nevirapine, Viramune, Viramune XR
Omudhome Ogbru, PharmD
Omudhome Ogbru, PharmD
Dr. Ogbru received his Doctorate in Pharmacy from the University of the Pacific School of Pharmacy in 1995. He completed a Pharmacy Practice Residency at the University of Arizona/University Medical Center in 1996. He was a Professor of Pharmacy Practice and a Regional Clerkship Coordinator for the University of the Pacific School of Pharmacy from 1996-99.
Medical and Pharmacy Editor:
GENERIC NAME: nevirapine
BRAND NAME: Viramune, Viramune XR
DRUG CLASS AND MECHANISM: Nevirapine is an oral medication that is used for the treatment of infections with the human immunodeficiency virus (HIV). It is in a class of drugs called reverse transcriptase inhibitors that also includes zalcitabine (Hivid), zidovudine (Retrovir), didanosine (Videx), and lamivudine (Epivir). It is in a subclass of protease inhibitors called nonnucleoside protease inhibitors that includes efavirenz (Sustiva) and delavirdine (Rescriptor). During infection with HIV, the HIV virus multiplies within the body's cells. The newly-formed viruses then are released from the cells and spread throughout the body where they infect other cells. In this manner, the infection spreads to new, uninfected cells that the body is continually producing, and HIV infection is perpetuated. When producing new viruses, the HIV virus must manufacture new DNA for each virus. Reverse transcriptase is the enzyme that the virus uses to form this new DNA. Nevirapine directly inhibits the activity of reverse transcriptase and blocks the production of DNA and new viruses. Nevirapine does not kill existing HIV virus and it is not a cure for HIV. The FDA approved nevirapine in September 1996.
GENERIC AVAILABLE: Yes
PREPARATIONS: Tablets: 200 mg; Suspension: 10 mg/ml. Tablets (extended release): 400 mg.
STORAGE: Tablets and suspension should be stored at room temperature, 15 C to 30 C (59 F to 86 F).
PRESCRIBED FOR: Nevirapine is used together with other anti-HIV drugs for the treatment of HIV infection.
DOSING: The starting dose for adults is 200 mg daily (lead-in period). After 14 days the dose should be increased to 200 mg every 12 hours or 400 mg of extended release once daily. The 14 day lead-in period must be observed in order to reduce the incidence of rash, and it should not be longer than 28 days. Any patient who develops a rash during the lead-in period should not receive twice daily treatment or extended release tablets until the rash has resolved. Nevirapine must be administered in combination with other anti-HIV drugs because the HIV virus quickly becomes resistant nevirapine when it is used alone. Nevirapine may be administered without regard to meals since food does not reduce its absorption.
DRUG INTERACTIONS: Nevirapine has several drug interactions because it is converted to inactive compounds by liver enzymes. Several drugs increase or decrease the activity of these enzymes. Conversely, nevirapine affects the breakdown of other drugs by the liver.
Nevirapine reduces blood concentrations of atazanavir (Reyataz), efavirenz (Sustiva), clarithromycin (Biaxin), amprenavir (Agenerase), indinavir (Crixivan), ketoconazole, itraconzole (sporanox), and lopinavir (Kaletra).
Atazanavir (Reyataz), fluconazole (Diflucan), and fosamprenavir increase blood levels of nevirapine.
Rifampin (Rifadin), rifabutin (Mycobutin), ketoconazole (Nizoral) and St. John's Wort decrease blood concentrations of nevirapine by increasing its breakdown. Decreased blood concentration may reduce the effectiveness of nevirapine.
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