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Non-nucleoside reverse transcriptase inhibitor (1st gen)

Nevirapine

Brand names: Viramune

Nevirapine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used as part of combination antiretroviral therapy for HIV-1 infection.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It binds directly and non-competitively to HIV-1 reverse transcriptase, disrupting the enzyme's catalytic site and blocking conversion of viral RNA into DNA.

Prescribing in practice

  • It can cause severe, potentially fatal hepatotoxicity and serious skin reactions including Stevens-Johnson syndrome, especially in the first weeks, so a lead-in dosing period and close monitoring are required.
  • Risk of hepatic reactions is higher when started at higher CD4 counts, which influences the decision to initiate.
  • It is a CYP enzyme inducer with numerous drug interactions, including reduced efficacy of some hormonal contraceptives and interactions with other antiretrovirals.

Monitoring

Monitor liver function frequently during the early weeks of treatment and review urgently if rash or hepatic symptoms occur.

Counselling the patient

  • Seek urgent help if you develop a rash, fever, blistering, or yellowing of the skin or eyes.
  • Do not stop or change the dose without advice, and tell your clinician about all other medicines.

Evidence & guidelines

The hepatotoxicity and skin-reaction warnings and lead-in dosing are established in the SPC and reflected in HIV treatment guidance.

Reference: BHIVA; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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