Nevirapine for HIV

About nevirapine

Nevirapine is an antiretroviral medicine. It is used for human immunodeficiency virus (HIV) infection. It slows the progress of HIV infection, but it is not a cure. HIV destroys cells in the body, called CD4 T cells. These cells are a type of white blood cell and are important because they are involved in protecting your body from infection. If left untreated, the HIV infection weakens your immune system so that your body cannot defend itself against bacteria, viruses and other germs. Nevirapine slows down the progress of HIV infection by reducing the amount of virus in your body. It does this by stopping the virus from copying (replicating) itself.

Nevirapine will be prescribed for you by a doctor who is a specialist. It belongs to a group of antiretroviral medicines known as non-nucleoside reverse transcriptase inhibitors. It is given alongside a number of other antiretroviral medicines, as part of a combination therapy. Taking three or more antiretroviral medicines at the same time is more effective than taking one alone. Taking a combination of different medicines also reduces the risk that the virus will become resistant to any individual medicine. It is vital to take them exactly as prescribed to maintain success and to help to prevent the virus from becoming resistant to the medicines. These medicines are usually taken for life.

Before taking nevirapine

Some medicines are not suitable for people with certain conditions, and sometimes a medicine can only be used if extra care is taken. For these reasons, before you start taking nevirapine it is important that your doctor knows:

• If you are pregnant or breastfeeding.

• If you have any problems with the way your liver works, or if you have any problems with the way your kidneys work.

• If you have a rare inherited blood disorder called porphyria.

• If you are taking any other medicines. This includes any medicines which are available to buy without a prescription, as well as herbal and complementary medicines.

• If you have ever had an allergic reaction to a medicine.

How to take nevirapine

• Before you start the treatment, read the manufacturer's printed information leaflet from inside the pack. It will give you more information about nevirapine, and it will also provide you with a full list of the side-effects which you could experience from taking it.

• Take nevirapine exactly as your doctor tells you to. To begin with you will be given an 'immediate-release' form of nevirapine. Adults are usually given 200 mg tablets, and there is a liquid medicine which is suitable for children to take. You will be asked to take one dose a day for 14 days. After these first 14 days, you will be either asked to increase the number of doses you are taking each day to two doses (taken 12 hours apart), or you will be supplied with prolonged-release tablets. Prolonged-release tablets allow nevirapine to be absorbed by your body more slowly and evenly throughout the day, so you will only need to take one dose a day of this type of tablet.

• You can take nevirapine tablets and liquid medicine either with or without food. The tablets should be swallowed whole with a drink of water, and should not be crushed or chewed.

• Try to take your doses at the same time(s) of day each day, as this will help you to remember to take nevirapine regularly.

• If you are taking an 'immediate-release' form of nevirapine (200 mg tablets or oral liquid medicine) and you forget to take a dose at your usual time, you should take it as soon as you remember, providing it is within eight hours of the time you should have taken the dose. If when you remember, it is more than eight hours late then do not take the missed dose, but do remember to take your next dose on time. Do not take two doses together to make up for a missed dose.

• If you are taking prolonged-release tablets and you forget to take a dose on time, you should take it as soon as you remember, providing it is within 12 hours of the time you should have taken the dose. If when you remember, it is more than 12 hours late then do not take the missed dose, but do remember to take your next dose on time. Do not take two doses together to make up for a missed dose.

Instructions for using the dosing syringe for Viramune® Suspension

1. Shake the bottle gently, and then open it.

2. Insert the adapter into the bottle neck by pressing it down and then screwing it in.

3. Insert the nozzle of the 5 ml dosing syringe into the adapter. Make sure the plunger is fully pushed into the syringe.

4. Turn the bottle (and syringe) upside down.

5. Gently pull out the plunger of the syringe so that the medicine fills the syringe to the mark which corresponds to your dose in mls.

6. Turn the bottle the correct way up again, and remove the syringe from the bottle.

7. Put the tip of the syringe into your child's mouth (or if appropriate, your mouth). Gently push in the plunger so that the medicine is released.

8. Repeat steps 3-7 if you have been told to use more than 5 ml (one syringeful) for the dose.

9. Close the bottle by using the flip lid on the adapter.

Getting the most from your treatment

• Keep your regular appointments with your doctor so that your progress can be monitored. You will need to have regular blood tests to make sure your liver stays healthy.

• It is important that you continue to take nevirapine and your other antiretroviral treatment regularly. This will help to prevent the HIV from becoming resistant to the medicines you are taking. Even if you miss only a small number of doses, the virus can become resistant to treatment.

• If you develop an infection soon after you start the treatment, let your doctor know. As a result of taking nevirapine, your immune system may start fighting an infection which was present before you started the treatment, but which you may not have been aware of.

• Follow carefully any advice your doctor gives to you about making lifestyle changes to reduce any risk of damage to your heart and blood vessels. These can include stopping smoking, eating healthily and taking regular exercise.

• Although treatment with antiretroviral medicines may reduce the risk of you passing HIV to others through sexual contact, it does not stop it. It is important that you use condoms.

• It is not uncommon for people with HIV to feel low or even depressed, especially soon after the diagnosis has been made and treatment has been started. If you have any feelings of depression, or any distressing thoughts about harming yourself, then you should speak with your doctor straightaway.

• Some people who have taken antiretroviral medicines (particularly over a long time) have developed a condition called osteonecrosis. This is a bone disease where bone tissue dies because there is a reduced blood supply to it. It leads to joint pains and stiffness, and can cause difficulties in movement. If you notice any of these symptoms, speak with your doctor.

• If you buy any medicines, supplements or herbal remedies 'over the counter', check with a pharmacist that they are suitable to take with nevirapine and your other medicines. This is because some medicines interfere with antiretrovirals and can stop them from working properly. In particular, do not take St John's wort.

• If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.

• Treatment for HIV is usually lifelong. Continue to take nevirapine regularly, even if you feel well. This is to keep your immune system healthy.

Can nevirapine cause problems?

Along with their useful effects, most medicines can cause unwanted side-effects although not everyone experiences them. The table below contains some of the most common ones associated with nevirapine. You will find a full list in the manufacturer's information leaflet supplied with your medicine. The unwanted effects often improve as your body adjusts to the new medicine, but speak with your doctor or pharmacist if any of the following continue or become troublesome.

Important: your doctor will discuss with you the possibility of unwanted side-effects such as severe rashes, allergic reactions, and liver problems. Contact your doctor straightaway if you experience any of the following symptoms:

• Severe skin rash, skin blistering, high temperature, sore mouth or eyes, swollen mouth or face, mouth ulcers, muscle or joint aches and pains, general swelling, or feeling generally unwell.

• Loss of appetite, feeling or being sick, yellowing of your skin or the whites of the eyes (jaundice), and tummy pain.

If you experience any other symptoms which you think may be due to the medicine, speak with your doctor or pharmacist for further advice.

How to store nevirapine

• Keep all medicines out of the reach and sight of children.

• Store in a cool, dry place, away from direct heat and light.

Important information about all medicines