Non-nucleoside reverse transcriptase inhibitor (1st gen)
Nevirapine
Brand names: Viramune
Adult dose
Dose: 200mg OD for 14 days, then 200mg BD (or 400mg MR OD)
Route: PO
Frequency: BD
Clinical pearls
- Largely superseded by newer NNRTIs (rilpivirine, doravirine)
- Lead-in 14-day low-dose to reduce rash; hepatotoxicity highest in women with CD4 >250 and men with CD4 >400
Contraindications
- Severe hepatic impairment
- Pregnancy (caution if CD4 >250)
- Hypersensitivity
Side effects
- Severe hepatotoxicity (incl. fulminant — black box)
- Severe rash (SJS/TEN)
- Hypersensitivity reaction
- DRESS
Interactions
- Many — CYP3A4 inducer
- Reduces hormonal contraceptive efficacy
- Methadone (raised dose required)
- Statins
Monitoring
- LFTs (frequent first 12 weeks)
- Skin
- Viral load
- CD4
Reference: BNF; BHIVA; https://bnf.nice.org.uk/drugs/nevirapine/. Verify against your local formulary and the latest BNF before prescribing.
Related
Curated clinical cross-links plus same-class fallbacks.
Calculators
- SMART Risk Score for Recurrent CVD · Cardiovascular Risk
- PCSK9 Inhibitor Eligibility Assessment · Lipid Management
- Immune-Related Adverse Events (irAE) -- GI Toxicity Colitis Grading · Oncology-Related GI
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- DIPSS — Dynamic International Prognostic Scoring System for Myelofibrosis · Cancer Prognosis
- BALL Score for Relapsed/Refractory CLL · Leukaemia
Pathways
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023