CLINICAL USE

Non-nucleoside reverse transcriptase inhibitor:Treatment of progressive or advanced HIV infection in combination with at least two other antivirals

DOSE IN NORMAL RENAL FUNCTION

200 mg daily, increasing to twice daily after 14 days if tolerated

PHARMACOKINETICS

  • Molecular weight                           :266.3
  • %Protein binding                           :60
  • %Excreted unchanged in urine     : <3
  • Volume of distribution (L/kg)       :1.12–1.3
  • half-life – normal/ESRD (hrs)      :45 (single dose) 25–30 (multiple dosing)/Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           : Dose as in normal renal function. See ‘Other Information’

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :Dialysed. Dose as in GFR
  • <10           : mL/min
  • HD                     :Dialysed. Dose as in GFR
  • <10           : mL/min
  • HDF/high flux   :Dialysed. Dose as in GFR
  • <10           : mL/min
  • CAV/VVHD      :Unknown dialysability. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Antibacterials: concentration decreased by rifampicin – avoid concomitant use; possibly increased rifabutin concentration
  • Anticoagulants: may increase or reduce effect of warfarin
  • Antidepressants: concentration reduced by St John’s wort – avoid concomitant use
  • Antifungals: concentration of ketoconazole reduced – avoid concomitant use; concentration increased by fluconazole; possibly reduced caspofungin concentration – may need to increase caspofungin dose
  • Antipsychotics: possibly reduced aripiprazole concentration – increase aripiprazole dose
  • Antivirals: concentration of indinavir and efavirenz reduced and possibly amprenavir, lopinavir and atazanavir – avoid concomitant use with atazanavirOestrogens and progestogens: accelerated metabolism (reduced contraceptive effect)

    ADMINISTRATION

    Reconstition

    –

    Route

    Oral

    Rate of Administration

    –

    Comments

    –

    OTHER INFORMATION

    Little data available on the use of nevirapine in renal failure, but need for dose adjustment is unlikely due to nevirapine being predominantly metabolised in the liver, and the inactive metabolites excreted in the urine. Use with cautionThere was a preliminary study of haemodialysis patients which showed that a normal dose was not associated with increased side effects.

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