Nevirapine Moringside Healthcare (Nevirapine)

Nevirapine is a non‑nucleoside reverse transcriptase inhibitor used in antiretroviral therapy for HIV‑1 infection.

• Initial HIV‑1 infection: reduces viral load when combined with other antiretroviral agents.
• Treatment‑experienced HIV‑1 infection: provides an additional mechanism of action in salvage regimens.
• HIV‑1 infection in pregnant women (category B): used under medical supervision as part of combination therapy.

• 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 prevents the conversion of viral RNA into DNA, thereby blocking viral replication and reducing the amount of virus in the bloodstream.

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

Common Side Effects

• Rash: mild to moderate skin eruptions.
• Nausea: occasional gastrointestinal discomfort.
• Headache: transient mild headaches.
• Fatigue: general feeling of tiredness.
• Diarrhea: loose stools, usually self‑limiting.
• Elevated liver enzymes: mild hepatic enzyme changes.

Serious or Rare Side Effects

• Stevens‑Johnson syndrome: severe skin reaction requiring immediate medical attention.
• Hepatotoxicity: significant liver injury, potentially leading to jaundice.
• Severe hypersensitivity: systemic allergic response with fever and malaise.
• Neutropenia: marked reduction in white blood cells.
• Anaphylaxis: rare life‑threatening allergic reaction.
• Autoimmune hepatitis: immune‑mediated liver inflammation.

Nevirapine requires careful monitoring and patient education to minimize risks.

• Liver monitoring: assess hepatic function before initiation and regularly during therapy.
• Rash assessment: examine any skin changes promptly; discontinue if severe.
• Pregnancy counseling: use only when benefits outweigh risks; monitor fetal development.
• Hepatic impairment: adjust therapy and monitor closely in patients with existing liver disease.
• Drug hypersensitivity: avoid in individuals with known hypersensitivity to nevirapine or other NNRTIs.
• Store below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Nevirapine interacts with several medicines that affect its metabolism or increase toxicity.

Major Interactions (Avoid)

• Rifampicin: strong enzyme inducer that markedly reduces nevirapine plasma levels.
• St. John’s wort: herbal inducer leading to subtherapeutic concentrations.
• Concurrent NNRTIs: additive toxicity and overlapping mechanisms.

Moderate Interactions (Monitor Closely)

• Azidothymidine (AZT): may increase risk of hepatotoxicity.
• Hormonal contraceptives: reduced efficacy, consider alternative contraception.
• Warfarin: potential alteration of INR, monitor coagulation parameters.
• Protease inhibitors (e.g., ritonavir): may increase nevirapine levels, adjust dose if needed.