NEVIRAPINE

Indications & Dose:

Combination therapy for HIV -1

BY MOUTH

Adult and child over 16 years, 200 mg once daily for firt 14 days then (if no rash present) 200 mg twice daily; Neonate and Child under 8 years, 150 mg/m2 (max. 200 mg) once daily for first 14 days, them  (if no rash present) 150  mg/m2 (max. 200 mg) twice  daily or 4mg/kg  (max. 200 mg) once daily for first 14 days then (if no rash present) 7 mg/ kg (max. 200 mg) twice daily, Child 8-16 years, 150 mg/m2 (max. 200 mg) once daily for first 14 days then (if no rash present) 4mg /kg (max. 200 mg) twice daily Note Dose titration  should be repeated if treatment interrupted for more than 7 days. Dose Chronic hepatitis C (in combination with interferon alfa of peginterferon alfa), Adult over 18 years, body-weight under 75 kg., 400 mg in the morning and 600 mg in the evenings body weight 75 kg and over, 600 mg twice daily Note Chronic hepatitis C genotype 2 or 3, or patients infected with  HIV and hepatitis C require a lower dose  of Copegus (in combination with peginterferon alf), usual dose 400 mg twice daily. Dose chronic hepatic C, Adult over 18 year (in combination with interferon alfa or peginterferon alfa), body-weight under 65 kg, 400 mg twice daily; body weight 65-85 kg, 400 mg in the morning and 600 mg in the evening body-weight over 85 kg 600 mg twice daily; Child and Adolescent 3-17 years (in combination with interferon alfa), body-weight under 47 kg,  15 mg/kg daily in 2 divided  dose; body – weight 47-49 kg, 200 mg in the morning and 400 mg in the evening; body-weight 50-65 kg 400 mg twice daily; weight over 65kg, as adult Dose bronchiolitis, by aerosol inhalation or nebulization (via small particle aerosol generator) of solution containing 20 mg/ml for 12-18 hours for

at least 3 days; max. 7 days. 

Contraindications:

Side Effects:

CNS: CNS side effects seen in 52% of patients, abnormal dreams, amnesia, anxiety, confusion, depression, dizziness, impaired concentration, insomnia, tremor

CV: Flushing, palpitations, tachycardia

EENT: Tinnitus

GI: Diarrhea, elevated transaminases, nausea

METAB: Hyperlipidemia

MS: Arthralgia, myalgia

RESP: Asthma

SKIN: Rash (27%) 

Cautions:

Precautions:

 Depression, liver disease, pregnancy (fetal malformations observed in monkeys) 

Interaction:

Drugs •

Amprenavir: Efavirenz decreases amprenavir plasma level; amprenavir dose adjustment recommended • Barbiturates: Barbiturates decrease plasma efavirenz levels; dose adjustment not recommended •

Carbamazepine: Carbamazepine decreases plasma efavirenz levels; dose adjustment not recommended •

Cisapride: Efavirenz increases cisapride plasma level; coadministratioh not recommended • Clarithromycin: Efavirenz decreases clarithromycin plasma levels; coadministration not recommended • Ergotamines: Efavirenz increases ergotamine plasma level; coadministration not recommended • Ethinyl estradiol: Efavirenz increases ethinyl estradiol plasma levels; dose adjustment not recommended •

lndinavir: Efavirenz reduces indinavir AUC by 31%; increase indinavir dose to 1000 mg q8h •

Lopinavir: Decreasd plasma lopinavir concentrations; consider increase dose of lopinavir/ ritonavir combination to 533 mg lopinavir and 133 mg ritonavir • Lovastatin: Efavirenz increases lovastatin plasma level; dose adjustment not recommended •

Midazolam: Efavirenz increases midazolam plasma level; coadministration not recommended •

Nelfinavir: Efavirenz increases nelfinavir AUC by 20%; dose adjustment not recommended • Phenobarbital: Decreased plasma efavirenz concentrations • Phenytoin: Phenytoin decreases plasma efavirenz level; dose adjustment not recommended •

Psychoactive drugs: Potential for additive CNS effects • Rifabutin: Efavirenz decreases plasma rifabutin level by 35%; no change in plasma efavirenz level; increase rifabutin dose to 450 mg qd •

Rifampin: Rifampin decreases plasma efavirenz level by 25%; dose adjustment not recommended • Ritonavir: Ritonavir increases efavirenz AUC by 21%; efavirenz increases- ritordvir AUC- by 18%; dose-adjustment not recommended •

St. John’s Wort (Hypericum perforatum): Substantial decrease in plasma efavirenz concentrations likely; coadministration not recommended • Saquinavir: Saquinavir reduces efavirenz AUC by 12%; efavirenz reduces saquinavir AUC by 62%; coadministration not recommended • Simvastatin: Efavirenz increases simvastatin plasma level; dose adjustment not recommended •

Triazolam: Efavirenz increases triazolam plasma level; coadministration not recommended •

Warfarin: Efavirenz increases warfarin effect 

Warnings:

Adverse Effects:

Lactations:

Pregnancy category C (fetal malformations observed in monkeys); breast feeding not recommended 

Special Precautions:

Counselling:

Side Effects Or Adverse Reactions:

Patient And Carer Advice: