Rifampin
Severe
Textbook
Nevirapine becomes ineffective.
If a patient treated with nevirapine develops TB and is put on rifampin, nevirapine should be replaced by efavirenz.
Source: KDT 7e · p809
Drug reference
Nevirapine
Antiretroviral · HIV Antiviral
Also known as NVP
AntiretroviralHIV Antiviral
CDSCO approved
EXCRETION
—
not curated
INTERACTIONS
12 major
SEVERE in our sources
PREGNANCY
—
not curated
Top interactionssee all 12 →
- RifampinSevereTextbookKDT 7e · p809
- AmiodaroneSevereDatabaseDDInter
- ArtemetherSevereDatabaseDDInter
- AtazanavirSevereDatabaseDDInter
Mechanism
Nevirapine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) that binds directly to a hydrophobic pocket adjacent to the active site of HIV-1 reverse transcriptase, causing a conformational change that disrupts the enzyme's catalytic function. Unlike nucleoside analogues, it does not require intracellular phosphorylation for activity and does not compete with nucleotide substrates. Nevirapine is a CYP3A4 inducer that accelerates its own metabolism, necessitating a dose escalation schedule, and has no activity against HIV-2.
Indications
HIV infection in combination with other antiretroviral drugsHIV-AIDSHIV-1 infection in adults and children in combination with other antiretroviral agentsHIV-1 infection in infants and children 15 days old or oldersingle-dose prevention of mother-to-child transmissionHIV infection (in combination regimens, included in first line triple drug regimen by NACO)
Dosing
- Adult
- Initially 200 mg once daily by mouth using immediate-release medicines for the first 14 days, initial dose titration should not exceed.
Pharmacokinetics
Half-life
25–30
Bioavailability
90–93%
Protein binding
60%
Metabolism
CYP3A4 > 2B6
Excretion
<3% (renal, unchanged)
Contraindications
- hepatic dysfunction
Side effects
Common
rashpruritusfeverfatigueheadachesomnolencenausearashes (commonest)
Serious
- Hypersensitivity reaction
- Severe rash
- Stevens-Johnson syndrome
- clinical hepatitis
- severe and fatal hepatitis
- severe skin reactions (occasionally)
- fever (dose dependently)
- rise in transaminases (dose dependently)
- hepatotoxicity (potentially)
Drug interactions
Amiodarone
Severe
Database
Decrease amiodarone levels.
Source: DDInter
Artemether
Severe
Database
Decreased artemether levels.
Source: DDInter
Atazanavir
Severe
Database
Drug interaction classified as: metabolism.
Source: DDInter
Avapritinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Benzhydrocodone
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Brigatinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Butorphanol
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Capmatinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Caspofungin
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Cobimetinib
Severe
Database
Drug interaction classified as: metabolism
Source: DDInter
Daclatasvir
Severe
Database
Clinical effect not specified
Source: DDInter
Related guidelines
Prevention of mother-to-child HIV transmission
NACO · Infectious Disease · 2023
Antiretroviral therapy for HIV
NACO · Infectious Diseases · 2018
Childhood pneumonia and respiratory infection
MOHFW · Paediatrics · 2021
Acute diarrhoea in children
IAP · Pediatrics · 2022
Hepatitis B — chronic infection
INASL · Gastroenterology · 2023
Other Antiretroviral drugs
Ask House about Nevirapine
Continue into a citation-backed clinical answer with the drug context already attached.
Sources: KD Tripathi 7e, Goodman & Gilman 14e, Katzung·Verified: 2026-05-10 · House clinical team