Viramune (Nevirapine) Oral: Uses, Side Effects, Dosages - Verywell Health
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What Is Viramune?
Viramune (nevirapine) is a prescription medication used in combination with other drugs to treat human immunodeficiency virus (HIV) infection. It belongs to a class of medications known as non-nucleoside reverse-transcriptase inhibitors (NNRTI).
Viramune works by blocking the activity of reverse transcriptase—an enzyme produced by HIV-1 that allows it to infect cells in the body and make more viruses.
Nevirapine is available as a tablet, extended-release tablet, or suspension (liquid).
Drug Facts
Generic Name: Nevirapine
Brand Name(s): Viramune
Administration Route(s): Oral
Drug Availability: Prescription
Therapeutic Classification: Antiretroviral agent
Available Generically: No
Controlled Substance: N/A
Active Ingredient: Nevirapine
Dosage Form(s): Tablet, extended-release tablet, suspension
What Is Viramune Used For?
The Food and Drug Administration (FDA) approved Viramune for the combination antiretroviral treatment of HIV-1 (the virus that causes acquired immune deficiency syndrome, or AIDS) infection.
Viramune does not cure HIV or AIDS.
How to Take Viramune
Take your HIV medications as prescribed by your healthcare provider.
Viramune is available as an oral tablet, oral suspension, and in the XR extended-release tablet. All of these are meant to be taken by mouth. However, you should not crush, chew, or break the extended-release tablets. You can take this medication with or without food.
Tablets
When starting Viramune, your provider will usually tell you to take one dose each day. This is to lower your chance of developing a serious rash, which can be a side effect. If you do not develop a rash, you can increase your dose to one tablet two times a day starting on day 15 of treatment.
XR Extended-Release Tablets
Similar to the regular tablets, you will start with one dose each day for the extended-release tablets for the first 14 days. As long as you don't have a rash, you will continue taking one XR extended-release tablet each day on day 15.
Oral Suspension
When taking the suspension, shake gently before each use. Use an oral dosing syringe and dosing cup to measure your dose. Ask your pharmacist for a syringe or cup if you do not have one. Use the dosing syringe instead of the cup for doses of less than 1 teaspoon (5 milliliters).
Even if you are taking Viramune, you can still get opportunistic infections, which are infections that occur more frequently in people with weakened immune systems. You should also continue to use safer sex practices, such as by using a condom or other barrier method, to lower the chance of passing HIV to others.
Storage
People should store Viramune at a controlled room temperature, which is about 68 degrees to 77 degrees Fahrenheit. Store away from moisture. Do not keep your medication in the bathroom.
Always carry your medication with you. If you are flying, make sure to keep the original prescription-labeled bottle or box in your carry-on bag. Don't leave this medication in your car, especially if the weather is going to be very cold or hot.
What Are the Side Effects of Viramune?
This is not a complete list of side effects and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 800-FDA-1088.
Common Side Effects
The most common side effects with Viramune include:
- Rash
- Nausea
- Headache
- Sleepiness
- Changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts, and waist)
If any of these side effects don't go away or become more severe, talk to your healthcare provider.
Severe Side Effects
Call your healthcare provider right away if you have serious side effects. Call 911 if your symptoms feel life-threatening or if you think you're having a medical emergency. Serious side effects and their symptoms can include the following:
- Severe allergic reactions: Symptoms may include trouble breathing, hives, and swelling of the tongue, lips, mouth, or throat
- Stevens-Johnson syndrome (rare disorder affecting the skin and mucous membranes)
- Liver failure
- Severe and/or life-threatening skin reactions
Report Side Effects
Viramune may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program or by phone (800-332-1088).
Dosage: How Much of Viramune Should I Take?
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For treatment of HIV infection:
- For oral dosage form (extended-release tablets):
- Adults—At first, one 200 milligram (mg) Viramune® immediate-release tablet once a day for the first 14 days. This is followed by one 400 mg Viramune XR® tablet once a day, together with other HIV medicines.
- Children 6 to 17 years of age with a body surface area of 1.17 square meter (m2) or greater—Dose is based on body size and must be determined by your doctor. The starting dose is usually 150 milligrams (mg) per square meter (m2) of Viramune® oral suspension or tablets for the first 14 days. This is followed by 400 mg of Viramune XR® once a day, together with other HIV medicines.
