Nevirapine — what it is and how it’s used
Nevirapine is an NNRTI (non-nucleoside reverse transcriptase inhibitor) used with other antiretrovirals to treat HIV-1. It blocks a key viral enzyme so HIV can’t copy itself and helps lower viral load when taken correctly. Clinicians don’t use nevirapine alone; it’s part of a combination regimen chosen by your HIV team.
Typical adult dosing starts with 200 mg once daily for 14 days (a lead-in) then moves to 200 mg twice daily. The lead-in period helps reduce the chance of rash. Some modern regimens vary, so always follow your prescriber’s instructions and the product label.
What to watch for: side effects and warnings
The main risks are liver injury and serious skin reactions. Watch for fever, rash, sore throat, or yellowing of the skin or eyes. Risk of severe liver toxicity is higher in women with CD4 counts above 250 cells/mm³ and in men with counts above 400 cells/mm³. If you notice symptoms, stop the drug and contact your clinic immediately.
Common side effects include nausea, headache, and tiredness. Rare but serious reactions include Stevens-Johnson syndrome and toxic epidermal necrolysis. Your provider should check liver function before you start and closely during the first 18 weeks when most problems appear.
Practical tips, interactions, and special situations
Nevirapine induces liver enzymes (CYP3A4), so it can lower levels of many drugs. That may reduce the effectiveness of hormonal birth control, some statins, and other medicines. Tell your doctor every drug and supplement you take so they can adjust therapy or choose alternatives.
Pregnancy and breastfeeding need specialist advice. Nevirapine crosses the placenta and has been used in mother-to-child prevention in some settings, but single-dose use can cause resistance. Follow a specialist’s plan if you are pregnant or planning pregnancy.
If you have side effects or toxicity, your clinic may switch you to an integrase inhibitor like dolutegravir or another NNRTI after checking resistance. Nevirapine interacts strongly with rifampicin and other TB drugs; co-treatment needs specialist advice. Typical monitoring is baseline liver tests, check again at 2 and 4 weeks, then monthly for three months, then as advised. Children can use nevirapine too but doses are weight-based and need pediatric oversight. Ask your provider for a clear plan before starting.
Because nevirapine has a low resistance barrier, missed doses increase the chance the virus becomes resistant. Take doses at the same time each day and don’t stop without talking to your clinic. If you miss a dose, follow your provider’s guidance—don’t double up unless instructed.
Before starting, get baseline bloodwork: liver function tests, full blood count, and CD4. Repeat tests as recommended and avoid heavy alcohol or other liver-harming drugs while on nevirapine.
Thinking of buying medication online? Use only licensed pharmacies and a valid prescription. Counterfeit or substandard drugs are real risks. If cost or access is an issue, ask your clinic about assistance programs, generics, or local support services.
Nevirapine can still be useful in the right setting, but it needs careful monitoring. If you notice rash, fever, jaundice, or extreme tiredness after starting, seek care right away. Your health team will help choose the safest, most effective HIV regimen for you.
