- WHAT IS NEVIRAPINE?
- WHO SHOULD TAKE IT?
- WHAT ABOUT DRUG RESISTANCE?
- HOW IS IT TAKEN?
- WHAT ARE THE SIDE EFFECTS?
- HOW DOES IT REACT WITH OTHER DRUGS?
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PrintNevirapine is a drug used for antiviral
therapy. It is also called Viramune®. It is manufactured
by Boehringer Ingelheim.
Nevirapine is a non-nucleoside reverse transcriptase inhibitor
(a “non-nuke” or NNRTI). These drugs stop HIV from multiplying
by preventing the reverse transcriptase enzyme from working. This
enzyme changes HIV’s genetic material (RNA) into the form of DNA.
This step has to occur before HIV’s genetic code gets inserted
into an infected cell’s genetic codes.
IT?
Nevirapine was approved as an antiviral drug for people with
HIV infection. There are no absolute rules about when to start
antiviral drugs. You and your doctor should consider your T-cell
count, your viral load, any symptoms you are having, and your
attitude about taking HIV medications. Fact
Sheet 411 has more information about guidelines
for the use of antiviral medications.
If you take nevirapine with other antiviral drugs, you can
reduce your viral load to extremely low levels, and increase your
T-cell counts. This should mean staying healthier longer.
Nevirapine can also be used to prevent transmission of HIV
from a pregnant woman to her new child. Although AZT (another
anti-HIV drug) prevents more infections, nevirapine costs less
and works better where women breast-feed their babies. The mother
gets one dose when she arrives at the hospital in labor, and the
newborn gets one dose during the first three days of life. This
approach could be very beneficial in developing countries.
RESISTANCE?
Many new copies of HIV are mutations. They are slightly different
from the original virus. Some mutations can keep multiplying
even when you are taking an antiviral drug. When this happens,
the drug will stop working. This is called “developing resistance”
to the drug. See Fact Sheet 414
for more information on resistance.
Sometimes, if your virus develops resistance to one drug, it
will also have resistance to other antiviral drugs. This is called
“cross-resistance”. Cross-resistance among NNRTIs develops
very easily. If you develop resistance to one NNRTI, you probably
won’t be able to use any of them in your antiviral therapy.
Resistance can develop quickly. It is very important to
take antiviral medications according to instructions, on schedule,
and not to skip or reduce doses.
HOW
IS IT TAKEN?
Nevirapine is available in 200-milligram (mg) pills. The recommended
dose for adults is 200 mg per day for two weeks (the lead-in period),
then 400mg per day (200mg twice per day). It is important to follow
this schedule to reduce the risk of serious side effects.
SIDE EFFECTS?
When you start any antiviral treatment you may have temporary
side effects such as headaches, hypertension, or a general sense
of feeling ill. These side effects usually get better or disappear
over time.
The most common side effect of nevirapine is a skin rash, which
develops in about 25 percent of people taking the drug. This side
effect is much more common for women than for men. If you develop
a rash during the lead-in (lower dose) period, you should not
increase to the full dose. If the rash is uncomfortable, you should
stop taking the drug. Some doctors used the drug prednisone to
treat the rash. However, research showed that it can actually
make the rash worse. A rare side effect is Stevens-Johnson syndrome.
This is a serious skin rash that can be fatal.
Nevirapine can also cause liver damage. Patients should be
carefully monitored during the first two months taking the drug
to watch for signs of skin or liver problems. Nevirapine can also
cause liver damage. Patients should be carefully monitored during
the first two months of taking nevirapine to watch for signs of
skin or liver problems. Because of the risk of liver damage, nevirapine
should not be used for post-exposure prophylaxis
(PEP).
WITH OTHER DRUGS?
Nevirapine is broken down by the liver and can interact with
other drugs that also use the liver. Combining these drugs
can change the amount of each drug in your bloodstream and cause
an under- or overdose. Drugs to watch out for include several
antihistamines, sedatives, and anti-fungal drugs. Make sure that
your doctor knows about ALL drugs you are taking.
Nevirapine makes the liver work faster. This reduces the blood
levels of most protease inhibitors. There is very little information
about combining nevirapine with protease inhibitors.
It also lowers blood levels of some birth control medications,
which could make them ineffective.
Nevirapine also lowers blood levels of methadone. This can
cause symptoms of drug withdrawal. Methadone doses may need to
be increased for people taking nevirapine.
Revised February
7, 2002
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New Mexico AIDS Education and Training Center
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