nevirapine (non-CYTOTOXIC hazardous) (Special Access Medication) *

Disclaimer to the Online Edition

This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

nevirapine (non-CYTOTOXIC hazardous) (Special Access Medication) *

Refer to the Procedure for Safe Handling of Hazardous Drugs (CYTOTOXIC and non-CYTOTOXIC) and Safe Handling of Hazardous Drugs

Indication

  • In combination with other antiretrovirals, to reduce the risk of vertical transmission from mother to baby when mother is HIV positive

Dosage Guidelines

Birth weight (wt) = ____ kg Birth height/length (ht) = ____ cm

  • Estimate body surface area (BSA) (m2) = (0.05 x kg) + 0.05

  • Postmenstrual Age greater than or equal to 34 weeks:

    First 2 weeks of age: 150 mg/m2/dose ORAL daily

    2 to 4 weeks of age: increase to 150 mg/m2/dose ORAL q12 hours

    Greater than 4 weeks of age: increase to 200 mg/m2/dose ORAL q12 hours

  • Postmenstrual Age 25 weeks to less than 34 weeks: (based on unpublished data)1,2 

    First 2 weeks of age: 75-100 mg/m2/dose ORAL daily

    2 to 4 weeks of age: increase to 100 mg/m2/dose ORAL q12 hours

Administration

  • ORAL
  • May administer with feeds

Adverse Effects

  • Rash – Usually within first 6 weeks of therapy; if non-severe rash occurs in the first 14 days of therapy, do not increase dose until rash has resolved
  • Nausea, diarrhea, vomiting
  • Granulocytopenia, thrombocytopenia
  • Increase liver enzymes, cholestatic hepatitis, jaundice

Comments

  • Nevirapine is a hepatic enzyme inducer and has the potential to interact with erythromycin, rifampin, phenytoin, PHENobarbital and caffeine
  • Not recommended for use in patients with severe hepatic impairment or increased AST/ALT
  • Monitor liver enzymes, CBC, urea and creatinine

Supplied As

  • 10 mg/mL oral suspension
  • * Pharmacy maintains a future use supply of nevirapine -approval through the Special Access Program is not required prior to initiation

References

LexiComp Sick Kids, Lau E, Brophy J, Samson L, Kakkar F, et al. Nevirapine Pharmacokinetics and Safety in Neonates Receiving Combination: Antiretroviral Therapy for Prevention of Vertical HIV Transmission. Journal of Acquired Immune Deficiency Syndromes April 15, 2017; 74 (5) 493–4981, Expert Opinion, Unpublished Monte Carlo simulations, 2014, Hospital for Sick Children, Toronto2