Nevirapine Accord (Nevirapine)

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

• HIV‑1 infection (treatment): Reduces viral load when used with other antiretroviral agents.
• Treatment‑experienced HIV‑1 patients: Provides an alternative option for those with resistance to other drugs.
• Pediatric HIV‑1 infection (≥2 kg): Used under specialist supervision as part of a regimen for children.

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

Nevirapine may cause a range of adverse reactions, from mild to severe. Monitoring for side effects is essential during therapy.

Common Side Effects

• Rash: Often mild, may appear on trunk or limbs.
• Headache: Transient, usually resolves without intervention.
• Nausea: May be accompanied by mild abdominal discomfort.
• Fatigue: Generalized tiredness reported by some patients.
• Diarrhea: Loose stools occurring early in treatment.
• Elevated liver enzymes: Detected in routine blood tests.

Serious or Rare Side Effects

• Stevens‑Johnson syndrome: Severe skin reaction requiring immediate medical attention.
• Hepatotoxicity: Significant liver injury, presenting with jaundice or elevated bilirubin.
• Severe hypersensitivity: Includes fever, eosinophilia, and organ involvement.
• Hematologic abnormalities: Such as anemia or neutropenia.
• Immune reconstitution syndrome: Worsening of opportunistic infections after immune recovery.

Before initiating Nevirapine, clinicians should assess patient history and monitor for potential risks.

• Liver function: Evaluate baseline hepatic enzymes and monitor regularly.
• Skin reactions: Inspect for rash; discontinue if severe or progressing.
• Pregnancy: Use only if benefits outweigh risks; consult specialist.
• Drug resistance: Perform resistance testing when possible.
• Concomitant medications: Review for interactions that affect metabolism.
• Store at ambient temperature: Keep below 25 °C, in original packaging, protected from moisture and direct sunlight.

Nevirapine interacts with several drug classes, influencing efficacy and safety.

Major Interactions (Avoid)

• Rifampicin: Reduces nevirapine plasma levels, compromising antiviral effect.
• Carbamazepine: Induces metabolism, leading to subtherapeutic concentrations.
• St. John's wort: Potent CYP3A4 inducer, markedly decreasing nevirapine exposure.

Moderate Interactions (Monitor Closely)

• Protease inhibitors (e.g., ritonavir): May increase nevirapine levels, requiring dose adjustment.
• Hormonal contraceptives: Potential reduction in contraceptive efficacy.
• Warfarin: May alter anticoagulant effect; monitor INR closely.