Physicians starting patients on nevirapine (Viramune®) need to be aware of new precautions published in February 2004 by Boehringer Ingelheim. A nevirapine combination is recommended as an "alternative" antiretroviral starting regimen in the current U.S. treatment guidelines,1
but may be the best starting regimen for some patients -- for example, because of its favorable effect in raising HDL ("good cholesterol"). The new warning is paradoxically good news, because it helps avoid problems with nevirapine, including identifying which patients should use it very cautiously or not at all. For example, women with a CD4+ count above 250 have a 12 times greater risk of liver toxicity than other patients. And patients need special monitoring when they start nevirapine treatment, because the risk of problems is greatest then.
For more information see the following at:
- The "Dear Health Care Professional" letter from Boehringer Ingelheim;
- The new "black box" warning in the Viramune prescribing information; and
- "Guidelines for the Management of Rash with Viramune," and "Guidelines for the Management of Hepatitic Events with Viramune."
ISSN # 1052-4207
Copyright 2004 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.