Nevirapine

Nevirapine Brand Names- Viramune | Viramune XR

What is Nevirapine

Nevirapine is a first-generation oral non-nucleoside reverse transcriptase inhibitor (NNRTI).

Unlike nucleoside reverse transcriptase inhibitors (NRTIs), nevirapine does not require phosphorylation for activity.

Nevirapine is approved for the treatment of human immunodeficiency virus (HIV) infection in combination with other antiretroviral agents.

It is also used for perinatal HIV prophylaxis in combination with zidovudine or as part of a 3-drug combination antiretroviral regimen with zidovudine and lamivudine at treatment doses for neonates with presumed HIV exposure or those at high risk for perinatal HIV transmission.

Like other antiretrovirals, nevirapine is not recommended as monotherapy because of rapid emergence of resistant HIV isolates.

Serious and life-threatening hepatotoxicity and skin rashes have been reported with nevirapine use.

Females and patients with higher CD4 cell counts prior to initiation of therapy are at increased risk of liver toxicity.

Indications

• human immunodeficiency virus (HIV)
• human immunodeficiency virus (HIV) infection
• perinatal human immunodeficiency virus (HIV) prophylaxis

Side Effects

1. abdominal pain
2. anaphylactoid reactions
3. anemia
4. angioedema
5. anorexia
6. antimicrobial resistance
7. arthralgia
8. breast enlargement
9. bullous rash
10. conjunctivitis
11. Cushingoid features
12. diarrhea
13. drowsiness
14. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
15. elevated hepatic enzymes
16. eosinophilia
17. erythema nodosum
18. fatigue
19. fever
20. headache
21. hepatic encephalopathy
22. hepatic failure
23. hepatic necrosis
24. hepatitis
25. hepatomegaly
26. hepatotoxicity
27. hyperbilirubinemia
28. hypercholesterolemia
29. hypophosphatemia
30. jaundice
31. lipodystrophy
32. lymphadenopathy
33. maculopapular rash
34. malaise
35. myalgia
36. nausea
37. neutropenia
38. oral ulceration
39. paresthesias
40. pruritus
41. rash
42. rhabdomyolysis
43. Stevens-Johnson syndrome
44. stomatitis
45. thrombocytopenia
46. toxic epidermal necrolysis
47. urticaria
48. vomiting
49. withdrawal

Monitoring Parameters

• blood glucose
• CBC with differential
• CD4+ T cell count
• hepatitis B serology
• LFTs
• plasma hepatitis C RNA
• plasma HIV RNA
• pregnancy testing
• serum bilirubin (total and direct)
• serum cholesterol
• serum lipid profile
• urinalysis

Contraindications

• autoimmune disease
• Black patients
• breast-feeding
• children
• dialysis
• females
• Graves’ disease
• Guillain-Barre syndrome
• hepatic disease
• hepatitis
• hepatitis B and HIV coinfection
• hepatitis C and HIV coinfection
• hepatotoxicity
• Hispanic patients
• human immunodeficiency virus (HIV) infection resistance
• immune reconstitution syndrome
• infants
• neonates
• nevirapine hypersensitivity
• pregnancy
• serious rash