- Children younger than 6 years of age with a body surface area of less than 1.17 m2—Use is not recommended.
- For oral dosage forms (suspension or tablets):
- Adults—200 milligrams (mg) once a day for 2 weeks, followed by 200 mg 2 times per day, together with other medicines.
- Children and infants 15 days of age and older—Dose is based on body size and must be determined by your doctor.
- Infants younger than 15 days of age—Use and dose must be determined by your doctor.
- For oral dosage form (extended-release tablets):
Modifications
Talk to your healthcare provider if you are pregnant or plan to become pregnant. Together, you can weigh the potential benefits and risks of taking Viramune during your pregnancy. Viramune can potentially increase the risk of life-threatening liver toxicity in pregnant people, especially in those with high CD4 counts. CD4 counts represent the level of CD4 helper T-cels in your blood. These cells are vital to immune function.
If you are taking Viramune while pregnant, your provider may encourage you to join the Antiretroviral Pregnancy Registry, which monitors the health outcomes of pregnant people and the fetus. You can register by calling 800-258-4263.2
Additionally, a person 65 years or older often processes drugs more slowly. A lower dose or different schedule may be required.
Missed Dose
If a dose of Viramune is missed, take the dose as soon as you remember. If it is too close to the next dose, just skip that dose and take the next dose at the regularly scheduled time. Do not take extra to make up for the missed dose. Doing so can increase your risk for side effects.
Overdose: What Happens If I Take Too Much Viramune?
Viramune overdoses at doses ranging from 800–1,800 milligrams a day have been reported.
Symptoms of an overdose can include:
- Edema (swelling)
- A skin condition called erythema nodosum
- Fatigue
- Fever
- Headache
- Insomnia (inability to sleep)
- Nausea
- Pulmonary infiltrates
- Rash
- Vertigo (a dizzy sensation)
- Vomiting
- Weight loss
Overdose symptoms will generally resolve after stopping the medication.
What Happens If I Overdose on Viramune?
If you think you or someone else may have overdosed on Viramune, call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn't breathing after using Viramune, call 911 immediately.
Precautions
It is very important that your doctor check your or your child's progress to make sure that this medicine is working properly. Blood tests may be needed to check for unwanted effects.
Liver problems may occur while you are using this medicine. Check with your doctor right away if you or your child are having more than one of these symptoms: abdominal pain or tenderness, clay-colored stools, dark urine, fever, headache, itching, loss of appetite, nausea and vomiting, skin rash, swelling of the feet or lower legs, unusual tiredness or weakness, or yellow eyes or skin.
Tell your doctor if you or your child gets any type of skin rash, even a mild rash. Call your doctor right away if you or your child have a rash with blisters, fever, mouth sores, red or irritated eyes, swelling of the face, muscle or joint pain, or muscle weakness.
Your immune system may get stronger, when you start taking HIV medicines. Tell your doctor right away if you or your child notice any changes in your health. Sometimes the immune system will start to fight infections that were hidden in your body, such as pneumonia, herpes, or tuberculosis. Autoimmune disorders (eg, Graves' disease, polymyositis, and Guillain-Barré syndrome) may also occur.
This medicine may cause you to have excess body fat. Tell your doctor if you or your child notice changes in your body shape, including an increased amount of body fat in your neck or upper back, face, around your chest, or stomach area. You might also lose fat from your legs, arms, or face.
This medicine may decrease the effects of some birth control pills. To avoid getting pregnant, use an additional form of birth control along with your pills. Other forms of birth control include a condom, diaphragm, or contraceptive foam or jelly.
This medicine does not decrease the risk of transmitting the HIV infection to others through sexual contact or by contaminated blood. Make sure you understand and practice safe sex, even if your partner also has HIV. Avoid sharing needles with anyone. .
Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal (eg, St. John's wort) or vitamin supplements.
What Are Reasons I Shouldn't Take Viramune?
There are a few reasons why your healthcare provider may not choose Viramune as part of your treatment plan.
Allergy
A person should not take Viramune if they are allergic to the ingredients.
Pregnancy
It is best to talk to your provider if you are pregnant or plan to become pregnant, so they can decide the best option for you.
