Nevirapine

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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

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