Nevirapine Viatris (Nevirapine)

Nevirapine is an antiretroviral agent that targets the HIV‑1 reverse transcriptase enzyme, forming part of combination therapy for viral suppression.

• HIV‑1 infection (adults): Used with other antiretrovirals to reduce viral load and improve immune function.
• HIV‑1 infection (children): Provides a pediatric option within combination regimens to control disease progression.
• Prevention of mother‑to‑child transmission: Administered during labor to lower the risk of neonatal HIV infection.

• Nevirapine binds to a non‑nucleoside site on the HIV‑1 reverse transcriptase enzyme, inducing a conformational change that blocks the enzyme’s ability to transcribe viral RNA into DNA. This inhibition prevents the integration of viral genetic material into host cells, thereby halting replication of the virus and allowing the immune system to recover.

Nevirapine may cause a range of adverse reactions, from mild to severe. Monitoring and prompt reporting of symptoms are essential for patient safety.

Common Side Effects

• Rash: mild to moderate skin eruptions that may be itchy.
• Nausea: occasional upset stomach or feeling of queasiness.
• Fatigue: general tiredness or lack of energy.
• Headache: mild to moderate head discomfort.
• Abdominal pain: cramping or discomfort in the stomach area.
• Diarrhoea: loose, frequent stools.

Serious or Rare Side Effects

• Stevens‑Johnson syndrome: severe skin reaction with blistering.
• Hepatic failure: signs of liver injury such as jaundice.
• Severe rash: extensive or bullous skin lesions.
• Hypersensitivity reactions: fever, eosinophilia, or organ involvement.
• Hepatotoxicity: elevated liver enzymes or liver dysfunction.
• Anemia: significant drop in red blood cell count.

Before initiating therapy with Nevirapine, clinicians should consider several safety measures to minimize risk.

• Monitor liver function: obtain baseline and periodic liver enzyme tests.
• Assess for rash: educate patients to report any skin changes promptly.
• Avoid use in pre‑existing hepatic impairment: contraindicated in patients with severe liver disease.
• Caution with CYP3A inducers: dose adjustments may be required when co‑administered.
• Store at room temperature: keep in the original pack, protect from moisture and light.

Nevirapine can interact with other medicines, affecting its efficacy or safety.

Major Interactions (Avoid)

• Ritonavir‑boosted protease inhibitors: may increase nevirapine concentrations leading to toxicity.
• St. John's wort: can markedly reduce nevirapine levels, compromising antiviral effect.

Moderate Interactions (Monitor Closely)

• CYP3A substrates (e.g., certain statins): may require dose adjustment.
• Oral contraceptives: nevirapine can lower hormonal efficacy, consider alternative contraception.
• Nephrotoxic agents: monitor renal function when used together.