Nevirapine

VIRAMUNE

Open Nevirapine in the interactive console ↗

Pronunciation: ne-VYE-ra-peen (VI-ra-myoon)

Nevirapine ballicule: receptor binding, kinetics and half-life diagram — Mechanism of action: Nevirapine ballicule

Nevirapine VIRAMUNE mascot mnemonic cartoon — Visual mnemonic: Nevirapine mascot
**“Virile moon Never rapping”**

What it isNon-nucleoside reverse-transcriptase inhibitor; HIV infection.

Why this oneIts durable niche is neonatal prophylaxis after perinatal HIV exposure, especially where newer agents are unavailable.

What limits itSevere rash and hepatotoxicity can be fatal; a lead-in phase reduces rash, and enzyme induction creates major interactions.

Nevirapine molecular structure (skeletal formula) — Molecular structure: Nevirapine

FDA-approved for

HIV infection (1996)

FDA label

Read the full label on DailyMed ↗

BOXED WARNING Life-threatening/fatal hepatotoxicity and severe skin reactions (SJS/TEN, hypersensitivity), especially in the first 18 weeks; do not restart after clinical hepatitis or severe rash.

FDA dosing	Population	Start	Target	Max
HIV-1 infection (with other antiretrovirals)	adult (≥16 yr)	200 mg QD × 14 days (lead-in)	200 mg BID	400 mg/day
HIV-1 infection (with other antiretrovirals)	pediatric ≥15 days	150 mg/m² QD × 14 days (lead-in)	150 mg/m² BID	400 mg/day

Titration Escalate to BID after the 14-day 200 mg once-daily lead-in (do not escalate if rash present; lead-in must not exceed 28 days)

Renal No adjustment if CrCl ≥20 mL/min; on hemodialysis give an additional 200 mg after each session

Hepatic Contraindicated in moderate or severe (Child-Pugh B or C) impairment

Instructions

Strictly follow the 14-day 200 mg once-daily lead-in to reduce rash
If dosing is interrupted for >7 days, restart with the 14-day lead-in
Permanently discontinue for a symptomatic hepatic event or severe rash/hypersensitivity; do not restart after recovery
Must not be used as monotherapy
Oral suspension (50 mg/5 mL) available for pediatric dosing (same 150 mg/m²)

Available strengths

tab 200 mg
susp 50 mg/5 mL
ER tab 400 mg

Contraindications

Moderate or severe (Child-Pugh B or C) hepatic impairment
Use as part of occupational or non-occupational post-exposure prophylaxis (PEP)

Cautions

Severe/fatal hepatotoxicity (greatest first 6–18 weeks; higher risk in women and higher CD4+)
Severe skin reactions (SJS/TEN, hypersensitivity)
Immune reconstitution syndrome
Fat redistribution
Rapid resistance if used as monotherapy

Adverse reactions

Rash (15%; Grade 3/4 in 2%)
Hepatitis/hepatotoxicity
Nausea
Headache
Fatigue
Granulocytopenia (pediatric)

Pregnancy APR data show no increased overall birth-defect risk; severe hepatic events reported in pregnant women, especially CD4+ >250

Lactation Present in human milk; CDC advises HIV-infected mothers in the US not to breastfeed

Cost

Nevirapine (VIRAMUNE)

What pharmacies pay · NADAC 9/30/26

Strength		#/mo	generic $	CostPlus
200 mg	tab	30 qd	$4.42/mo	out of stock
50 mg/5 mL	susp	per unit		offered

Generic entry2012

⚠ BOXED WARNINGS

Severe hepatotoxicity
Severe skin reactions

Classes and tags

Clinical profile

Therapeutic safety burden3 / 4

Overdose danger2 / 4

Weight-gain liability0 / 4

Sedation liability0 / 4

QT / Torsades0 / 4

Direct muscarinic antagonism0 / 4

Embryofetal risk2 / 4

Legacy pregnancy categoryUnknown / historical label unavailable

Defining liabilityAgent-specific renal, hepatic, hematologic, metabolic and drug-interaction toxicity.

Open Nevirapine in the interactive console ↗

Memory aids: interaction avatars

CYP2B6 inducer (moderate)

CYP2B6 substrate

CYP3A4 inducer (moderate)

Open Nevirapine in the interactive console ↗