Breastfeeding
The Centers for Disease Control and Prevention (CDC) recommends that people with HIV-1 do not breastfeed their infants to avoid transmission. Viramune also passes through breastmilk and could cause serious side effects. Talk with your provider if you are breastfeeding to discuss the best plan for you.
Older Adults
A person 65 years or above often processes drugs more slowly. A lower dose or different schedule may be required.
Other Health Conditions
In certain individuals, the body may handle Viramune differently. Inform your provider if you have liver impairment. People with serious liver disease should not take Viramune. Higher CD4+ cell counts can increase the risk of liver problems associated with this medication. If your CD4+ counts are high, you and your healthcare provider will decide whether starting Viramune is the right choice.
What Other Medications Interact With Viramune?
There are a few medications that can interact with Viramune.
Medications Requiring a Dosing Change When Taken With Viramune
When taken with these medications, the effects of Viramune or the other medications may increase or decrease. This can lead to an increased risk of side effects or either medication not working as it is intended. Changes in dose may be required. A few examples of these medications include:
- Reyataz (atazanavir)
- Biaxin (clarithromycin)
- Sustiva (efavirenz)
- Ethinyl estradiol and norethindrone
- Diflucan (fluconazole)
- Lexiva (fosamprenavir)
- Crixivan (indinavir)
- Nizoral (ketoconazole)
- Kaletra (lopinavir and ritonavir)
- Dolophine, Methadose (methadone)
- Viracept (nelfinavir)
- Mycobutin (rifabutin)
- Rifadin, Rimactane (rifampin)
- Invarase (saquinavir) and Norvir (ritonavir)
Potential Medication Interactions
There are a few medications that have a possible decrease in plasma concentrations when taken with Viramune:
- Anti-arrhythmics (e.g., amiodarone)
- Anticonvulsants (e.g., clonazepam, carbamazepine)
- Antifungals (e.g., itraconazole)
- Calcium channel blockers (e.g., diltiazem, verapamil)
- Cancer chemotherapy (e.g., cyclosporine)
- Ergotamine (brands include Belcomp-PB and Micomp-PB)
- Immunosuppressants (e.g., cyclosporin)
- Cisapride (brands include Prepulsid and Propulsid)
- Fentanyl
- Warfarin (brands include Coumadin and Jantoven)
This list does not include all drugs that can interact with Viramune. Before using Viramune, be sure to tell your healthcare provider about all of the prescription medications, over-the-counter (OTC) medications, vitamins, supplements, or herbs you are taking. This will help you avoid potential interactions. If you have any questions about drug interactions, speak with your provider.
What Medications Are Similar?
Viramune is often used to treat HIV-1 infection. There are a few other medications also used to treat this condition, including:
- Truvada (emtricitabine and tenofovir)
- Atripla (efavirenz, emtricitabine, and tenofovir disoproxil fumarate)
Truvada
Truvada contains two medications: emtricitabine and tenofovir. It is also prescribed to treat HIV-1 infection. Truvada is available as an oral tablet. The most common side effects include fatigue, depression, nausea, or diarrhea.
Atripla
Atripla is a combination of medications efavirenz, emtricitabine, and tenofovir disoproxil fumarate. It is also an oral medication prescribed to treat HIV-1 infection. Common side effects include fatigue, depression, nausea, or diarrhea.
This list contains examples of medications used to treat HIV-1 infection. It is not a list of drugs recommended to take with Viramune. Ask your healthcare provider if you have any questions.
How Can I Stay Healthy While Taking Viramune?
Viramune is a safe and effective medication when used correctly. This drug is often used to treat HIV-1 infection.
While Viramune does have the potential for serious side effects such as allergic reactions or severe skin reactions, the most common side effects may be milder. Those tend to include nausea, rash, or headache.
It is important to inform your healthcare provider of all of your other health conditions as well as any prescription medications, OTC medications, vitamins, supplements, or herbs you are taking.
Advances in treatment options have allowed people with HIV to live near-normal life expectancies, but living with this condition still has its challenges. The social, emotional, and financial stresses of managing a chronic condition can feel like a burden. However, there are plenty of services and resources available to help you along the way.
Medical Disclaimer
Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.
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