Nevirapine (trade name Viramune) is one of a class of drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs). Reverse transcriptase is a part of HIV required to infect cells in the body and make more virus. NNRTIs stop the reverse transcriptase from working properly. The recommended dosage of nevirapine is 200 mg once a day for the first two weeks, and then 200 mg twice a day thereafter. Nevirapine is also available as a liquid suspension for children.
Nevirapine has been approved for use in combination with other anti-HIV drugs, including protease inhibitors. New Public Health Service HIV treatment guidelines recommend combinations of three or four anti-HIV drugs as first treatment for HIV:
1. Two nucleoside analogs (AZT+3TC, d4T+3TC, d4T+ddI, AZT+ddI, or AZT+ddC) with one of the following: Crixivan, Fortovase, Norvir, Sustiva, Viracept or Norvir and Fortovase combined.
2. If one of the above combinations cannot be used, an alternative is two nucleoside analogs (same combinations as listed above) with Viramune or Rescriptor.
The guidelines also say that nevirapine may be useful as part of a second-line combination if a standard combination stops working.

Women, and patients with higher CD4 counts, are at increased risk of these hepatic events. Women with CD4 counts >250 cells/mm3, including pregnant women receiving chronic treatment for HIV infection, are at considerably higher risk of these events. Patients with signs or symptoms of hepatitis must discontinue Viramune and seek medical evaluation immediately.

It is essential that patients be monitored intensively during the first 18 weeks of therapy with Viramune to detect potentially life-threatening hepatotoxicity or skin reactions. The greatest risk of severe rash or hepatic events (often associated with rash) occurs in the first 6 weeks of therapy. However, the risk of any hepatic event, with or without rash, continues past this period and monitoring should continue at frequent intervals. In some cases, hepatic injury has progressed despite discontinuation of treatment. Viramune
should not be restarted following severe hepatic, skin or hypersensitivity reactions. In addition, the 14-day lead-in period with Viramune 200 mg daily dosing must be strictly followed.

In some cases, patients have shown non-specific signs or symptoms of fatigue, malaise, anorexia, nausea, jaundice, liver tenderness or swelling, with or without initially abnormal serum transaminase levels. Some of these events have progressed to hepatic failure with transaminase elevation, with or without hyperbilirubinemia, prolonged partial thromboplastin time, or eosinophilia. Rash and fever accompanied some of these hepatic events. Patients with signs or symptoms of hepatitis must be advised to discontinue Viramune and immediately seek medical evaluation, which should include liver function tests.

In addition, serious hepatotoxicity (including liver failure requiring transplantation in one instance) has been reported in HIV-uninfected individuals receiving multiple doses of Viramune in the setting of post-exposure prophylaxis, an unapproved use.