse transcriptase enzyme, inducing a conformational change that impairs the enzyme’s ability to synthesize DNA from viral RNA. This inhibition blocks the transcription step essential for viral replication, thereby decreasing the production of new virus particles and limiting disease progression.

Nevirapine may cause a range of adverse reactions, from mild to severe.

Common Side Effects

• Rash: mild to moderate skin eruptions that may be itchy.
• Nausea: occasional stomach discomfort or queasiness.
• Fatigue: feeling unusually tired or weak.
• Headache: mild to moderate head pain.
• Elevated liver enzymes: mild increases detected in routine labs.
• Abdominal pain: discomfort in the stomach area.

Serious or Rare Side Effects

• Stevens‑Johnson syndrome: severe skin reaction with blistering and detachment.
• Toxic epidermal necrolysis: life‑threatening widespread skin loss.
• Severe hepatotoxicity: marked liver injury that can lead to failure.
• Hypersensitivity reactions: systemic allergic responses including fever and organ involvement.
• Hepatic failure: acute loss of liver function requiring urgent care.

Nevirapine requires careful monitoring and patient counseling before and during therapy.

• Liver monitoring: obtain baseline liver function tests and repeat regularly.
• Rash monitoring: inspect skin for any new rash and discontinue if severe.
• Hepatic disease caution: avoid use in patients with moderate to severe pre‑existing liver disease.
• Pregnancy caution: assess risk‑benefit ratio; use only when benefits outweigh potential fetal risks.
• Store at below 25°C: keep in the original pack, protect from moisture and direct sunlight.

Nevirapine can interact with several drug classes, affecting its efficacy or safety.

Major Interactions (Avoid)

• Rifampin: strong enzyme inducer that markedly reduces nevirapine plasma levels.
• Carbamazepine, phenytoin, St. John's wort: potent CYP3A4 inducers that may compromise antiviral effect.

Moderate Interactions (Monitor Closely)

• Protease inhibitors (e.g., ritonavir): may increase nevirapine concentrations and risk of toxicity.
• Hormonal contraceptives: nevirapine can lower contraceptive effectiveness; additional methods advised.
• Warfarin: may alter anticoagulant control; monitor INR more frequently.