#viramune

[fundacionluchandovenceras]

VIRAMUNE VIRAMUNE XR, VIRAMUNE NEVIRAPINA Inhibidor de la transcriptasa inversa no análogo de los nucleósidos . . . . . #viramune #nevirapina #inhibidor #transcriptasa #inversa #analogo #nucleosidos #arv #retrovirrales #antiretrovirrales #salud #saludresponsable #saludmentalyemocional #saludables #saludybienestar #medicos #medicines #medicina #medicines #Vih #sida #sidachile https://www.instagram.com/p/CBcUyH2nGnf/?igshid=nb57ahupgx2c

[pharmablogger]

NEVIRAPINE | All You Need To Know | Ailment.info

Complete information on Nevirapine from dosage, side effects, interactions and pregnancy & breast feeding warnings for patient and professional use.

[hivforum]

I told my doctor that you said it's fine to take both tablets of NVP 200mg at the same time. She said there's no proof that it's safe, that you are speaking based only on your personal experience, and that I shouldn't take the risk. But I want to.

My comments were based on the pharmacokinetics of nevirapine and the results of the 2NN study, which I mentioned. But I’m not here to tell you to ignore your doctor’s advice. If you choose to do that, it’s your decision.

[hivforum]

My doc is against my taking 2 tablets of NVP (200mg) at the same time. She said she must follow what the manufacturer prescribes. My question is: are there any risks to my health if I decide to take both tablets at once? I've been on it for 2 yrs.

The pharmacokinetics of nevirapine support taking both tablets at the same time, although the company never bothered to get that dose approved since they were developing the long acting 400 mg formulation. (Is that an option?) 

An old trial compared 200 mg twice daily vs. 400 mg once daily (before the availability of the long-acting version). The once daily dose was just as effective but had more early toxicity. However, this was a study of initial therapy. Since most nevirapine toxicity occurs in the first few weeks, it’s not surprising that you might see differences during that time period. In people who are already tolerating nevirapine, you wouldn’t expect to see toxicity with a switch to 400 mg daily, and this switch was commonly made in the U.S. back when we used to use nevirapine. 

l understand your doctor’s concern since it’s not an approved dose, but many HIV experts are comfortable with this switch, including me.

[hivforum]

I've been doing well on nevirapine for almost 3 years. Now my doc wants me to switch to efavifenz. I asked her why and she said that with time nev. will be toxic to my liver and resistance is more likely to occur than with efav. Is she right?

No, not exactly. While it’s true that nevirapine has more liver toxicity than efavirenz, the toxicity occurs in the first months of therapy. If you’ve been on it for for almost 3 years, you’re out of danger. 

As for resistance, it’s also true that failure of nevirapine can lead to broader cross-resistance within the NNRTI class than failure of efavirenz, but resistance only happens if you fail.  You’ve been taking it for 3 years without failure, so resistance doesn’t sound like an issue.

I’m not telling you not to switch. Efavirenz is a better drug to start with than nevirapine, but you’re not starting therapy. You’ll probably also have to deal with some efavirenz side effects, at least in the beginning.

[hivforum]

Dear Doctor Joel, at with liver, kidney function and HB normal my doctor gave me with she said an "standard regimen" of combivir and viramune. But even after 3 months im still feeling nauseous, occasional vomiting, dizzy and fatigue. I want to change my regimen that have the least side effects. I am an 48kg person with East Asian genetic that hard to gain weight either by fat or muscle. Could.u recommend me a regimen so that i could consult it with my doctor next time? Thanks.

The combination of Combivir and Viramune is not a standard regimen in the U.S., but you didn’t say where you were writing from—a critical piece of information that almost everyone leaves out. Nausea and fatigue are common side effects of the AZT in Combivir. 

In the U.S., four of the five recommended regimens include integrase inhibitors and the fifth is a protease inhibitor-based regimen. Neither Combivir nor Viramune is recommended anymore. 

The WHO guidelines for resource-limited countries now recommend tenofovir + lamivudine + efavirenz as the preferred initial regimen. 

[hivforum]

Which medication is the more effective: efavirenz or nevirapine? Why must nevirapine be taken 2x a day and efavirenz only 1x? After started, how long does nevirapine take to become safe to the liver?

The effectiveness is probably similar, but nevirapine can have more severe early toxicity, including serious liver and skin toxicity. In a head-to-head comparison trial (2NN), nevirapine was “not non-inferior” to efavirenz, which is a confusing statistical way of saying that it failed to meet the criteria for non-inferiority (comparability), probably due to early nevirapine toxicity.

Nevirapine toxicity is an even more important issue today than it was in the past. Since nevirapine toxicity is a hypersensitivity reaction, it is more likely to occur if your immune system is relatively healthy. We’re now treating people at higher CD4 counts than we used to, and the higher your CD4 count is, the greater the risk of toxicity. Nevirapine toxicity tends to occur during the first 4-6 weeks of therapy. After that, it becomes a safe and well tolerated drug.

Nevirapine does not need to be taken twice a day. In the U.S. and elsewhere, a 400 mg extended-release formulation has been approved (see photo). If it’s not available to you, it’s probably OK to take both of the 200 mg tablets at the same time, especially once you’ve made it through the first few weeks. But no matter which form you take, you have to start with 200 mg once a day, increasing to 400 mg only after the first two weeks, assuming you’re not experiencing any toxicity.