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# Nevirapine

An old, cheap NNRTI. It can cause hepatitis and severe skin reactions in the first weeks, more often in people with high CD4 counts.

Updated 2026-11-01

- Class: [Non-nucleoside reverse transcriptase inhibitors (NNRTIs)](https://durgical.com/en/pharmacology/classes/non-nucleoside-reverse-transcriptase-inhibitors/)
- Enzyme: HIV-1 reverse transcriptase (NNRTI pocket)
- ATC code: J05AG01
- WHO Model List of Essential Medicines

Also called: NVP

✂**HIV-1 reverse transcriptase (NNRTI pocket)**Nevirapine

ⓘ The figure shows nevirapine in the allosteric pocket of HIV-1 reverse transcriptase.

**Target in 3D:** HIV-1 reverse transcriptase (NNRTI pocket). PDB structure 1VRT (RCSB PDB, public domain). [View the structure at RCSB PDB](https://www.rcsb.org/structure/1VRT) · Drag to rotate · pinch to zoom

## Mechanism of action

Like other NNRTIs, it sits in the allosteric pocket of HIV-1 reverse transcriptase and locks the enzyme. Resistance appears quickly if used alone or added to a failing regimen.

- It binds the allosteric pocket of reverse transcriptase
- It blocks the enzyme's movement
- Viral DNA synthesis stops

## Pharmacokinetics

**Metabolism**
Liver, by CYP3A and CYP2B6; it induces these same enzymes and speeds its own metabolism

## Indications

- HIV-1 infection, combined with other antiretrovirals [HIV infection and AIDS →](https://durgical.com/en/conditions/hiv-infection-and-aids/)

## Adverse effects

### Common

- Rash
- Nausea
- Headache
- Raised transaminases

### Serious (rare, important)

- Severe or fatal hepatotoxicity, especially in the first 6 weeks
- Stevens-Johnson, toxic epidermal necrolysis and hypersensitivity reactions

## Contraindications

- Moderate or severe hepatic impairment
- Post-exposure prophylaxis (occupational or non-occupational)

## Key interactions

**St John's wort**
Greatly lowers nevirapine; not recommended

**Methadone**
Nevirapine lowers methadone (risk of withdrawal)

**CYP3A and CYP2B6 substrates**
Can lower their levels by induction

## What is monitored

- Close liver tests during the first 18 weeks
- Skin: any rash, especially with fever or systemic symptoms
- CD4 before starting

## Administration and safety

- By mouth
- It starts with a two-week lead-in at lower exposure, which reduces rash; if stopped for more than a week, the lead-in is repeated
- The dose is not stepped up while a rash is present

## Nursing care

- Teach to seek care at once for rash, fever, blisters, jaundice or abdominal pain
- Check transaminases before and during the first weeks
- Record the start date to track the lead-in period

## Pregnancy and breastfeeding

Hepatotoxicity risk is higher in women with CD4 above 250 cells/mm³, so it is not started in them unless the benefit justifies it.

## Memory aid

'NEVirapine: NEVer rush': two-week lead-in, liver and skin watched.

## Test yourself

Think of the answer, then tap the question to see it.

## Which two serious toxicities mark nevirapine use?

Hepatotoxicity and severe skin reactions (Stevens-Johnson), especially in the first weeks.

## Who has a higher hepatotoxicity risk when starting nevirapine?

Women with CD4 above 250 cells/mm³ and men with CD4 above 400 cells/mm³.

## What is the two-week lead-in for?

It reduces how often rash occurs; if rash appears, the dose is not stepped up until it resolves.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/pharmacology/nevirapine/)

## Related drugs

- [Efavirenz](https://durgical.com/en/pharmacology/efavirenz/)
- [Zidovudine](https://durgical.com/en/pharmacology/zidovudine/)

## Related conditions

- [HIV infection and AIDS](https://durgical.com/en/conditions/hiv-infection-and-aids/)

[← Back to the class: Non-nucleoside reverse transcriptase inhibitors (NNRTIs)](https://durgical.com/en/pharmacology/classes/non-nucleoside-reverse-transcriptase-inhibitors/)

Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - NEVIRAPINE tablet](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=5f6c3eed-2a5d-46ed-9a7c-59715f338a15) (DailyMed (U.S. National Library of Medicine), 2026); [Nevirapine: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a600035.html) (MedlinePlus (U.S. National Library of Medicine), 2025); [ATCDDD - ATC/DDD Index](https://atcddd.fhi.no/atc_ddd_index/?code=J05AG01) (WHO Collaborating Centre for Drug Statistics Methodology, 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/) (World Health Organization, 2025).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/pharmacology/nevirapine/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/pharmacology/nevirapine/