NEVIRAPINE (NVP)

Non-nucleoside reverse transcriptase inhibitor (NNRTI) antiretroviral medicine

Dosage Forms

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Tablet

50 mg
200 mg

Syrup

10 mg/ml

Fixed Dose Combinations(FDC) tablet

AZT 60 mg + 3TC 30 mg + NVP 50 mg
AZT 300 mg + 3TC 150 mg + NVP 200 mg

Uses

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  • HIV/AIDS

Dose and Duration

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A lead-in dose of NVP 200 mg once daily should be given for the first 14 days in new adult patients on NVP. If no rash is observed, increase dose to twice daily. Take normal dose of the other two ARVs in the regimen in those first 14 days. Switch to the triple Fixed Dose Combination (FDC) tablet after 14 days if applicable.
HIV infection, alternative first line treatment (in combination with TDF + 3TC)

Adult and child >25 kg: 200 mg every 12 hours (lead-in dose 200 mg once daily for 14 days)

Child <25 kg: Use NVP 50 mg tablet as in table below

Weight (kg) No. of NVP 50 mg tablets
20–24.9 3 tabs every 12 hours
14–19.9 2½ tabs every 12 hours
10–13.9 2 tabs every 12 hours
6–9.9 1½ tabs every 12 hours
3–5.9 1 tabs every 12 hours
HIV infection, first line treatment in children (in combination with ABC + 3TC)

Child <3 years: 4 mg/kg twice daily (lead-in dose 4 mg/kg once daily for first 14 days)

eMTCT infant regimen (0–6 weeks)

Infant 2–2.49 kg: 10 mg once daily for 6 weeks

Infant ≥2.5 kg: 15 mg once daily for 6 weeks

Contraindications

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  • CD4 count >350 cells/ml (greater risk of liver damage)
  • Severe liver disease
  • Post-exposure prophylaxis

Side Effects

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  • Rash, allergic reactions
  • Stevens-Johnson syndrome
  • Liver damage
  • Headache
  • Stomach upset

Interactions

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  • Rifampicin (reduced effect of nevirapine)
  • Efavirenz (increased risk of side effects)
  • Lopinavir/ritonavir (reduced effect of lopinavir)
  • Atazanavir/ritonavir (reduced effect of atazanavir)
  • Ketoconazole (reduced effect of ketoconazole)
  • Oral contraceptives (reduced contraceptive effect)

Patient Instructions

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  • Take medicine at the same time every day
  • A mild skin rash may develop within the first 6 weeks; usually goes away on its own
  • Report to health worker immediately in case any severe skin rash, fever, feeling of sickness, weakness, muscle pain, mouth ulcers, or swelling of face occur
  • Stop taking the medicine and report to health worker immediately in case any yellowing of skin and eyes, swollen abdomen, or persistent nausea and vomiting occur as this indicates liver damage

Pregnancy

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  • Can be used

Breast-feeding

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  • Can be used

⚠️ Caution

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  • Monitor closely for side effects of liver damage, especially in first 18 weeks
  • If liver disease occurs without allergic reactions, discontinue medicine and restart after symptoms have resolved
  • If liver disease occurs with allergic reactions, discontinue medicine permanently
  • Women using oral contraceptives should switch to another contraceptive method (e.g. condoms or medroxyprogesterone acetate depot injection)