Nevirapine for HIV

Nevirapine is a prescription medication approved by the U.S. Food and Drug Administration (FDA) to treat human immunodeficiency virus type 1 (HIV-1) infection in adults and children, depending on the dosage form.

How Nevirapine Works and How It’s Taken

Nevirapine is a type of HIV medicine called a non-nucleoside reverse transcriptase inhibitor (NNRTI). It blocks reverse transcriptase, an enzyme HIV-1 needs to make more copies of itself. This helps reduce viral activity in the body.

Doctors prescribe nevirapine with other HIV medicines to treat HIV-1 infection. HIV-1 is the virus that causes acquired immune deficiency syndrome (AIDS).

Nevirapine comes in three forms:

Immediate-release tablets
Oral suspension
Extended-release tablets

Immediate-release tablets and oral suspension can be used in adults and children ages 15 days and older. Extended-release tablets can be used in adults and in children ages 6 years and older who have a body surface area of at least 1.17 square meters.

Nevirapine can be taken with or without food. Extended-release tablets must be swallowed whole and should not be chewed, crushed, or divided.

Typical Dosing for HIV

Adults starting immediate-release nevirapine usually take 200 milligrams once daily for the first 14 days. After that, the recommended dose is 200 milligrams twice daily.

Children ages 15 days and older usually start with 150 milligrams per square meter once daily for 14 days. After that, the recommended dose is 150 milligrams per square meter twice daily. The dose is based on body surface area, which uses a child’s height and weight. The total daily dose should not be more than 400 milligrams.

Adults starting extended-release nevirapine first take 200 milligrams of immediate-release nevirapine once daily for 14 days. They then take 400 milligrams of extended-release nevirapine once daily. Eligible children follow an immediate-release lead-in before starting 400 milligrams of extended-release nevirapine once daily. People who are already taking immediate-release nevirapine twice daily may be able to switch to extended-release nevirapine without repeating the 14-day lead-in period.

If a rash develops during the first 14 days, the dose should not be increased until the rash goes away. The once-daily lead-in period should not last longer than 28 days. If nevirapine is stopped for more than seven days, the 14-day lead-in dosing must be restarted.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Nevirapine Side Effects

In clinical studies of nevirapine used with other HIV medicines to treat HIV-1, side effect rates varied by dosage form, age, and study. These include:

Rash
Nausea
Headache

Serious Side Effects and Warnings

Nevirapine can cause serious side effects that may require immediate medical attention. These include:

Severe liver problems — Hepatotoxicity can occur, including hepatitis and liver failure. In rare cases, these problems can be fatal.
Severe skin reactions — Skin reactions can include Stevens-Johnson syndrome and toxic epidermal necrolysis, which can cause widespread rash, blistering, and skin peeling.
Serious allergic or hypersensitivity reactions — These reactions can include anaphylaxis, angioedema, and drug reaction with eosinophilia and systemic symptoms, or DRESS, a drug reaction that can include rash plus fever and organ problems such as liver injury.
Immune reconstitution syndrome — Immune system changes after starting HIV treatment can unmask hidden infections or trigger autoimmune conditions like Graves’ disease, polymyositis, or Guillain-Barré syndrome.
Fat redistribution — Changes in where body fat is stored can occur, such as increased belly fat or a “buffalo hump.”

Get medical help right away if you think you are having a serious reaction.

What To Know Before Taking Nevirapine

Before starting nevirapine, your doctor will check your liver with blood tests. Your doctor may also check your CD4 cell count, which measures a type of immune cell that helps your body fight infections. Higher CD4 cell counts can raise the risk of serious liver problems when starting nevirapine.

Before taking nevirapine, tell your doctor if you or your child:

Have or have had hepatitis or other liver problems
Receive dialysis
Have trouble swallowing pills
Have any allergies to nevirapine or its ingredients

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements. Some medicines and herbal products can interact with nevirapine.

Do not take nevirapine if:

You have moderate or severe liver problems, called Child-Pugh Class B or C. This means the liver is not working well enough to safely use nevirapine.
For postexposure prophylaxis, or PEP. PEP is medicine taken after a possible exposure to HIV to try to prevent infection.
Have any allergies to nevirapine or its ingredients.

Do not miss doses or let your supply of nevirapine run out. The amount of virus in your blood may increase, and the virus may become harder to treat.

If you miss a dose, take it as soon as you remember. If it is almost time for your next dose, skip the missed dose and take your next dose at the regular time. Do not take two doses at the same time.

If you stop taking nevirapine for more than seven days, contact your doctor before restarting it. You may need to restart the once-daily starting dose for 14 days.

If you are pregnant or plan to become pregnant, talk with your doctor. A pregnancy registry is available for people who take nevirapine during pregnancy. Healthcare providers can register pregnancies by visiting the Antiretroviral Pregnancy Registry or calling 800-258-4263.

If you are breastfeeding or plan to breastfeed, talk with your healthcare provider about the risks. Nevirapine can pass into breast milk, and HIV-1 may also be passed to a baby through breast milk.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is nevirapine for HIV?

Clinical studies show that nevirapine can help lower the amount of HIV-1 in the blood when it is taken with other HIV medicines. Results varied by study and dosage form.

In one adult study of immediate-release nevirapine, 18 percent of people had a viral load below 50 copies per milliliter at 48 weeks, compared with 2 percent of people who did not receive nevirapine. Their CD4 cell counts, which measure immune cells that help fight infection, also increased more.

In another adult study, 45 percent of people taking nevirapine with zidovudine and didanosine had a viral load below 400 copies per milliliter at 48 weeks, compared with 19 percent of people taking zidovudine and didanosine without nevirapine.

In a pediatric study of nevirapine oral suspension used with other HIV medicines, 47 percent of children had and maintained a viral load below 400 copies per milliliter at 48 weeks.

Extended-release nevirapine was also effective in clinical studies. In one adult study, 69 percent of people taking extended-release nevirapine had a viral load below 50 copies per milliliter at 96 weeks, compared with 67 percent taking immediate-release nevirapine.

How long does nevirapine take to work for HIV?

Clinical studies measured results over periods such as 24, 48, and 96 weeks. The studies do not say exactly how long it takes nevirapine to start controlling HIV-1.

Nevirapine is taken every day with other HIV medicines, not by itself. Your doctor will use blood tests, including your viral load and CD4 cell count, to see how well your treatment is working.

Can nevirapine interact with other medicines?

Yes. Nevirapine can interact with other medicines.

Nevirapine affects liver enzymes that help break down many medicines. Because of this, it can change the amount of some medicines in your body, and other medicines can also change the amount of nevirapine in your body. This applies to the immediate-release tablets, oral suspension, and extended-release tablets.

Important examples include:

St. John’s wort — Do not use it with nevirapine unless your doctor tells you to. It can lower nevirapine levels and may make treatment less effective.
Efavirenz — Taking it with nevirapine is not recommended because it may increase side effects without improving how well treatment works.
Some other HIV medicines — Medicines such as atazanavir, fosamprenavir, lopinavir, and others may need to be avoided, adjusted, or monitored when used with nevirapine.
Warfarin — Nevirapine can affect warfarin levels, so blood-thinning tests may need to be checked more often.

Tell your doctor about all prescription medicines, over-the-counter medicines, vitamins, and herbal supplements you take. Do not start a new medicine without checking with your doctor or pharmacist first.