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Overview

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This medicine contains an important and useful components, as it consists of
Polynucleotideis available in the market in concentration

Name

Nevirapine

Precaution

Before initiating **Nevirapine**, it is essential to consult a healthcare provider due to several precautions associated with its use. Nevirapine is an **antiretroviral medication** primarily used in the treatment of **HIV**. The following considerations must be noted: - **Liver function**: Nevirapine can cause **liver toxicity**, which can be severe and life-threatening. It is particularly important to monitor liver function, especially in patients with **pre-existing liver conditions** (such as **hepatitis** or **cirrhosis**). Liver enzyme levels should be checked regularly during the treatment. - **Hypersensitivity reactions**: Nevirapine may cause severe **skin rashes**, **fever**, and **flu-like symptoms**. **Stevens-Johnson Syndrome** or **toxic epidermal necrolysis** are rare but serious adverse effects. Immediate discontinuation of the medication is required if any severe skin reactions occur. - **Pregnancy**: While **Nevirapine** is used in **HIV treatment** during pregnancy, it should only be prescribed after careful assessment of the risks and benefits. It is not recommended in the **first trimester** unless absolutely necessary due to the risk of **liver toxicity**. - **Drug interactions**: Nevirapine can interact with other medications, especially those that affect liver enzymes (e.g., **CYP450 inducers/inhibitors**). Dose adjustments and careful monitoring of interactions are critical. - **Immune reconstitution syndrome**: In some patients with advanced HIV, **Nevirapine** can trigger **immune reconstitution inflammatory syndrome (IRIS)**, a reaction where the immune system becomes overly active after starting therapy. Patients should be closely monitored during early treatment.

Indication

**Nevirapine** is prescribed primarily for the treatment of **HIV-1 infection**. Its indications include: - **HIV-1 infection**: It is a **reverse transcriptase inhibitor** used as part of **combination therapy** for the treatment of **HIV**. Nevirapine helps to reduce the **viral load** and prevent the progression to **AIDS** in HIV-positive individuals. - **Prevention of mother-to-child transmission**: It may be used as part of a regimen to prevent the **transmission of HIV** from **mother to child** during labor and delivery. - **Post-exposure prophylaxis**: Nevirapine is also used in some cases for **post-exposure prophylaxis** (PEP) to reduce the likelihood of **HIV** infection after possible exposure to the virus, such as in healthcare workers who experience needlestick injuries.

Contra indication

**Nevirapine** should not be used in certain situations due to the risk of **severe adverse reactions**. Contraindications include: - **Severe liver disease**: Patients with **moderate to severe hepatic impairment** (e.g., **cirrhosis**, **hepatitis**) should not use **Nevirapine**, as it may worsen liver function or lead to life-threatening liver failure. - **History of severe hypersensitivity reactions**: Patients who have experienced severe **skin reactions**, such as **Stevens-Johnson syndrome** or **toxic epidermal necrolysis**, after using **Nevirapine** or similar drugs should not take it again. - **Co-infection with Hepatitis C or B**: Co-infection with **hepatitis B** or **hepatitis C** significantly increases the risk of **hepatotoxicity**. Nevirapine should be avoided in these cases unless the benefits outweigh the risks, and liver function must be monitored closely. - **First trimester of pregnancy**: Nevirapine is **contraindicated** in the **first trimester** of pregnancy due to concerns about **liver toxicity** and its impact on the **fetus**.

Side Effect

Common and severe side effects associated with **Nevirapine** include: - **Liver toxicity**: The most serious side effect of **Nevirapine** is **hepatotoxicity**, which can result in **hepatitis**, **liver failure**, and **death** in severe cases. **Liver function tests** should be conducted before starting therapy and regularly monitored during treatment. - **Skin reactions**: **Rashes**, which may progress to severe reactions like **Stevens-Johnson syndrome** or **toxic epidermal necrolysis**, are common. Patients should be monitored for any signs of skin irritation or blistering. - **Gastrointestinal symptoms**: **Nausea**, **vomiting**, **diarrhea**, and **abdominal pain** are common, especially during the initiation of therapy. These symptoms generally subside over time. - **CNS effects**: Some patients experience **headache**, **dizziness**, or **fatigue** as side effects of **Nevirapine** therapy. - **Immune reconstitution inflammatory syndrome (IRIS)**: This syndrome occurs when the immune system begins to recover, potentially leading to worsening of symptoms related to **HIV-associated infections**. It can manifest as fever, swollen lymph nodes, and inflammation.

