Nevirapine Mylan (Nevirapine)

Nevirapine is a non‑nucleoside reverse transcriptase inhibitor indicated for HIV‑1 infection, where it helps suppress viral replication as part of combination therapy.

• HIV‑1 infection: Used in combination antiretroviral regimens to reduce viral load and improve immune function.

• Nevirapine binds to a non‑nucleoside site on the HIV‑1 reverse transcriptase enzyme, inducing a conformational change that blocks the enzyme’s activity. This prevents transcription of viral RNA into DNA, thereby inhibiting viral replication and allowing the immune system to recover.

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

Common Side Effects

• Rash: mild to moderate skin eruptions.
• Nausea: occasional gastrointestinal upset.
• Headache: transient cranial discomfort.
• Fatigue: general feeling of tiredness.
• Dizziness: occasional light‑headedness.
• Insomnia: difficulty falling or staying asleep.

Serious or Rare Side Effects

• Stevens‑Johnson syndrome: severe skin reaction requiring immediate medical attention.
• Hepatotoxicity: liver enzyme elevations or hepatitis.
• Severe hypersensitivity: including fever, malaise, and organ involvement.
• Neutropenia: marked reduction in white blood cells.
• Hepatic failure: rare but potentially life‑threatening liver dysfunction.
• Anaphylaxis: acute allergic reaction with airway compromise.

Nevirapine requires careful monitoring due to its safety profile.

• Liver monitoring: assess hepatic function before initiation and periodically during therapy.
• Rash vigilance: discontinue if severe or progressive skin reactions develop.
• Hypersensitivity: avoid in patients with known allergy to nevirapine or related compounds.
• Pregnancy caution: use only if benefits outweigh potential risks, as safety data are limited.
• Baseline CD4 count: evaluate immune status prior to starting therapy.
• Store at room temperature: keep in the original container, protect from moisture and direct sunlight.

Nevirapine interacts with several drugs that affect its metabolism.

Major Interactions (Avoid)

• Rifampin: strong enzyme inducer that markedly reduces nevirapine plasma levels.
• Carbamazepine: induces CYP enzymes, lowering nevirapine exposure.
• Phenytoin: reduces nevirapine concentrations through hepatic induction.

Moderate Interactions (Monitor Closely)

• Protease inhibitors (e.g., ritonavir): may increase nevirapine levels, requiring dose adjustment.
• Azole antifungals (e.g., fluconazole, ketoconazole): inhibit metabolism and can raise nevirapine concentrations.
• St. John's wort: herbal inducer that may decrease nevirapine effectiveness.