Interactions

• Abacavir; Dolutegravir; Lamivudine
• Abacavir; Lamivudine, 3TC; Zidovudine, ZDV
• Abemaciclib
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Codeine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Adefovir
• Alfentanil
• Aliskiren; Amlodipine
• Aliskiren; Amlodipine; Hydrochlorothiazide, HCTZ
• Alprazolam
• Amiodarone
• Amitriptyline; Chlordiazepoxide
• Amlodipine
• Amlodipine; Atorvastatin
• Amlodipine; Benazepril
• Amlodipine; Celecoxib
• Amlodipine; Hydrochlorothiazide, HCTZ; Olmesartan
• Amlodipine; Hydrochlorothiazide, HCTZ; Valsartan
• Amlodipine; Olmesartan
• Amlodipine; Telmisartan
• Amlodipine; Valsartan
• Amoxicillin; Clarithromycin; Lansoprazole
• Amoxicillin; Clarithromycin; Omeprazole
• Amprenavir
• Apalutamide
• Aprepitant, Fosaprepitant
• Aripiprazole
• Artemether; Lumefantrine
• Artesunate
• Aspirin, ASA; Butalbital; Caffeine; Codeine
• Aspirin, ASA; Caffeine; Dihydrocodeine
• Aspirin, ASA; Carisoprodol; Codeine
• Aspirin, ASA; Oxycodone
• Atazanavir
• Atazanavir; Cobicistat
• Atorvastatin
• Atorvastatin; Ezetimibe
• Avanafil
• Avapritinib
• Axitinib
• Barbiturates
• Bedaquiline
• Benzhydrocodone; Acetaminophen
• Bepridil
• Bicalutamide
• Boceprevir
• Bortezomib
• Brentuximab vedotin
• Brexpiprazole
• Brigatinib
• Bromocriptine
• Brompheniramine; Guaifenesin; Hydrocodone
• Brompheniramine; Hydrocodone; Pseudoephedrine
• Budesonide
• Budesonide; Formoterol
• Bupivacaine
• Bupivacaine Liposomal
• Bupivacaine; Lidocaine
• Buprenorphine
• Buprenorphine; Naloxone
• Cabozantinib
• Calcium-channel blockers
• Capmatinib
• Carbamazepine
• Carbinoxamine; Hydrocodone; Phenylephrine
• Carbinoxamine; Hydrocodone; Pseudoephedrine
• Cariprazine
• Caspofungin
• Ceritinib
• Cevimeline
• Chlordiazepoxide
• Chlordiazepoxide; Clidinium
• Chlorpheniramine; Codeine
• Chlorpheniramine; Dihydrocodeine; Phenylephrine
• Chlorpheniramine; Dihydrocodeine; Pseudoephedrine
• Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine
• Chlorpheniramine; Hydrocodone
• Chlorpheniramine; Hydrocodone; Phenylephrine
• Chlorpheniramine; Hydrocodone; Pseudoephedrine
• Cinacalcet
• Cisapride
• Clarithromycin
• Clevidipine
• Clonazepam
• Clorazepate
• Clozapine
• Cobicistat
• Cobimetinib
• Codeine
• Codeine; Guaifenesin
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Conjugated Estrogens; Medroxyprogesterone
• Cyclophosphamide
• Cyclosporine
• Daclatasvir
• Dapsone
• Darunavir
• Darunavir; Cobicistat
• Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Dasatinib
• Deflazacort
• Delavirdine
• Dextromethorphan; Quinidine
• Diazepam
• Dienogest; Estradiol valerate
• Dihydrocodeine; Guaifenesin; Pseudoephedrine
• Diltiazem
• Diphenhydramine; Hydrocodone; Phenylephrine
• Disopyramide
• Docetaxel
• Dofetilide
• Dolutegravir
• Dolutegravir; Lamivudine
• Dolutegravir; Rilpivirine
• Donepezil
• Donepezil; Memantine
• Doravirine
• Doravirine; Lamivudine; Tenofovir disoproxil fumarate
• Doxercalciferol
• Doxorubicin
• Dronabinol
• Dronedarone
• Drospirenone
• Drospirenone; Estradiol
• Drospirenone; Ethinyl Estradiol
• Drospirenone; Ethinyl Estradiol; Levomefolate
• Echinacea
• Efavirenz
• Efavirenz; Emtricitabine; Tenofovir
• Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate
• Elagolix; Estradiol; Norethindrone acetate
• Elbasvir; Grazoprevir
• Elvitegravir
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide
• Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate
• Empagliflozin; Linagliptin
• Empagliflozin; Linagliptin; Metformin
• Emtricitabine; Rilpivirine; Tenofovir alafenamide
• Emtricitabine; Rilpivirine; Tenofovir disoproxil fumarate
• Enalapril; Felodipine
• Encorafenib
• Entrectinib
• Enzalutamide
• Erdafitinib
• Erlotinib
• Erythromycin