Pregnancy Category ID

2

Mode of Action

**Nevirapine** is a **non-nucleoside reverse transcriptase inhibitor (NNRTI)**. It works by binding directly to the **reverse transcriptase enzyme**, which is essential for the replication of **HIV**. By inhibiting this enzyme, **Nevirapine** prevents the conversion of **HIV RNA** into **DNA**, thus inhibiting the replication of the virus. This leads to: - **Reduced viral replication**: By inhibiting the reverse transcriptase, **Nevirapine** reduces the viral load in the body and slows the progression of the **HIV infection**. - **Improved immune function**: As the viral load decreases, the immune system can recover and function better, reducing the risk of opportunistic infections and helping to prevent the progression to **AIDS**.

Interaction

Nevirapine is metabolized by the liver enzyme system **CYP450**, particularly **CYP3A4**. Therefore, it has several drug interactions, including: - **CYP450 inducers**: Medications that increase liver enzyme activity (e.g., **rifampicin**, **phenytoin**, **carbamazepine**) can reduce **Nevirapine** levels, decreasing its effectiveness. **Dosage adjustments** may be necessary. - **CYP450 inhibitors**: Drugs that inhibit **CYP450 enzymes** (e.g., **ketoconazole**, **clarithromycin**) may increase **Nevirapine** levels, leading to an increased risk of **toxicity**, particularly **liver damage**. Close monitoring is required. - **Protease inhibitors**: The combination of **Nevirapine** with **protease inhibitors** like **lopinavir/ritonavir** or **atazanavir** may result in either increased side effects or reduced therapeutic efficacy, depending on the specific drugs used. It is often prescribed with other **reverse transcriptase inhibitors** (e.g., **lamivudine**, **abacavir**). - **Other HIV medications**: When used in combination with other **HIV drugs**, the dosing schedules must be carefully coordinated to avoid **adverse interactions** and ensure optimal viral suppression. - **Oral contraceptives**: Nevirapine may decrease the effectiveness of **oral contraceptives**, potentially leading to **unintended pregnancies**. Additional or alternative methods of contraception should be considered.

Pregnancy Category Note

Information not available

Adult Dose

For **adults** with **HIV-1 infection**, the typical dosage of **Nevirapine** is as follows: - **Initial dosing**: The recommended starting dose is typically **200 mg orally once daily** for the first 14 days to assess tolerance. - **Maintenance dosing**: After 14 days, the dose is increased to **200 mg twice daily**. Doses may be adjusted based on patient tolerance, other medications being taken, and liver function. - **Combination therapy**: Nevirapine is used in combination with other **antiretroviral medications**, including **nucleoside reverse transcriptase inhibitors (NRTIs)** and other **NNRTIs**.

Child Dose

For **children**, the dosing of **Nevirapine** is based on age and body weight. - **For children 2 years and older**: The recommended dose is usually **4 mg/kg once daily** for the first 14 days, followed by **4 mg/kg twice daily** for maintenance. - **For children under 2 years**: The use of **Nevirapine** in children under 2 years is limited and should only be prescribed under the supervision of a healthcare provider with expertise in pediatric HIV care. As with all medications, it is essential for patients and caregivers to **consult a healthcare provider** for personalized dosing recommendations and monitoring.

Renal Dose

**Nevirapine** does not require dose adjustment in **renal impairment**, as it is primarily metabolized by the **liver**. However, for patients with **severe renal dysfunction**, careful monitoring should be conducted, especially if they are on other medications that affect kidney function.

Administration

Information not available