Starting on nevirapine
Nevirapine is only recommended as an ‘alternative’ NNRTI in the UK. It is used less because of a small risk of very serious side effects.
Nevirapine has some side effects that are similar to efavirenz. This includes risk of serious rash and liver toxicity (that can both be fatal), but not sleep or mood disturbance.
The risk with nevirapine was found to be linked to starting treatment with a higher CD4 count (over 250 for women, and over 400 cells/mm3 for men). Whether the risk is reduced by observing these upper CD4 cut-offs is the subject of ongoing research.
- A serious skin reaction called Stevens-Johnson Syndrome (SJS) has been reported in 0.3% of people starting nevirapine compared to 0.1% in people starting efavirenz.
- You need to start nevirapine at 200 mg once-daily for the first 2 weeks, and then, only if you do not have a rash, increase the dose to 200 mg twice-daily. Any rash should be promptly shown to your doctor.
- Nevirapine is not routinely recommended in people with hepatitis C and HIV, because it may increase liver disease.
- The reactions with nevirapine usually only occur in the first 2 months. Over this time, you should be monitored more carefully. Otherwise, nevirapine is reported as an easy drug to tolerate.