Nevirapine: Medication Information and Guidelines

Recommended Dose and Dosage Regimen

The recommended dose of nevirapine for the treatment of HIV infection varies depending on factors such as patient weight, prior antiretroviral therapy, and concomitant medications. In adults, the typical initial dose of nevirapine is 200 mg once daily for the first 14 days, followed by 200 mg twice daily thereafter. For pediatric patients, dosing is based on body weight and is administered as oral suspension or tablets. Dosage adjustments may be necessary in patients with hepatic impairment or who are taking interacting medications. Follow the specific dosing regimen prescribed by your healthcare provider and the manufacturer’s instructions for the appropriate formulation of nevirapine.

Frequency of Administration

Nevirapine is typically administered orally, with dosing frequency determined by the specific formulation and indication. In adults, nevirapine is usually taken once daily for the first 14 days, followed by twice-daily dosing thereafter. Pediatric dosing may vary based on body weight and age, with oral suspension or tablet formulations available for administration. Nevirapine should be taken consistently at the same time each day to maintain therapeutic drug levels and optimize treatment outcomes. Follow the recommended dosing schedule provided by your healthcare provider or pharmacist for optimal management of HIV infection.

Route of Administration

Nevirapine is available in oral formulations, including tablets and oral suspension, for the treatment of HIV infection. Oral nevirapine tablets should be swallowed whole with a full glass of water to facilitate drug absorption and minimize gastrointestinal upset. Nevirapine oral suspension should be shaken well before each use and measured with a calibrated dosing spoon or syringe to ensure accurate dosing. Nevirapine should be taken with or without food, depending on individual preference and tolerability. Select the appropriate nevirapine formulation based on patient age, weight, and indication, and follow the package instructions and your healthcare provider’s recommendations for proper administration.

Mechanism of Action (MOA)

Nevirapine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) that exerts its antiretroviral effects by inhibiting the activity of HIV-1 reverse transcriptase, an enzyme required for viral replication. Nevirapine binds to a hydrophobic pocket near the active site of reverse transcriptase, leading to conformational changes that disrupt enzyme function and inhibit viral RNA-dependent DNA polymerase activity. By blocking the conversion of viral RNA into DNA, nevirapine prevents the synthesis of new viral DNA strands and inhibits the replication of HIV-1 in infected cells. Nevirapine is active against both wild-type and drug-resistant strains of HIV-1 and is used as part of combination antiretroviral therapy (ART) to suppress viral replication and improve immune function in patients with HIV infection.

Pharmacokinetics (PK)

The pharmacokinetics of nevirapine are characterized by rapid absorption, extensive distribution, and hepatic metabolism. After oral administration, nevirapine is rapidly absorbed from the gastrointestinal tract, with peak plasma concentrations achieved within 2 to 4 hours. The absolute bioavailability of nevirapine is approximately 93%, and food intake does not significantly affect drug absorption. Nevirapine is extensively metabolized in the liver via cytochrome P450 enzymes, primarily CYP3A4 and CYP2B6, to inactive metabolites that are eliminated via renal and fecal routes. The elimination half-life of nevirapine is approximately 25 to 30 hours in adults and may be prolonged in patients with hepatic impairment. Dosage adjustments are necessary in patients with hepatic dysfunction to avoid drug accumulation and minimize the risk of toxicity.

Pharmacodynamics (PD)

Nevirapine exerts its antiretroviral effects by inhibiting the activity of HIV-1 reverse transcriptase, an enzyme required for viral replication. By binding to a hydrophobic pocket near the active site of reverse transcriptase, nevirapine disrupts enzyme function and inhibits viral RNA-dependent DNA polymerase activity. This prevents the conversion of viral RNA into DNA and inhibits the synthesis of new viral DNA strands, leading to suppression of viral replication and reduction in plasma HIV-1 RNA levels. Nevirapine is active against both wild-type and drug-resistant strains of HIV-1 and is used as part of combination antiretroviral therapy (ART) to achieve and maintain virologic suppression in patients with HIV infection.

Pathophysiology

Nevirapine is indicated for the treatment of HIV-1 infection in combination with other antiretroviral agents. HIV-1 is a retrovirus that infects and replicates within CD4+ T lymphocytes and other immune cells, leading to progressive depletion of CD4+ T cells and impairment of immune function. Untreated HIV infection can result in the development of acquired immunodeficiency syndrome (AIDS), opportunistic infections, malignancies, and other complications. Antiretroviral therapy (ART) aims to suppress viral replication, restore immune function, and prevent HIV-associated morbidity and mortality. Nevirapine inhibits viral replication by targeting HIV-1 reverse transcriptase and is used as part of combination ART regimens to achieve sustained virologic suppression and improve clinical outcomes in patients with HIV infection.

Primary Indications

Nevirapine is indicated for the treatment of HIV-1 infection in combination with other antiretroviral agents in adults and pediatric patients. Nevirapine is recommended for use as part of combination antiretroviral therapy (ART) regimens in treatment-naive patients with HIV-1 infection and in treatment-experienced patients who require alternative therapy due to virologic failure or intolerance to other antiretroviral drugs. Nevirapine is effective against both wild-type and drug-resistant strains of HIV-1 and is used as a first-line or alternative option for HIV treatment in resource-limited settings where other antiretroviral agents may be less accessible or affordable.

