Question
Nevirapine in the UK: nevirapine PR or doubling the old dose?
21 February 2012. Related: Adherence, All topics, Changing treatment.
I’m currently taking nevirapine (Viramune) twice a day and Truvada (tenofovir+FTC) once a day. I asked my clinic if they would be getting the new Viramune PR tablets (so i could take this once a day) in but they said it was unlikely as most people take 2 tablets of the standard once a day.
I am thinking about taking 2 tabs of nevirapine once a day but i hear that in some people then this means that the levels of nevirapine in the blood might not be enough over a 24 hour period.
I’m worried that by changing to taking it once a day i would develop resistance to it if my levels were not high enough at the end of the dose.
What do you advise with regards to taking the standard nevirapine once a day. I don’t think the clinic will be getting the long acting ones in so i won’t be able to take them instead.
Answer
As background for other people reading this, there are now two formulations of nevirapine.
- nevirapine 200 mg (original), and
- nevirapine PR 400 mg (called nevirapine XR outside Europe)
The original 200 mg formulation is licensed as a twice-daily drug: 200 mg every 12 hours. However, in the last few years many people take both 200 mg tablets together, once a day. This has a benefit if the other meds in your combination are also once-daily.
Taking the original nevirapine this way is not as good as twice daily for someone just starting treatment. However, it seems to work well for people who already been undetectable for a while (perhaps a year or more) and who are very adherent.
In practice, some people do this by testing their drug levels first, using therapeutic drug monitoring (TDM). Others just switch and check that their viral load stays undetectable with more frequently viral load monitoring. This can be a few weeks after the change and then a month later. In the UK, both options should be easily available.
The new formulation, which is called nevirapine prolonged release (PR) in Europe (and nevirapine extended release in the USA) is a once daily single 400 mg tablet.
This is not just the old version compressed more tightly into one pill. It is a different formulation where the drug stays in your body longer so that after 24 hours, you would have higher drug levels compared to those after a double dose of the original formulation.
So although the original formulation is widely used once-daily, the new formulation has been specifically designed to do this. Given that your other meds are once-daily, changing to taking all your meds together is likely to improve your quality of life. So you are right to be asking your clinic about this.
The new formulation however is the same price as the old formulation, so I’m not sure why your clinic is not saying that this will become available. It might be that they are using the last of the original and that this will change in the future. Cost should not be a factor in this and there are other advantages of the newer formulation.
Which clinic doe you attend? perhaps take in this Q&A when you see your doctor, and write to your doctor and the head of the clinic to ask why.
In summary, your options are to ask for a TDM test for your current nevirapine drug levels, and then decide if switching is safe or to switch to once-daily with the current formulation, but check your viral load more closely.
Although both these options are technically not approved, they are widely used. Most people find once-daily meds improves their life. Or (and!) ask your clinic again about the new version.
Hi
Thanks for your comment.
You are right to ask to see your doctor as no medicine should be changed without having discussed this first.
In this case the formualtions are slightly different so they are not the same as switching one manufacturer\s drug for a generic version.
As this question is important for other people in London I have posted it as a question with a much more detailed answer at this link.
Please see this link for the full answer.
Simon, I am so so confused right now as I am on Viramune 400 mg for 2 years or so and my clinic has recently decided WITHOUT CONSULTING ME THAT I AM GOING TO CHANGE TO NEVIRAPINE 200 MG(GENERIC OPTION) 2 TABLETS a day taken once. Their reasoning is the price and I really want to understand if the generic option they want to offer is the same as the slow release I am on right now. I understand that NHS is trying to cut down the price of meds but what angers me is their lack of planning; why at the first place did they introduced us to the best viramune slow release if they knew it was going to change? It feels like we patients are some kind of bins to take whatever meds they think is cheap. what if tomorrow another company starts producing other cheap generics; Am I going to be asked to change again? I am angry right now because at my last appointment, my consultant never mentioned this change; it’s when i went to the pharmacy that the pharmacist started explaining the change; I obviously refused to take it as I think any change of meds should be discussed with the doctor. Another thing I doubt is if the 2 versions of nevirapine are similar, why these pharmaceutical companies can’t produce the latest version that is beneficial to us patients, the science of meds should keep moving forward not go backward. Please Simon, email your advice as soon as you can as I have to make my decision as I am running out of meds soon; I really want to stay on the slow release, what are my options? The thing is I am on my 3rd combination and as this is working I DON’T WANT ANYTHING TO MESS IT UP FOR ME, NOT IN THE NAME OF MONEY, MY LIFE IS TOO PRECIOUS AND i PAY MORE THAN ENOUGH TAXES THAT I DESERVE TO BE GIVEN THE BEST MEDECINES.
Thanks for your quick reply.