• Erythromycin; Sulfisoxazole
• Estazolam
• Estradiol Cypionate; Medroxyprogesterone
• Estradiol; Levonorgestrel
• Estradiol; Norethindrone
• Estradiol; Norgestimate
• Estradiol; Progesterone
• Estrogens
• Ethinyl Estradiol; Desogestrel
• Ethinyl Estradiol; Ethynodiol Diacetate
• Ethinyl Estradiol; Etonogestrel
• Ethinyl Estradiol; Levonorgestrel
• Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
• Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
• Ethinyl Estradiol; Norelgestromin
• Ethinyl Estradiol; Norethindrone
• Ethinyl Estradiol; Norethindrone Acetate
• Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
• Ethinyl Estradiol; Norethindrone; Ferrous fumarate
• Ethinyl Estradiol; Norgestimate
• Ethinyl Estradiol; Norgestrel
• Ethosuximide
• Ethotoin
• Etonogestrel
• Etravirine
• Ezetimibe; Simvastatin
• Fedratinib
• Felodipine
• Fentanyl
• Flibanserin
• Fluconazole
• Flurazepam
• food
• Fosamprenavir
• Fosphenytoin
• Glasdegib
• Guaifenesin; Hydrocodone
• Guaifenesin; Hydrocodone; Pseudoephedrine
• Guanfacine
• Haloperidol
• Homatropine; Hydrocodone
• Hydantoins
• Hydrocodone
• Hydrocodone; Ibuprofen
• Hydrocodone; Phenylephrine
• Hydrocodone; Potassium Guaiacolsulfonate
• Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine
• Hydrocodone; Pseudoephedrine
• Hydroxyprogesterone
• Ibrutinib
• Ibuprofen; Oxycodone
• Idelalisib
• Ifosfamide
• Imatinib
• Indinavir
• Interferon Alfa-2a
• Interferon Alfa-2b
• Interferon Alfa-2b; Ribavirin
• Interferon Alfa-n3
• Interferon Alfacon-1
• Interferon Beta-1a
• Interferon Beta-1b
• Interferon Gamma-1b
• Interferons
• Isavuconazonium
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Isradipine
• Itraconazole
• Ivabradine
• Ixabepilone
• Ketoconazole
• Lamivudine, 3TC; Zidovudine, ZDV
• Lefamulin
• Lemborexant
• Letermovir
• Leuprolide; Norethindrone
• Levobupivacaine
• Levomethadyl
• Levonorgestrel
• Lidocaine
• Lidocaine; Prilocaine
• Linagliptin
• Linagliptin; Metformin
• Loperamide
• Loperamide; Simethicone
• Lopinavir; Ritonavir
• Lorlatinib
• Lovastatin
• Lovastatin; Niacin
• Lumacaftor; Ivacaftor
• Lumacaftor; Ivacaftor
• Lumateperone
• Lurasidone
• Lurbinectedin
• Medroxyprogesterone
• Mefloquine
• Mestranol; Norethindrone
• Methadone
• Midazolam
• Mitotane
• Nanoparticle Albumin-Bound Paclitaxel
• Nefazodone
• Nelfinavir
• Neratinib
• Niacin; Simvastatin
• Nicardipine
• Nifedipine
• Nilotinib
• Nimodipine
• Nisoldipine
• Norethindrone
• Norgestrel
• Olaparib
• Ombitasvir; Paritaprevir; Ritonavir
• Oritavancin
• Orlistat
• Oxycodone
• Paclitaxel
• Paricalcitol
• Pazopanib
• Peginterferon Alfa-2a
• Peginterferon Alfa-2b
• Peginterferon beta-1a
• Pemigatinib
• Perampanel
• Perindopril; Amlodipine
• Pexidartinib
• Phenytoin
• Pimavanserin
• Posaconazole
• Praziquantel
• Prednisone
• Progesterone
• Progestins
• Quinidine
• Ranolazine
• Red Yeast Rice
• Ribavirin
• Ribociclib
• Ribociclib; Letrozole
• Rifampin
• Rifapentine
• Rilpivirine
• Riluzole
• Rimegepant
• Ritonavir
• Rivaroxaban
• Roflumilast
• Romidepsin
• Ruxolitinib
• Saquinavir
• Segesterone Acetate; Ethinyl Estradiol
• Selpercatinib
• Selumetinib
• Sertraline
• Sildenafil
• Simeprevir
• Simvastatin
• Simvastatin; Sitagliptin
• Siponimod
• Sirolimus
• Sofosbuvir; Velpatasvir
• Sofosbuvir; Velpatasvir; Voxilaprevir
• Somatropin, rh-GH
• Sonidegib
• St. John’s Wort, Hypericum perforatum
• Sufentanil
• Sunitinib
• Tacrolimus
• Tadalafil
• Tasimelteon
• Tazemetostat
• Telaprevir
• Telithromycin
• Telotristat Ethyl
• Terbinafine
• Thiotepa
• Tolvaptan
• Trandolapril; Verapamil
• Triazolam
• Trimetrexate
• Tucatinib
• Ubrogepant
• Ulipristal
• Venetoclax
• Verapamil
• Vorapaxar
• Voriconazole
• Voxelotor
• Warfarin
• Zanubrutinib
• Zidovudine, ZDV
• Zolpidem
• Zonisamide