Nevirapine Mylan (Nevirapine)

Nevirapine is used in antiretroviral therapy to suppress HIV‑1 replication.

• HIV‑1 infection (adults): Used as part of combination therapy to achieve sustained viral load reduction.
• HIV‑1 infection (children): Provides an effective antiviral component within pediatric antiretroviral regimens.
• Treatment‑experienced patients: Added to regimens when resistance to other agents is present.
• Prevention of mother‑to‑child transmission: Included in maternal regimens to reduce vertical transmission risk.

• Nevirapine binds to a non‑nucleoside site on the HIV‑1 reverse transcriptase enzyme, inducing a conformational change that impairs the enzyme’s ability to transcribe viral RNA into DNA. This inhibition blocks a critical step in the viral replication cycle, preventing the formation of new viral particles and reducing plasma viral load when used with other antiretrovirals.

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.
• Fatigue: general tiredness.
• Headache: transient cranial discomfort.
• Abdominal pain: mild stomach discomfort.
• Dizziness: occasional light‑headedness.

Serious or Rare Side Effects

• Stevens‑Johnson syndrome: severe skin reaction requiring immediate medical attention.
• Hepatic failure: signs of liver toxicity such as jaundice.
• Severe hypersensitivity: systemic allergic response.
• Hepatotoxicity: elevated liver enzymes.
• Severe neutropenia: marked reduction in white blood cells.
• Life‑threatening rash: extensive skin involvement.

Nevirapine requires careful monitoring and patient counseling to minimize risks.

• Liver function monitoring: check transaminases before initiation and regularly thereafter.
• Rash surveillance: discontinue immediately if severe or progressing.
• Hypersensitivity awareness: educate patients about signs of systemic allergic reactions.
• Pregnancy considerations: assess risk‑benefit ratio before use in pregnant women.
• Hepatic impairment dosing: adjust or avoid in patients with moderate to severe liver disease.
• Drug interaction review: evaluate concomitant medications that affect CYP3A4.
• Store at ambient temperature: keep in original packaging, protect from moisture and direct sunlight.

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

Major Interactions (Avoid)

• Rifampicin: induces metabolism, reducing nevirapine levels.
• St. John’s wort: strong CYP3A4 inducer, may lower drug exposure.
• Protease inhibitors (e.g., ritonavir): can increase nevirapine concentrations, raising toxicity risk.

Moderate Interactions (Monitor Closely)

• Efavirenz: may increase hepatic toxicity when combined.
• Zidovudine: requires monitoring for additive hematologic effects.
• Hormonal contraceptives: nevirapine may reduce contraceptive efficacy.
• Certain anticonvulsants (e.g., carbamazepine): may modestly decrease nevirapine levels.
• Antifungal azoles (e.g., ketoconazole): can increase nevirapine exposure.