Nevirapina Accord (Nevirapine)

Nevirapine is an NNRTI used in the management of HIV‑1 infection as part of combination therapy.

• HIV‑1 infection in adults: reduces viral load when combined with other antiretrovirals.
• HIV‑1 infection in adolescents: contributes to viral suppression as part of a regimen.
• Prevention of mother‑to‑child transmission of HIV‑1: used with other agents to lower transmission risk during pregnancy and delivery.

• Nevirapine binds to a hydrophobic pocket of the HIV‑1 reverse transcriptase enzyme, inducing a conformational change that blocks both RNA‑dependent and DNA‑dependent DNA polymerase activities. This inhibition prevents the synthesis of viral DNA from the RNA template, thereby halting viral replication within infected cells.

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

Common Side Effects

• Rash: mild to moderate skin eruptions.
• Nausea: occasional gastrointestinal upset.
• Fatigue: general tiredness.
• Headache: mild to moderate intensity.
• Dizziness: transient episodes.
• Abdominal pain: mild discomfort.

Serious or Rare Side Effects

• Stevens‑Johnson syndrome: severe skin reaction requiring immediate medical attention.
• Hepatic failure: signs of liver toxicity such as jaundice.
• Severe hypersensitivity: systemic allergic response.
• Anemia: notable decrease in red blood cell count.
• Neutropenia: reduced neutrophil levels increasing infection risk.
• Severe skin reactions: including toxic epidermal necrolysis.

Before initiating therapy, several safety considerations should be addressed.

• Liver monitoring: assess hepatic function regularly due to risk of hepatotoxicity.
• Rash assessment: evaluate any skin eruption promptly for progression.
• Hepatic impairment: avoid or adjust use in patients with severe liver disease.
• Pregnancy caution: discuss potential risks with a healthcare professional.
• Drug interactions: review concomitant medications for possible interactions.
• Store at room temperature: keep in original container, protect from moisture and light.

Nevirapine interacts with several medicines that can alter its effectiveness or safety.

Major Interactions (Avoid)

• Rifampicin: induces metabolism, reducing nevirapine levels.
• Protease inhibitors (e.g., ritonavir): can increase nevirapine toxicity.
• Carbamazepine: strong enzyme inducer decreasing nevirapine exposure.

Moderate Interactions (Monitor Closely)

• Efavirenz: may affect plasma concentrations of both drugs.
• Hormonal contraceptives: efficacy may be reduced.
• Warfarin: nevirapine may alter anticoagulant effect, requiring INR monitoring.