Nevirapine is administered orally, in fact, the medicines that contain it are formulated in the form of tablets (including prolonged release) or oral suspension. These are hospital medicines (band H) available in pharmacies, but only upon presentation of a non-repeatable limitative medical prescription or RNRL (drugs that can be sold to the public on prescription from hospital centers or specialists).
Examples of Medicines containing Nevirapine
- Nevirapine Accord®
- Nevirapine Aurobindo®
- Nevirapine Mylan®
- Nevirapine Sandoz®
- Nevirapine Teva®
- Viramune®
Normally, nevirapine is taken concomitantly with other antiretroviral drugs.
, as they can become serious and life-threatening.Treatment should be stopped immediately and the physician immediately alerted if hypersensitivity reactions occur in the form of rashes associated with symptoms, such as:
- Fever;
- Vesicles;
- Ulcers in the mouth
- Eye inflammation;
- Facial swelling
- General swelling;
- Shortness of breath;
- Muscle or joint pain
- State of general malaise;
- Abdominal pain.
If only a "rash occurs with no other symptoms, the doctor should still be alerted."
Please note
Prednisone should not be used to treat nevirapine-related skin rashes.
Nevirapine should be discontinued and the doctor advised immediately even if symptoms of liver damage appear, such as:
- Loss of appetite
- Nausea;
- He retched;
- Jaundice
- Abdominal pain.
The risk of developing liver damage is higher in patients:
- Female;
- Co-infected with hepatitis B or hepatitis C;
- With abnormal liver function test values;
- Never previously treated with higher CD4 cell counts at the start of nevirapine therapy (women more than 250 cells / mmᶾ, men more than 400 cells / mmᶾ);
- Previously treated, with HIV-1 viral load detectable in the blood and with higher CD4 cell counts at the start of nevirapine therapy (women more than 250 cells / mmᶾ, men more than 400 cells / mmᶾ).
Inflammatory signs and symptoms
In some patients with advanced HIV infection and a history of opportunistic infection, inflammatory signs and symptoms of previous infections may occur after initiation of nevirapine treatment. These signs and symptoms are thought to be due to an improvement in the organic immune response which allows the body to fight infections that may have been present without obvious symptoms. Should such signs and symptoms occur, the physician should be contacted immediately.
Autoimmune Disorders
Autoimmune disorders may also arise after initiation of nevirapine therapy. Similar disorders may also occur many months after initiation of treatment.
If you notice any symptoms of infection or other symptoms such as muscle weakness, initial weakness in the hands and feet which then moves up to the trunk of the body, palpitations, tremor or hyperactivity, the doctor should be informed immediately.
Bone diseases
Some patients treated with nevirapine in combination with other antiretrovirals may develop osteonecrosis, the signs of which may be: joint stiffness, discomfort and pain (especially in the hips, knees and shoulders) and difficulty in movement. In case of their appearance, therefore, the doctor must be immediately alerted.
Risk factors for the development of this disease can be:
- The duration of combination antiretroviral therapy;
- The use of corticosteroids;
- Consumption of alcohol;
- A severe weakness of the immune system;
- A high body mass index.
Body fat
A change in body fat may occur in patients treated with combination antiretroviral therapy. In such cases, it is necessary to contact the doctor.
Oral contraceptives and hormonal therapies
If oral contraceptives or other hormonal contraceptive methods are used to avoid pregnancy, barrier methods (condoms) should be used additionally during nevirapine treatment, both to prevent pregnancy and to prevent transmission of the infection. from HIV.
If you are on HRT during menopause, you should inform your doctor before starting nevirapine treatment.
Blood analysis
If you are on combination therapy with nevirapine and zidovudine, your doctor should be informed as your white blood cell levels may need to be checked.
Kidney dialysis
In the case of patients undergoing kidney dialysis, the physician may consider adjusting the dose of nevirapine administered as dialysis can partially remove the active substance from the blood.
PLEASE NOTE
- Nevirapine should not be taken after exposure to HIV unless the doctor prescribes it.
- Nevirapine does NOT cure HIV infection, therefore, you can continue to get infections and other diseases associated with HIV infection.
- Patients treated with nevirapine can still transmit HIV infection, although the risk is reduced by the effect of antiretroviral therapy.
- It is important to discuss with your doctor the necessary precautions to avoid passing the infection to other people.
Use of Nevirapine in children and adolescents
Nevirapine can be used in adolescents aged 16 years or older and in children and adolescents under 16 years of age who weigh at least 50 kg or have a body surface area greater than 1.25 square meters.
Driving and using machines
Fatigue may occur during treatment with nevirapine. Caution is recommended in the use of machinery and in driving vehicles and to avoid such activities should the aforementioned sense of fatigue occur.
and rifabutin;- Atazanavir;
- Lopinavir / ritonavir;
- Fosamprenavir;
- Efavirenz;
- Etravirine;
- Rilpivirine;
- Delavirdine;
- Zidovudine;
- Elvitegravir / cobicistat.
