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|Viramune Viramune

Viramune

Generic name: Nevirapine
Brand names: Viramune

Why is Viramune prescribed?

Viramune is prescribed for advanced cases of HIV. HIV--the human immunodeficiency virus that causes AIDS--undermines the immune system over a period of years, eventually leaving the body defenseless against infection. Viramune is generally prescribed only after the immune system has declined and infections have begun to appear. It is always taken with at least one other HIV medication such as Retrovir or Videx. If taken alone, it can cause the virus to become resistant. Even if used properly, it may be effective for only a limited time.

Like other drugs for HIV, Viramune works by impairing the virus"s ability to multiply.

Most important fact about Viramune

The most important side effect of Viramune is a rash which occasionally becomes so serious as to be life-threatening. The rash strikes approximately one in four patients, and becomes severe in about 2 percent. It usually appears during the first 6 weeks of therapy and strikes women more often than men. If you notice any signs of a rash, inform your doctor immediately. If it becomes severe or is accompanied by fever, blisters, mouth sores, red eyes, swelling, muscle or joint aches, or general fatigue, stop taking the drug and call your doctor.

How should you take Viramune?

Be sure to take Viramune every day, exactly as prescribed. Increase the dosage only when directed. To avoid development of resistance, be careful to take your other HIV drugs as well.

If you are using the oral suspension, shake it gently before each dose. Give it to the child with an oral dosing syringe or dosing cup. After each dose, rinse the cup with water and give the rinse to the child as well.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for the next dose, skip the one you missed and go back to your regular schedule. Do not double the dose.

--Storage instructions...

Store tablets and oral suspension at room temperature in a tightly closed bottle.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, inform your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue using Viramune.

• More common side effects may include:
  Abdominal pain, allergic reactions (including hives, blisters, mouth sores, or swollen mouth and throat), anemia, diarrhea, drowsiness, drug withdrawal, fat redistribution, fatigue, fever, headache, joint pain, liver damage, muscle aches, nausea, rash, tingling, vomiting

Why should Viramune not be prescribed?

If Viramune gives you an allergic reaction, you cannot use Viramune.

You should also avoid Viramune if you have severe liver impairment.

Special warnings about Viramune

Viramune has been known to cause serious--even fatal--liver damage, especially during the first 18 weeks of therapy. People with hepatitis B or C and women with a CD4+ cell count above 250 are more likely to develop this problem. Overall, women are at greater risk than men. If you already have moderate liver impairment, use Viramune with caution, if at all. Warning signs of liver damage include fatigue, a vaguely ill feeling, poor appetite, nausea, yellowish skin or eyes, pale stools, dark urine, and tenderness in the midriff. Check with your doctor immediately if you develop these symptoms. If liver damage has occurred, you"ll have to permanently discontinue Viramune therapy.

You should know that HIV medications also cause a redistribution of fat in some people, increasing the amount of fat found around the middle and on the upper back, and reducing the amount of fat in the arms, legs, and face.

Remember that Viramune does not completely eliminate HIV from the body. The virus can still be passed to others during sex or through blood contamination.

Though Viramune can slow the progress of HIV, it is not a cure. HIV-related infections remain a danger, so frequent check-ups and tests are still advisable.

Possible food and drug interactions when taking Viramune

If Viramune is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Viramune with the following:

Clarithromycin (Biaxin)
Efavirenz (Sustiva)
Fluconazole (Diflucan)
Indinavir (Crixivan)
Ketoconazole (Nizoral)
Lopinavir/Ritonavir (Kaletra)
Methadone (Dolophine)
Nelfinavir (Viracept)
Rifabutin (Mycobutin)
Rifampin (Rifadin, Rimactane)
St. John"s wort
Saquinavir (Fortovase)
Zidovudine (Retrovir)

Viramune may interfere with birth control pills and other hormonal contraceptives. Do not use this form of contraception during Viramune therapy.

Also, it"s important to talk to your doctor before combining Viramune with any of the following:

Antiarrhythmic heart medications such as disopyramide (Norpace)
Anticonvulsant (seizure) medications such as carbamazepine (Tegretol), clonazepam (Klonopin)
Antifungal medications such as itraconazole (Sporanox)
Blood-thinning medications such as warfarin (Coumadin)
Calcium channel blocker (angina) medications such as diltiazem (Cardizem), nifedipine (Procardia), verapamil (Calan)
Cancer chemotherapy medications such as cyclophosphamide (Cytoxan)
Immunosuppressant medications such as cyclosporine (Sandimmune, Neoral)
Migraine medications such as ergotamine (Cafergot)
Opiate agonists (narcotic) pain medications such as fentanyl (Duragesic)

Special information if you are pregnant or breastfeeding

If you are pregnant you may be at a higher risk of developing serious--even fatal--liver damage while taking Viramune. If you are pregnant or plan to become pregnant, notify your doctor immediately.

Avoid breastfeeding. HIV can be passed to a nursing infant through breast milk.

Recommended dosage

ADULTS

For the first 14 days, the dose is 1 tablet a day. If no serious rash appears, the dose is then increased to 1 tablet twice a day. If you miss your doses for more than 7 days, the doctor will have to restart you at the lower initial dose.

CHILDREN

2 months to 8 years of age

For the first 14 days, the dose of oral suspension is 4 milligrams per 2.2 pounds of body weight once a day. If no serious rash appears, the dose is then increased to 7 milligrams per 2.2 pounds twice a day.

8 years and older

For the first 14 days, the dose of oral suspension is 4 milligrams per 2.2 pounds of body weight once a day. If no serious rash appears, the dose is then increased to 4 milligrams per 2.2 pounds twice a day.

For both adults and children, total daily dosage should never exceed 400 milligrams (2 tablets).

In certain cases your Viramune dosage may need to be adjusted. Be sure to tell the doctor if you develop a rash within the first 14 days of using Viramune or if you stop taking the drug for more than 7 days. Also tell the doctor if you"re undergoing kidney dialysis.

If you develop hepatitis during Viramune treatment, you will have to stop taking the drug.

Overdosage

Any medication taken in excess can have serious consequences. If you suspect an overdose, seek medical attention immediately.

• Symptoms of Viramune overdose may include:
  Dizziness, fatigue, fever, headache, insomnia, nausea, rash, reddened bumps on the skin, respiratory problems, swelling, vomiting, weight loss