nevirapine

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

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Route

Oral

Rate of Administration

–

Comments

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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.

See how to identify renal failure stages according to GFR calculation

See how to diagnose irreversible renal disease

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