Nevirapin Mylan (Nevirapine)

• Nevirapine is an NNRTI used to manage HIV‑1 infection by targeting viral replication.
• HIV‑1 infection: suppresses viral load when combined with other antiretroviral agents.
• Prevention of mother‑to‑child transmission: reduces the risk of vertical HIV transmission when used in pregnant women as part of combination therapy.
• Treatment‑experienced patients: provides an alternative NNRTI option for individuals with resistance to other antiretrovirals.

• Nevirapine binds to a hydrophobic pocket of the HIV‑1 reverse transcriptase enzyme, inducing a conformational change that blocks the enzyme’s activity. This inhibition prevents conversion of viral RNA into DNA, halting proviral DNA synthesis and subsequent viral replication. By targeting a non‑active site, nevirapine retains activity against strains resistant to nucleoside reverse transcriptase inhibitors.

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

Common Side Effects

• Rash or skin irritation
• Nausea or vomiting
• Fatigue or weakness
• Headache
• Dizziness
• Abdominal pain or discomfort

Serious or Rare Side Effects

• Stevens‑Johnson syndrome or toxic epidermal necrolysis
• Severe hepatic failure or hepatitis
• Hypersensitivity reactions with fever and eosinophilia
• Neutropenia or severe anemia
• Elevated bilirubin or transaminases
• Life‑threatening skin reactions

• When prescribing nevirapine, clinicians should observe several safety considerations.
• Liver monitoring: check baseline and periodic liver function tests due to risk of hepatotoxicity.
• Rash assessment: inspect for skin reactions, especially during the first 8 weeks.
• Pregnancy risk: avoid use in pregnancy unless benefits outweigh risks, as it is Category D.
• Drug interaction review: evaluate concomitant medications that induce or inhibit CYP3A4.
• Adherence counseling: emphasize strict adherence to prevent resistance development.
• Store at below 25°C: keep in the original container, protect from moisture and heat.

Nevirapine interacts with several medicines through metabolic pathways.

Major Interactions (Avoid)

• Rifampicin: strong CYP3A4 inducer that reduces nevirapine exposure.
• Protease inhibitors boosted with ritonavir: increase nevirapine levels, raising toxicity risk.
• St. John’s wort: herbal inducer that markedly lowers nevirapine concentrations.
• Azole antifungals (e.g., ketoconazole): may increase nevirapine levels, leading to adverse effects.

Moderate Interactions (Monitor Closely)

• Efavirenz: co‑administration may increase hepatic toxicity; monitor liver enzymes.
• Hormonal contraceptives: nevirapine can reduce efficacy; advise alternative contraception.
• Anticonvulsants (e.g., carbamazepine): may alter nevirapine metabolism; adjust dosing as needed.