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Viramune rash
Mar 11, 2001

Doctor,I developed rash by day 11th on viramune but I would like to continue taking the drug because is so easy to take with combivir. Do you think that it will be possible for me to overcome the rashes and stay on the drug? thanks

Response from Dr. Cohen

It is possible that the initial rash you might get when starting Viramune will fade as you stay on it. This must be done, however, with some monitoring by whoever prescribed it to you - since the rash might fade, but it might worsen, and you might need help in judging how far to go before stopping. Sometimes, albeit rarely, a rash can be severe and that is what we are trying to avoid. Signs of a severe rash are when it starts to involve the inside of the mouth, or the whites of the eyes or eyelids. And, in addition to monitoring for a rash, it is critical to have liver function test monitoring - since this can also be an early problem when starting this drug.

There have been several studies trying to prevent the rash when starting this medication. So far, there is some info that suggests also starting it with an antihistamine drug might decrease the risk of a rash. It may be of some use if the rash has already happened as well. What is far more ambiguous is the role of steroids since one study suggested benefit while another suggested no benefit at all from them. Another approach, although more controversial, was a slower dose escalation of Viramume - starting at 100 mg. per day, instead of the standard 200 mg taken for the first two weeks - and then, after a week increasing from 100 mg up to 200mg, then a week later to 300 mg and then finally up to the 400 mg. But it is less clear if any of these approaches will help once a rash has started.

What is clear is that the rash, if it happens, usually happens just about the second week on meds - so you are right on time. What is also clear is that many can "treat through" and continue to see if the rash fades. What is very clear is that this must be done with the monitoring of someone who can help guide you through this. That needs to be someone who can see you - despite being the power of the net, I cannot see how your rash is doing at this end...

Hope that helps. CC

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