Nevirapina Aurovitas (Nevirapine)

Nevirapine is used to manage HIV‑1 infection, a viral disease that targets the immune system.

• HIV‑1 infection (treatment): Reduces viral load and helps restore immune function when used in combination antiretroviral therapy.
• HIV‑1 infection in pregnant women (prevention of mother‑to‑child transmission): Decreases the risk of transmitting the virus to the newborn when given during labor.
• HIV‑1 infection in adolescents: Provides an effective component of combination regimens for patients aged 12 years and older.

• Nevirapine binds to a specific allosteric site on the HIV‑1 reverse transcriptase enzyme, inducing a conformational change that blocks the enzyme’s RNA‑dependent DNA polymerase activity. By preventing the conversion of viral RNA into DNA, the drug halts replication of HIV within infected cells, thereby lowering plasma viral concentrations and allowing immune recovery when combined with other antiretrovirals.

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 or painful.
• Nausea: feeling of stomach upset often accompanied by loss of appetite.
• Fatigue: generalized tiredness or lack of energy.
• Headache: mild to moderate head pain.
• Abdominal pain: discomfort or cramps in the stomach area.
• Diarrhoea: loose, watery stools occurring intermittently.

Serious or Rare Side Effects

• Stevens‑Johnson syndrome: severe skin reaction with blistering and detachment.
• Toxic epidermal necrolysis: life‑threatening skin loss and mucosal involvement.
• Hepatotoxicity: marked elevation of liver enzymes or liver failure.
• Severe hypersensitivity reactions: including fever, eosinophilia, and organ involvement.
• Hematologic abnormalities: such as anaemia or neutropenia.

Before initiating nevirapine therapy, several safety considerations should be observed.

• Baseline liver assessment: evaluate hepatic enzymes and function prior to treatment.
• CD4 count monitoring: avoid starting in women with CD4 > 250 cells/µL or men with CD4 > 400 cells/µL due to higher rash risk.
• Hypersensitivity history: do not use in patients with known allergy to nevirapine or other NNRTIs.
• Concomitant hepatotoxic drugs: avoid or monitor when combined with other agents that affect liver function.
• Pregnancy and breastfeeding: use only when benefits outweigh potential risks and under close medical supervision.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Nevirapine interacts with several medicines that can alter its plasma levels or increase toxicity.

Major Interactions (Avoid)

• Rifampicin: strong enzyme inducer that markedly reduces nevirapine concentrations.
• Carbamazepine: induces hepatic metabolism leading to subtherapeutic nevirapine levels.
• Phenytoin: accelerates clearance of nevirapine, diminishing efficacy.

Moderate Interactions (Monitor Closely)

• Protease inhibitors (e.g., ritonavir): may increase nevirapine exposure and risk of liver toxicity.
• Hormonal contraceptives: nevirapine can lower contraceptive effectiveness, requiring additional barrier methods.
• St John’s wort: herbal inducer that may reduce nevirapine plasma concentrations.