Brand name: Viramune

Common name: nevirapine (NVP)

Class: non-nucleoside analog (also called non-nucleoside reverse transcriptase inhibitor, NNRTI, or non-nuke)

Standard dose: One 200 mg tablet daily for two weeks, then full dose of one 200 mg tablet twice daily; frequently prescribed as two 200 mg tablets once a day, although once-daily dosing is not FDA-approved. If rash occurs in first two weeks, it is important to report condition to healthcare provider as soon as possible. No food restrictions (may be taken with or without food). Liquid formulation is available. Take missed dose as soon as possible, but do not double up on your next dose.

AWP: $413.24 / month

Manufacturer contact: Boehringer-Ingelheim, www.viramune.com, 1 (800) 274–8651

AIDS Treatment Information Service: 1 (800) HIV–0440 (448–0440)

Potential side effects and toxicity: Most common side effects include headache, nausea, vomiting and rash. The reason for the 14-day lead-in dosing is to reduce the frequency of rash and incidence of drug-induced hepatitis. A serious side effect of the NNRTI class is rash, which can be life-threatening. If you experience blistering, mouth sores, conjunctivitis (redness or inflammation of eye, or pink eye, which if untreated may result in permanent vision loss), swelling, muscle or joint aches, fever or general malaise (general ill feeling), stop taking Viramune and your other anti-HIV meds and seek immediate medical attention.

Do not increase dose if rash develops during dose escalation or if you develop any rash accompanied by the above listed conditions. An increase in liver enzyme levels has been observed and in rare instances the development of hepatitis. May need to stop taking nevirapine until liver function returns to normal. Permanently discontinue if abnormalities return. Although rare, severe and life-threatening skin reactions and hepatotoxicity (liver damage), including fatal cases of each, have occurred.

Potential drug interactions: Methadone dose may need to be increased due to withdrawal symptoms. Viramune reduces levels of protease inhibitors. If they are taken at the same time the doses must be increased. Crixivan should be increased to 1,000 mg every eight hours. Kaletra should be increased to four capsules twice-a-day. Viramune interacts with rifampin requiring dose adjustment, but not with Mycobutin (rifabutin). The effectiveness of birth control pills may be decreased when taking Viramune; women and their male partners should consider the use of alternative contraception methods with barrier.

Tips: Because of the incidence of rash (9% of any grade through 52 weeks of treatment) associated with Viramune, examine yourself thoroughly for the slightest sign of rash. Notify your doctor of any rash, even mild. Rash may be avoided by using dose escalation schedule. Women may be at higher risk for rash. Use of pretreatment, such as prednisone or Benadryl (diphenhydramine), a non-prescription oral antihistamine, may be used to minimize the risk of rash and to control itching but the reaction can actually be worse—discuss it with your healthcare provider. A topical (placed on the skin) hydrocortisone or an oatmeal-containing cream, such as Aveeno, may improve comfort. Topical antihistamine-containing products should be avoided since there have been reports of irritation and rashes spreading. In any case, let your medical provider know you have a rash. Monitor liver function tests during first six months, initially every two weeks. The increased period of risk for liver injury is primarily in the first 6–12 weeks of taking Viramune. Do not ignore yellowing of your eyes or skin, as this may be a sign of a severe liver effect. A package insert warning states that women with more than 250 T-cells have a 12-times greater risk of serious liver side effects, including fatal ones.

Studies show that Viramune crosses the blood-brain barrier to a useful degree, which may be beneficial for patients at risk for neurological damage (such as dementia) from HIV. Viramune has also been shown to have a positive impact on cholesterol and triglycerides levels. When given around the time of labor Viramune has demonstrated effectiveness in preventing the transmission of HIV from mother to child, but there was an increase in HIV drug resistance in the moms. Single or double dose Viramune may be used for babies born to HIV-positive mothers.