Nevirapine Lp Arrow (Nevirapine)

Nevirapine is used in antiretroviral therapy targeting HIV‑1 replication.

• HIV‑1 infection: Reduces viral load and improves immune function in patients with HIV‑1 infection.
• Combination antiretroviral therapy: Forms part of highly active antiretroviral regimens to achieve sustained virologic suppression.
• Prevention of mother‑to‑child transmission: Included in maternal regimens to lower the risk of vertical HIV transmission.

• Nevirapine binds to a non‑nucleoside site on the HIV‑1 reverse transcriptase enzyme, inducing a conformational change that impairs the enzyme’s activity. This inhibition blocks the synthesis of viral DNA from the RNA template, preventing the integration of viral genetic material into host cells and thereby halting viral replication.

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

Common Side Effects

• Rash: Skin eruptions ranging from mild erythema to pruritic lesions.
• Nausea: Transient gastrointestinal discomfort.
• Fatigue: Generalized tiredness.
• Headache: Mild to moderate cephalic pain.
• Abdominal pain: Discomfort in the upper abdomen.
• Dizziness: Light‑headed sensation.

Serious or Rare Side Effects

• Stevens‑Johnson syndrome: Severe mucocutaneous reaction requiring immediate medical attention.
• Hepatic failure: Acute liver injury with elevated enzymes.
• Severe hypersensitivity: Systemic allergic response with fever and organ involvement.
• Hepatotoxicity: Persistent liver enzyme elevation.
• Neutropenia: Marked reduction in neutrophil count.
• Life‑threatening skin reactions: Toxic epidermal necrolysis or drug reaction with eosinophilia and systemic symptoms.

Nevirapine requires careful monitoring to minimize risks.

• Liver function monitoring: Perform baseline and periodic liver enzyme tests.
• Rash surveillance: Observe for any skin changes and discontinue if severe.
• Hypersensitivity caution: Avoid use in patients with known hypersensitivity to nevirapine.
• Drug‑induced hepatotoxicity: Use cautiously with other hepatotoxic agents.
• Dose adjustment in hepatic impairment: Consider reduced dosing in moderate liver disease.
• Store at ambient temperature: Keep in the original container, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Rifampicin: Strong inducer that markedly reduces nevirapine plasma levels.
• St. John’s wort: Herbal inducer leading to decreased drug exposure.
• Protease inhibitors (e.g., ritonavir): Can increase nevirapine concentrations and risk of toxicity.

Moderate Interactions (Monitor Closely)

• Azole antifungals (e.g., fluconazole): May raise nevirapine levels modestly.
• Macrolide antibiotics (e.g., erythromycin): Can affect metabolism and require monitoring.
• Oral contraceptives: Nevirapine may reduce hormonal efficacy; consider alternative contraception.