In any case, the doctor should be informed if you are taking, have recently taken or intend to take any kind of medicines or products, including non-prescription drugs (SOPs), over-the-counter drugs (OTC), herbal and phytotherapeutic products and homeopathic products.
, manifesting undesirable effects different in type and intensity, or not manifesting them at all.Treatment with the active ingredient should be discontinued and the doctor immediately alerted if skin rashes appear associated or not with other symptoms and / or symptoms of liver damage (see chapter "Warnings and Precautions').
During treatment with nevirapine, even very serious allergic reactions (anaphylaxis) may occur with symptoms such as:
- Rash;
- Swelling of the face;
- Bronchial spasm;
- Anaphylactic shock.
Hypersensitivity reactions can also manifest themselves as skin reactions with side effects such as:
- Fever;
- Skin blisters and ulcers in the mouth
- Inflammation of the eyes;
- Swelling of the face and generalized;
- Shortness of breath;
- Muscle or joint pain
- Reduction in the number of white blood cells (granulocytopenia);
- Generalized malaise;
- Hepatic and / or renal insufficiency.
Common side effects
Among the undesirable effects that most commonly occur during nevirapine treatment, we find:
- Allergic reactions in sensitive individuals;
- Skin rashes;
- Granulocytopenia (very common especially in children);
- Nausea;
- Abdominal pain;
- Diarrhea;
- Hepatitis;
- Headache;
- Fever;
- Fatigue;
- Abnormal liver function tests.
Uncommon and rare side effects
Less common side effects that may occur during nevirapine therapy include:
- Allergic reactions characterized by skin rash, swelling of the face, difficulty in breathing (bronchial spasm) or anaphylactic shock;
- Jaundice
- Anemia (very common especially in children);
- Urticaria;
- Angioedema;
- Stevens-Johnson syndrome or toxic epidermal necrolysis;
- Myalgia and / or arthralgia;
- Decrease in blood levels of phosphorus;
- Increased blood pressure
- Fulminant hepatitis;
- Drug reaction with eosinophilia and systemic symptoms.
Undesirable effects in combination therapy
The following side effects have also been reported following the use of nevirapine in combination with other medicines:
- Reduction in the number of red blood cells or platelets
- Inflammation of the pancreas;
- Reduced or abnormal sensitivity of the skin.
However, these effects are believed to be caused by other antiretrovirals and are unlikely to be caused by nevirapine alone.
Nevirapine overdose
There is currently little information regarding the effects of nevirapine overdose. In any case, in case of overdose - ascertained or suspected - it is necessary to contact your doctor immediately or go to the nearest emergency room, taking the package of the medicine taken with you.
NEVER take nevirapine doses higher than those prescribed by your doctor or those stated in the package leaflet of the medicine.
starting from viral RNA. This process is very important for the survival of retroviruses such as HIV.
Through the inhibition of this enzyme, therefore, nevirapine is able to exert a certain antiviral action against the human immunodeficiency virus, without however being able to definitively eradicate it from the body.
). The tablets must be swallowed whole and must not be chewed, crushed or broken.Nevirapine should only be taken if prescribed by the doctor and only as directed by the latter.
Furthermore, since nevirapine must always be taken in combination with other medicines, it is necessary to respect the instructions provided by the doctor also regarding the intake of these other drugs.
Adults
The dose usually administered is 200 mg of active ingredient per day for the first 14 days (induction phase). After 14 days the usual dose is 200 mg of nevirapine twice a day.
The initial 14-day phase has been shown to reduce the incidence of skin reactions.
Children
The dose for children is 4 mg / kg body weight or 150 mg / m² body surface area once daily for the first 14 days of treatment (induction phase). After that, it will be passed to two administrations per day, the doctor will calculate the correct dose based on the weight or body surface area of the child.
Please note
For the correct use of nevirapine-based medicines and for the correct preparation of the dose of oral suspension to be administered, please refer to the package leaflet of the medicine prescribed by your doctor and it is recommended to strictly follow the instructions provided by it.
Missed dose of Nevirapine
It is important never to forget to take nevirapine. Should this happen, if you notice within 8 hours of the forgotten dose, take the missed dose as soon as possible. If it has been more than 8 hours, take only the next dose at the scheduled time. In any case, it may be helpful to contact your doctor.
Discontinuation of Nevirapine treatment
Taking all doses of nevirapine at the appropriate times greatly increases the effectiveness of antiretroviral medicines and decreases the chances of HIV infection becoming resistant to the medicines you are taking.
Treatment should be continued unless the doctor decides to stop it. If you have any doubts, you should contact the latter.
you must inform your doctor before taking nevirapine.
If you are being treated with the active substance, you must stop breastfeeding. However, it is recommended that you do not breastfeed if you are infected with HIV, as it is possible for the baby to become infected through breast milk.
