Nevirapine Oral: PMTCT Dosing and Precautions

Therapeutic action

Antiretroviral, HIV-1 non nucleoside reverse transcriptase inhibitor.

Indications

Prevention of mother-to-child transmission of HIV in neonates, alone or in combination with other antiretrovirals.

Forms and strengths

• 50 mg/5 ml oral suspension.
• 50 mg scored dispersible tablet.

Dose

Depending on the risk of acquiring HIV infection, for information only.

• Full term neonate from birth to 6 weeks of age: 15 mg (1.5 ml) oral suspension or 25 mg (1/2 dispersible tablet) once daily. From birth to 4 weeks, preferably use the oral suspension.
• After 6 weeks and up to 12 weeks of age: 20 mg (2 ml) oral suspension or 25 mg (1/2 dispersible tablet) once daily.
• Preterm or low-birth weight neonate: seek specialist advice.
• High risk: 6 weeks when combined with zidovudine. For breastfed children, extend treatment an additional 6 weeks.
• Low risk with NVP alone: 4 to 6 weeks for non-breastfed children and 6 weeks for breastfed children.

Contra-indications, adverse effects, precautions

• Do not administer to neonates with severe hepatic impairment or born to mothers with resistance to NVP or HIV-2 mono-infection.
• May cause rash and hepatic disorders, especially in the first 6 weeks of treatment, as well as gastrointestinal disturbances.
• Less frequently, may cause severe hypersensitivity reactions and life-threatening hepatotoxicity.
• Any isolated rash requires immediate medical attention and surveillance.
• Stop NVP immediately and permanently in the event of severe rash, rash with hypersensitivity features, or signs of hepatic disorders.
• NVP is a hepatic enzyme inducer and may interact with many drugs; concomitant use requires monitoring.
• Avoid combination with rifampicin because NVP plasma concentrations decrease.