Viramune

The recommended adult dose of nevirapine is 200 mg once a day for the first 2 weeks, and then 200 mg twice a day (every 12 hours) or 1 tablet of 400 mg extended release nevirapine once a day (every 24 hours) after the initial 2 weeks. Your doctor may decide on a different dosing pattern. Do not change your dose unless instructed by your doctor. The initial dose of 200 mg once daily helps to reduce the risk of rash that may develop with use of nevirapine. If you do develop a rash while taking Viramune, call your doctor for further instruction.

Viramune may be taken with or without food. Do not crush or chew the extended release tablets.

It is important to take Viramune exactly as prescribed by your doctor. The effectiveness of the medicine depends on maintaining the right amount of nevirapine in the bloodstream. If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice. If you miss many doses in a row, talk to your doctor about how to resume dosing.

If you have been asked to stop taking the medication for more than a 7-day period, your doctor will likely have you start taking only one 200 mg tablet daily for the first 14 days and then increase to 200 mg twice daily after that.

Store nevirapine tablets at room temperature and protect them from excessive light and moisture. Keep the bottle tightly closed and out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Each white, oval, biconvex tablet, embossed with "54 193" on one side with a single bisecting line separating the "54" and "193" and marked on the other side with a single bisecting line, contains nevirapine 200 mg. Nonmedicinal ingredients: colloidal silicon dioxide, lactose, magnesium stearate, microcrystalline cellulose, povidone, and sodium starch glycolate.

Do not take nevirapine if you:

• are allergic to nevirapine or any ingredients of Viramune
• have needed to stop taking the medication due to severe rash, allergic reactions, or hepatitis caused by nevirapine
• have severely reduced liver function
• ​​have galactose intolerance, Lapp lactase deficiency (a rare hereditary condition), or glucose-galactose malabsorption​
• are taking the herbal medication St. John’s wort

There may be an interaction between nevirapine and any of the following:

• Apixaban
• "azole" antifungals (e.g., ketoconazole, Voriconazole)
• birth control pills
• Bosentan
• Bupropion
• Carbamazepine
• clarithromycin
• Clozapine
• Cyclophosphamide
• Dabrafenib
• daclatasvir
• Deferasirox
• Enzalutamide
• estrogens (e.g., conjugated estrogen, Estradiol, ethinyl estradiol)
• Hepatitis C antivirals (daclatasvir, velpatasvir)
• other HIV non-nucleoside reverse transcriptase inhibitors (NNRTIs; e.g., delavirdine, efavirenz, etravirine)
• HIV integrase inhibitors (e.g., dolutegravir, elvitegravir)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• HIV nucleoside reverse transcriptase inhibitors (NRTIs; e.g., abacavir, didanosine, lamivudine, tenofovir, zidovudine)
• HIV protease inhibitors (e.g., atazanavir, indinavir, ritonavir, saquinavir)
• maraviroc
• Methadone
• Modafinil
• Phenobarbital
• Phenytoin
• primidone
• progestins (e.g., Dienogest, Levonorgestrel, medroxyprogesterone, Norethindrone)
• quinidine
• quinine
• rifabutin
• rifampin
• rilpivirine
• Rivaroxaban
• St. John's wort
• Selegiline
• siltuximab
• Tocilizumab
• Warfarin

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with Viramune. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the Nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

Before you begin using a medication, be sure to inform your doctor of any medical conditions or Allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use Viramune.

Birth control: Nevirapine may reduce the effectiveness of birth control pills. Use another form of birth control if taking Viramune.

Fat redistribution: Over time, Viramune may change how fat is distributed in your body and may change your body shape. You may notice increased fat in the upper back and neck, breast, around the back, chest, and stomach area; or loss of fat from the legs, arms, and face. The long-term effects of this are not known.

Immune reconstitution syndrome: Viramune may cause immune reconstitution syndrome, where signs and symptoms of inflammation from previous infections appear. These symptoms occur soon after starting anti-HIV medication and can vary. They are thought to occur as a result of the immune system improving and being able to fight infections that have been present without symptoms (such as pneumonia, herpes, or Tuberculosis). Report any new symptoms to your doctor as soon as possible.

Kidney function: If you have reduced kidney function, discuss with your doctor how Viramune may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Viramune, and whether any special monitoring is needed. People with severely reduced kidney function should not take Viramune.

Liver damage: Viramune may cause liver damage. The risk is highest during the first 6 weeks of treatment. Women are also more likely than men to experience liver damage when taking nevirapine. Women who had CD4+ counts of over 250 cells/mm³ or men who had CD4+ counts of over 400 cells/mm³ when treatment was started are at a higher risk, but anyone taking Viramune may be at risk of liver damage.

Your doctor will order regular blood tests to watch for early signs of liver damage. Stop using Viramune and contact your doctor as soon as possible if you notice any symptoms of liver damage, including unusual tiredness or weakness, abdominal pain, loss of appetite, or jaundice (yellow eyes or skin).

Liver function: Nevirapine is broken down by the liver so it can be removed from the body through the kidneys. Liver disease or reduced liver function may cause a build-up of nevirapine in the body and cause side effects.

If you have liver disease or decreased liver function, discuss with your doctor how Viramune may affect your medical condition, how your medical condition may affect the dosing and effectiveness of Viramune, and whether any special monitoring is needed.

If you experience symptoms of liver problems (e.g., abdominal pain, persistent vomiting, feeling unwell, fever, itching, yellowing of the skin and eyes, dark urine), contact your doctor immediately.

Skin reactions: Nevirapine can cause a severe form of skin reaction that may be life threatening. This is most likely to occur in the first 6 weeks of taking Viramune. If you experience a severe rash or a rash at the same time as fever, feeling generally unwell, blisters, muscle or joint aches, contact your doctor or get medical attention immediately.

Pregnancy: There are no adequate studies on the use of Viramune by pregnant women. Talk to your doctor for guidance.

Breast-feeding: It is not known if nevirapine passes into breast milk. Women who have HIV infection are cautioned against breast-feeding because of the risk of passing HIV to a baby who does not have the infection.

Children: The safety and effectiveness of Viramune have not been established for those less than 15 years of age.