Nevirapina Accord (Nevirapine)

Nevirapine is a non‑nucleoside reverse transcriptase inhibitor used in the management of HIV‑1 infection.

• HIV‑1 infection (treatment‑naïve adults): reduces viral load and delays disease progression.
• HIV‑1 infection (treatment‑experienced adults): provides an alternative regimen when resistance develops.
• Prevention of mother‑to‑child transmission of HIV‑1: lowers the risk of vertical transmission when combined with other antiretrovirals.

• Nevirapine binds to a non‑nucleoside site on the HIV‑1 reverse transcriptase enzyme, inducing conformational changes that inhibit the enzyme’s RNA‑dependent DNA polymerase activity. This blockade prevents the conversion of viral RNA into DNA, thereby halting viral replication and reducing the amount of virus in the bloodstream.

Nevirapine may cause a range of adverse reactions, from mild to severe. Patients should be monitored for any new symptoms during therapy.

Common Side Effects

• Rash: mild to moderate skin eruptions.
• Nausea: occasional gastrointestinal upset.
• Fatigue: general tiredness.
• Headache: transient cranial discomfort.
• Dizziness: occasional light‑headedness.
• Abdominal pain: mild stomach discomfort.

Serious or Rare Side Effects

• Stevens‑Johnson syndrome: severe skin reaction requiring immediate discontinuation.
• Toxic epidermal necrolysis: life‑threatening skin detachment.
• Severe hepatic injury: marked elevation of liver enzymes or hepatitis.
• Hypersensitivity reactions: fever, eosinophilia, or organ involvement.
• Grade 3/4 neutropenia: significant reduction in white blood cells.
• Lactic acidosis: rare metabolic disturbance.

Nevirapine requires careful monitoring to minimize risks and ensure safe use.

• Liver function monitoring: assess baseline and periodic liver enzymes.
• Skin reactions: discontinue immediately if severe rash or mucosal involvement occurs.
• Hepatic risk: avoid in patients with active hepatitis or severe liver disease.
• Drug interactions: review concomitant medications, especially CYP inducers or inhibitors.
• Pregnancy and breastfeeding: evaluate risk‑benefit ratio before use.
• Store at ambient temperature: keep in the original container, protect from moisture and light.

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

Major Interactions (Avoid)

• Ritonavir: potent CYP3A4 inhibition can raise nevirapine concentrations.
• St. John’s wort: strong CYP3A4 induction may reduce nevirapine effectiveness.

Moderate Interactions (Monitor Closely)

• Efavirenz: additive central nervous system effects may increase neuropsychiatric symptoms.
• Zidovudine: combined use may heighten risk of hepatotoxicity.
• Oral contraceptives: nevirapine may decrease hormonal contraceptive efficacy.