Contraindications

Contraindications to nevirapine use include hypersensitivity to nevirapine or any component of the formulation, severe hepatic impairment (Child-Pugh Class C), and concomitant use of drugs with narrow therapeutic indices or known hepatotoxicity. Nevirapine should not be used in patients with moderate or severe hepatic dysfunction, as it may exacerbate liver injury and increase the risk of hepatotoxicity. Use caution when prescribing nevirapine to patients with a history of severe skin reactions or rash, as they may be at increased risk of hypersensitivity reactions. Nevirapine is contraindicated during the first 14 days of postpartum in women with CD4+ T cell counts greater than 250 cells/mm3 or in women with pre-existing liver dysfunction.

Purpose of Taking Medication

The purpose of nevirapine therapy is to suppress viral replication and improve immune function in patients with HIV-1 infection. Nevirapine is used as part of combination antiretroviral therapy (ART) regimens to achieve and maintain virologic suppression, reduce plasma HIV-1 RNA levels, and prevent the progression of HIV-associated disease. Nevirapine inhibits viral replication by targeting HIV-1 reverse transcriptase, an enzyme required for the synthesis of viral DNA from RNA templates. By blocking viral replication, nevirapine helps control HIV infection and reduces the risk of opportunistic infections, malignancies, and other complications associated with untreated HIV disease. Nevirapine therapy is indicated for both treatment-naive and treatment-experienced patients with HIV-1 infection and is used as a first-line or alternative option for HIV treatment in resource-limited settings.

Usage Instructions

Nevirapine should be taken exactly as prescribed by your healthcare provider, with or without food, depending on individual preference and tolerability. Swallow nevirapine tablets whole with a full glass of water to facilitate drug absorption and minimize gastrointestinal upset. Shake nevirapine oral suspension well before each use and measure with a calibrated dosing spoon or syringe to ensure accurate dosing. Do not crush, chew, or break nevirapine tablets, as this may alter drug absorption and efficacy. Take nevirapine consistently at the same time each day to maintain therapeutic drug levels and optimize treatment outcomes. Follow the package instructions and your healthcare provider’s recommendations for proper administration of nevirapine and other antiretroviral medications.

Precautions and Care

Patients taking nevirapine should be monitored regularly for signs of adverse effects or complications, including hepatotoxicity, skin reactions, hypersensitivity reactions, and immune reconstitution syndrome. Use caution when prescribing nevirapine to patients with hepatic impairment or who are taking interacting medications that may affect drug metabolism or clearance. Advise patients to seek medical attention if they experience symptoms such as rash, fever, nausea, abdominal pain, jaundice, or other signs of hepatotoxicity while taking nevirapine. Nevirapine therapy should be initiated and monitored by healthcare providers experienced in the management of HIV infection, with appropriate laboratory monitoring and clinical assessment to optimize treatment outcomes and minimize the risk of adverse events.

Dietary Considerations

There are no specific dietary restrictions associated with nevirapine therapy. Maintain a balanced diet and adequate hydration to support overall health and well-being during HIV treatment. Patients with HIV infection should follow general dietary recommendations for healthy eating, including consuming a variety of nutrient-rich foods, limiting intake of processed foods and sugary beverages, and avoiding excessive alcohol consumption. Some patients may experience gastrointestinal side effects such as nausea, vomiting, or diarrhea while taking nevirapine, which may affect dietary intake and nutrient absorption. Consult your healthcare provider or a registered dietitian if you have any concerns about dietary considerations or nutritional management during HIV treatment.

Missed Dose

If a dose of nevirapine is missed, take it as soon as remembered unless it is almost time for the next scheduled dose. In that case, skip the missed dose and resume the regular dosing schedule. Do not double the dose to make up for a missed one. Follow the specific dosing regimen prescribed by your healthcare provider for optimal management of HIV infection. Missed doses of nevirapine may increase the risk of virologic failure and development of drug resistance, so it is important to maintain consistent adherence to treatment and follow-up with your healthcare provider regularly to monitor treatment response and adjust therapy as needed.

Possible Side Effects

Common side effects of nevirapine may include rash, nausea, fatigue, headache, and elevated liver enzymes. Less common side effects may include hypersensitivity reactions, hepatotoxicity, immune reconstitution syndrome, and hematologic abnormalities. Contact your healthcare provider if you experience severe or persistent side effects while taking nevirapine, as they may require medical evaluation or adjustment of therapy. Nevirapine therapy should be initiated and monitored by healthcare providers experienced in the management of HIV infection, with appropriate laboratory monitoring and clinical assessment to optimize treatment outcomes and minimize the risk of adverse events.

Storage and Disposal

Store nevirapine tablets or oral suspension at room temperature away from moisture, heat, and light, in their original packaging. Keep nevirapine oral suspension refrigerated after reconstitution and discard any unused portion after 30 days to maintain product stability and efficacy. Unused or expired nevirapine should be disposed of properly according to local regulations or guidelines for pharmaceutical waste disposal, to prevent accidental ingestion or misuse. Keep nevirapine out of reach of children and pets, and avoid storing it in areas accessible to unauthorized users. Follow the package instructions for proper disposal of unused medication to minimize environmental impact and ensure safe handling of antiretroviral drugs.

Important Note: Always consult with a healthcare professional for personalized medical advice and guidance regarding the use of given drug, especially regarding dosing, administration, and potential side effects. Your healthcare provider can provide tailored recommendations based on your individual medical history, current medications, and specific treatment needs. Never self-adjust your given drug regimen or discontinue treatment without first consulting your healthcare provider. If you have any questions or concerns about given drug or its use, talk to your doctor or pharmacist for further information and assistance.