Antiretroviral Agent: Nevirapine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) with specific activity against the Human Immunodeficiency Virus Type 1 (HIV-1).
Dosage Strength: The 200 mg tablet is a standard oral dosage form for adults, used for both the initial “lead-in” period and as part of the maintenance regimen.
Combination Therapy: It is always used in combination with at least two other antiretroviral agents to form a complete and effective treatment regimen for HIV-1.
Lead-in Dosing: To reduce the risk of serious side effects, a 14-day “lead-in” period with a lower dose of 200 mg once daily is required before starting the maintenance dose of 200 mg twice daily.
Advantages
Established Efficacy: Nevirapine has been a cornerstone of HIV treatment for many years, with a vast body of clinical data supporting its efficacy as a component of combination antiretroviral therapy (cART).
Prevention of Mother-to-Child Transmission: It is a key medication used to prevent the transmission of HIV from a mother to her baby during pregnancy and childbirth.
Once-Daily Maintenance: After the initial lead-in period, it can be administered as part of a once-daily regimen in fixed-dose combinations, which simplifies treatment and improves adherence.
Cost-Effective: As a well-established and older drug, nevirapine is often a cost-effective option, particularly in resource-limited settings.
Uses
HIV-1 Infection: The primary indication is for the treatment of HIV-1 infection in adults and adolescents, always in combination with other antiretroviral agents.
Prevention of Perinatal Transmission: It is used as a single dose for the prevention of mother-to-child transmission of HIV during childbirth.
First-Line Therapy: It has been a recommended component of first-line antiretroviral therapy in many international guidelines, especially in resource-limited settings.
Post-Exposure Prophylaxis (PEP): It can be used as a component of PEP regimens to prevent HIV infection following a potential exposure.
Nature
NNRTI Class: Nevirapine belongs to the non-nucleoside reverse transcriptase inhibitor (NNRTI) class of drugs.
Mechanism of Action: Nevirapine works by binding directly and non-competitively to a specific site on the HIV-1 reverse transcriptase enzyme. This binding causes a conformational change that inactivates the enzyme and blocks the synthesis of viral DNA.
Severe Side Effects: A key characteristic of nevirapine is the potential for serious adverse effects, including severe rash (e.g., Stevens-Johnson syndrome) and hepatotoxicity (liver damage). Close monitoring is essential, particularly during the first 18 weeks of therapy.
Drug Interactions: Nevirapine is an inducer of liver enzymes (CYP450 system), which means it can increase the metabolism of other drugs, potentially leading to a loss of their therapeutic effect.
Storage
Temperature: Store Nevirapine tablets at a controlled room temperature, typically between 20∘C to 25∘C (68∘F to 77∘F).
Protection: Keep the tablets in their original, tightly closed container, protected from light and moisture.
Patient Education: Patients must be educated on the importance of taking the lead-in dose for 14 days to reduce the risk of rash and to report any skin rash or signs of liver problems immediately to a physician.
Child Safety: Store the medication in a secure location, out of the reach of children and pets.
