Viramune

If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose and resume your usual dosing schedule. Do not double the dose to catch up.

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start using nevirapine and each time you get a refill. If you have any questions regarding the information, consult your doctor or pharmacist. Take this medication by mouth with or without food, usually once daily for the first 14 days when you start treatment, then twice daily or as directed by your doctor. If liver problems or skin/allergic reactions occur while you are taking this medication once daily, seek immediate medical attention and do not increase the dose to twice daily. If you are using the liquid suspension form of this medication, shake the bottle gently before each dose. Carefully measure the dose using a special measuring device/spoon. Do not use a household spoon because you may not get the correct dose. If you are using a dosing cup, rinse the cup with water after taking the medication and drink all of the rinse water to make sure you take the full dose. The dosage is based on your medical condition and response to treatment. In children, the dosage is also based on height and weight. Do not take more than 400 milligrams daily of nevirapine. Do not stay on the once-daily dosing schedule for more than 28 days. If you approach that period of time, your doctor should consider switching you to another medication. Consult your doctor for more details. If you stop taking this medication for more than 7 days for reasons other than the serious reactions described in the Warning section, ask your doctor for directions on how to restart treatment. You may need to take this medication once daily again for the first 14 days to decrease the risk of serious side effects. If you are taking HIV medications for the first time, you may experience symptoms of an old infection as your immune system begins to work better. Tell your doctor immediately if you notice any trouble breathing, fever, new cough, vision problems, headaches, or skin problems. It is very important to continue taking this medication (and other HIV medications) exactly as prescribed by your doctor. Do not skip any doses. Do not increase your dose, take this drug more often than prescribed, or stop taking it (or other HIV medicines) even for a short time unless directed to do so by your doctor. Skipping or changing your dose without approval from your doctor may cause the amount of virus to increase, make the infection more difficult to treat (resistant), or worsen side effects. This medication works best when the amount of drug in your body is kept at a constant level. Therefore, take this drug at evenly spaced intervals. To help you remember, take it at the same times each day. Tell your doctor if your condition does not improve or if it worsens.

The effects of some drugs can change if you take other drugs or herbal products at the same time. This can increase your risk for serious side effects or may cause your medications not to work correctly. These drug interactions are possible, but do not always occur. Your doctor or pharmacist can often prevent or manage interactions by changing how you use your medications or by close monitoring. To help your doctor and pharmacist give you the best care, be sure to tell your doctor and pharmacist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products) before starting treatment with this product. While using this product, do not start, stop, or change the dosage of any other medicines you are using without your doctor's approval. Some products that may interact with this drug include: efavirenz, rifabutin, warfarin. Other medications can affect the removal of nevirapine from your body, which may affect how nevirapine works. Examples include azole antifungals (such as fluconazole), rifamycins (such as rifampin), St. John's wort, among others. Nevirapine can speed up the removal of many other medications from your body, which may affect how they work. Examples of affected drugs include antiarrhythmics (such as amiodarone), some drugs used to treat seizures (such as carbamazepine, clonazepam), ketoconazole, macrolide antibiotics (such as clarithromycin), methadone, among others. Some other drugs to treat HIV infection (including protease inhibitors such as atazanavir, lopinavir/ritonavir) may also interact with nevirapine. Your doctor will adjust your medications and monitor your treatment to reduce the risk of side effects. Do not use prednisone to prevent a rash because it can actually increase the risk of a rash during the first 6 weeks of nevirapine treatment. Ask your doctor for more details. This medication may decrease the effectiveness of hormonal birth control products (such as pills, patch, ring). This effect can result in pregnancy. Ask your doctor or pharmacist for details. Discuss whether you should use additional reliable birth control methods while taking this medication. This document does not contain all possible drug interactions. Keep a list of all the products you use. Share this list with your doctor and pharmacist to lessen your risk for serious medication problems.

Your condition can cause complications in a medical emergency. For enrollment information call MedicAlert at 1-800-854-1166 (US) or 1-800-668-1507 (Canada).

Do not share this medication with others. Laboratory and/or medical tests (such as liver tests, viral load, T-cell counts) should be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details. Keep all medical and laboratory appointments.

If overdose is suspected, contact a poison control center or emergency room immediately. US residents can call the US National Poison Hotline at 1-800-222-1222. Canada residents can call a provincial poison control center.

Before taking nevirapine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details. Before using this medication, tell your doctor or pharmacist your medical history, especially of: liver problems (such as hepatitis B or C, cirrhosis), kidney dialysis, lactose or galactose intolerance. Rarely, this drug may make some people drowsy. Do not drive, use machinery, or do any activity that requires alertness until you are sure you can perform such activities safely. Limit alcoholic beverages. To decrease your risk of spreading HIV disease to others, always use an effective barrier method (latex or polyurethane condoms/dental dams) during all sexual activity. Consult your doctor or pharmacist for more details. During pregnancy, this medication should be used only when clearly needed. However, HIV medicines are now usually given to pregnant women with HIV. Treatment has been shown to decrease the risk of HIV transmission to the baby. Nevirapine may be part of that treatment. Discuss the risks and benefits with your doctor. Nevirapine passes into breast milk. Because breast milk can transmit HIV, do not breast-feed.

Store at room temperature between 59-86 degrees F (15-30 degrees C) away from light and moisture. Do not store in the bathroom. Keep all medicines away from children and pets. Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company for more details about how to safely discard your product.

See also Warning and How to Use sections. Tiredness, nausea, vomiting, or diarrhea may occur. Drowsiness may rarely occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly. Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects. Nevirapine can commonly cause a rash that is usually not serious. However, you may not be able to tell it apart from a rare rash that could be a sign of a severe reaction. Therefore, seek immediate medical attention if you develop any rash. Changes in body fat may occur while you are taking this medication (such as increased fat in the upper back and stomach areas, decreased fat in the arms and legs). The cause and long-term effects of these changes are unknown. Discuss the risks and benefits of treatment with your doctor, as well as the possible use of exercise to reduce this side effect. A very serious allergic reaction to this drug is unlikely, but seek immediate medical attention if it occurs. See the Warning section for more details. This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist. In the US - Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

Rarely, nevirapine has caused severe (sometimes fatal) liver problems. Seek immediate medical attention if you develop symptoms of liver problems such as persistent nausea, loss of appetite, vomiting, stomach/abdominal pain, dark urine, pale stools, yellowing eyes/skin, unusual tiredness, rash. Rarely, nevirapine has also caused serious (sometimes fatal) skin/allergic reactions. Seek immediate medical attention if you have any signs of skin/allergic reactions, including: rash, itching/swelling/redness (especially of the eyes/face), blisters, fever, persistent sore throat, unusual tiredness, mouth sores, severe dizziness, trouble breathing, unusual change in the amount of urine, muscle pain/tenderness/weakness, joint pain. Women are at increased risk for developing these severe reactions. To help decrease the risk of skin/allergic reactions in all patients, nevirapine is started at a lower dose for the first 14 days. Also, people with higher T-cell counts at the start of nevirapine treatment are at greater risk for liver problems. Therefore, nevirapine is usually only started if the T-cell count is fewer than 250 in women or fewer than 400 in men. Keep all medical and laboratory appointments so your doctor can monitor how you are responding to nevirapine. The risk of these serious side effects is high in the first 18 weeks and highest during the first 6 weeks of nevirapine treatment. However, these side effects may occur at any time while taking this medication. If you have stopped taking nevirapine because of liver problems or skin/allergic reactions, you must never take any form of nevirapine again. Tell all of your doctors and pharmacists if you have ever stopped taking nevirapine because of these types of reactions.