Drug interactions

People taking nevirapine (Viramune) should not take the following drugs:

  • Hypericin (St John’s wort), which can reduce blood levels of nevirapine, possibly causing resistance.
  • Ketoconazole (Nizoral), due to lowered ketoconazole levels.

Taking nevirapine with a protease inhibitor reduces the concentration of the protease inhibitor in the blood. The non-nucleoside reverse transcriptase inhibitor etravirine is more suitable for combining with a protease inhibitor.

Combining efavirenz with nevirapine and etravirine, the other NNRTIs, is not recommended due to an increased frequency of side-effects.1

People taking nevirapine should also take non-standard doses of the following drugs, or take them with caution:

  • Amoxicillin (Amoxil) levels are increased by nevirapine, increasing the risk of side-effects.
  • Doxycycline (Vibramycin / Vibramycin-D) levels are reduced by nevirapine.
  • Erythromycin (Erymax / Erythrocin / Erythroped / Erythroped A) levels are increased by nevirapine, increasing the risk of side-effects.
  • Felodipine (Plendil) levels are reduced by nevirapine.
  • Fluconazole (Diflucan) can cause the concentration of nevirapine to double, increasing the risk of side-effects. It should be used with caution.2
  • Griseofulvin (Grisovin) levels are reduced by nevirapine.
  • Methadone hydrochloride (Methadose) levels are reduced by nevirapine, people taking both drugs should be closely monitored for withdrawal symptoms, and the methadone dose adjusted if necessary.3 4
  • Metronidazole (Flagyl / Flagyl S / Metroyl) levels are reduced by nevirapine.
  • Nifedipine (Adalat) levels are reduced by nevirapine.
  • Quinidine sulphate (Kinidin Dureles) levels are reduced by nevirapine.
  • Sildenafil (Viagra) levels are increased by nevirapine, and it should be taken at a reduced dose of 25mg.
  • Tadalafil (Cialis) levels are increased by nevirapine, and it should be taken at a reduced dose.
  • Theophylline levels are reduced by nevirapine.
  • Vardenafil (Levitra) should be taken at a lower dose in people taking nevirapine.
  • Warfarin levels are reduced by nevirapine.

Nevirapine may also reduce levels of beta-blockers and steroids. It also reduces the effectiveness of oral contraceptives and alternative forms of birth control are recommended.5

References

  1. van Leth F et al. Comparison of first-line antiretroviral therapy with regimens including nevirapine, efavirenz, or both drugs, plus stavudine and lamivudine: a randomised open-label trial, the 2NN Study. The Lancet 363: 1253-1263, 2004
  2. Geel J et al. Effect of fluconazole on nevirapine pharmacokinetics. 15th International AIDS Conference, Bangkok, abstract TuPeB4606, 2004
  3. Stocker H et al. Nevirapine significantly reduces the levels of racemic methadone and (R)-methadone in human immunodeficiency virus-infected patients. Antimicrob Agents Chemother 38: 4148-4153, 2004
  4. Altice FL et al. Nevirapine induced opiate withdrawal: among injection drug users with HIV infection receiving methadone. AIDS 13: 957-962, 1999
  5. Mildvan D et al. Pharmacokinetic interaction between nevirapine and ethinyl estradiol / norethindrone when administered concurrently to HIV-infected women. J Acquir Immune Defic Syndr 29: 471-477, 2002
Community Consensus Statement on Access to HIV Treatment and its Use for Prevention

Together, we can make it happen

We can end HIV soon if people have equal access to HIV drugs as treatment and as PrEP, and have free choice over whether to take them.

Launched today, the Community Consensus Statement is a basic set of principles aimed at making sure that happens.

The Community Consensus Statement is a joint initiative of AVAC, EATG, MSMGF, GNP+, HIV i-Base, the International HIV/AIDS Alliance, ITPC and NAM/aidsmap
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This content was checked for accuracy at the time it was written. It may have been superseded by more recent developments. NAM recommends checking whether this is the most current information when making decisions that may affect your health.

NAM’s information is intended to support, rather than replace, consultation with a healthcare professional. Talk to your doctor or another member of your healthcare team for advice tailored to your situation.