Nevirapine Viatris (Nevirapine)

Nevirapine is an antiretroviral medication used in the management of HIV‑1 infection.

• HIV‑1 infection (adults): Reduces viral load and improves immune function when used in combination therapy.
• HIV‑1 infection (children): Enables viral suppression in pediatric patients as part of approved regimens.
• Prevention of mother‑to‑child transmission: Decreases the risk of vertical transmission when administered during pregnancy and delivery.

• Nevirapine binds to a non‑nucleoside site on the HIV‑1 reverse transcriptase enzyme, inducing conformational changes that inhibit the transcription of viral RNA into DNA. This blockade prevents viral replication, allowing the immune system to control infection and reduce plasma viral load.

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.
• Fatigue: feeling of tiredness or weakness.
• Headache: transient cranial pain.
• Abdominal pain: mild stomach discomfort.

Serious or Rare Side Effects

• Stevens‑Johnson syndrome: severe skin reaction requiring immediate discontinuation.
• Hepatotoxicity: elevated liver enzymes or liver failure.
• Severe hypersensitivity: fever, eosinophilia, or organ involvement.
• Neutropenia: marked reduction in white blood cells.
• Anaphylaxis: rare life‑threatening allergic reaction.

Before initiating therapy, clinicians should assess patient history and monitor for potential risks.

• Monitor liver function: Perform baseline and periodic liver enzyme tests due to hepatotoxicity risk.
• Observe for rash: Discontinue immediately if severe skin reactions develop.
• Avoid strong CYP3A inducers: These can lower nevirapine exposure and reduce efficacy.
• Use caution in hepatic impairment: Adjust therapy based on liver function status.
• Store at ambient temperature below 25°C: Keep in the original container, protect from moisture and light.

Nevirapine interacts with several medicines, requiring careful management.

Major Interactions (Avoid)

• Ritonavir‑boosted protease inhibitors: May increase nevirapine levels and cause toxicity.
• St. John’s wort: Induces metabolism, markedly reducing nevirapine effectiveness.
• Efavirenz: Combined use can heighten hepatotoxic risk.

Moderate Interactions (Monitor Closely)

• CYP3A4 substrates (e.g., certain statins): May need dose adjustment.
• Oral contraceptives: Reduced hormonal efficacy; consider alternative contraception.
• Methadone: May require dose increase to maintain therapeutic effect.