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Uses
Nevirapine oral suspension, USP is indicated for combination antiretroviral treatment of HIV-1 infection in adults and in pediatric patients 15 days and older [see Clinical Studies (14.1, 14.2)].
Additional important information regarding the use of nevirapine oral suspension, USP for the treatment of HIV-1 infection:
- Based on serious and life-threatening hepatotoxicity observed in controlled and uncontrolled trials, nevirapine oral suspension, USP should not be initiated in adult females with CD4+ cell counts greater than 250 cells/mm3 or in adult males with CD4+ cell counts greater than 400 cells/mm3 unless the benefit outweighs the risk [see Boxed Warning and Warnings and Precautions (5.1)].
- The 14-day lead-in period with nevirapine oral suspension USP,200 mg daily dosing must be strictly followed; it has been demonstrated to reduce the frequency of rash [see Dosage and Administration (2.4)and Warnings and Precautions (5.2)].
- If rash persists beyond the 14-day lead-in period, do not dose escalate to 200 mg twice daily. The 200 mg once-daily dosing regimen should not be continued beyond 28 days, at which point an alternative regimen should be sought.
History
There is currently no drug history available for this drug.
Other Information
Nevirapine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) with activity against Human Immunodeficiency Virus Type 1 (HIV-1). Nevirapine is structurally a member of the dipyridodiazepinone chemical class of compounds.
The chemical name of nevirapine is 11-cyclopropyl-5,11-dihydro-4-methyl-6H-dipyrido [3,2-b:2',3'-e][1,4] diazepin-6-one. Nevirapine USP is a white to off-white crystalline powder with the molecular weight of 266.30 and the molecular formula C15H14N4O. Nevirapine has the following structural formula:
Nevirapine oral suspension, USP is for oral administration. Each 5 mL of nevirapine oral suspension contains 50 mg of nevirapine (as nevirapine hemihydrate). The suspension also contains the following excipients: carbopol 974PNF, methylparaben, propylparaben, non crystallizing sorbitol solution, sucrose, propylene glycol, polysorbate 80, sodium hydroxide, and purified water.
Sources
Sedalia Manufacturers
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Laboratoires Boiron
Sedalia | Aurobindo Pharma Limited
2.1 Adult PatientsThe recommended dose for nevirapine oral suspension is 200 mg daily for the first 14 days, followed by 200 mg twice daily, in combination with other antiretroviral agents. The lead-in period has been observed to decrease the incidence of rash. For concomitantly administered antiretroviral therapy, the manufacturer’s recommended dosage and monitoring should be followed.
2.2 Pediatric PatientsThe recommended oral dose for pediatric patients 15 days and older is 150 mg/m2 once daily for 14 days followed by 150 mg/m2 twice daily thereafter. The total daily dose should not exceed 400 mg for any patient.
Table 1 Calculation of the Volume of Nevirapine Oral Suspension (50 mg per 5 mL) Required for Pediatric Dosing Based on Body Surface and a Dose of 150 mg/m2 BSA range (m2) Volume (mL) 0.06 – 0.12
1.25
0.12 – 0.25
2.5
0.25 – 0.42
5
0.42 – 0.58
7.5
0.58 – 0.75
10
0.75 – 0.92
12.5
0.92 – 1.08
15
1.08 – 1.25
17.5
1.25+
20
Nevirapine suspension should be shaken gently prior to administration. It is important to administer the entire measured dose of suspension by using an oral dosing syringe or dosing cup. An oral dosing syringe is recommended, particularly for volumes of 5 mL or less. If a dosing cup is used, it should be thoroughly rinsed with water and the rinse should also be administered to the patient.
2.3 Monitoring of PatientsIntensive clinical and laboratory monitoring, including liver enzyme tests, is essential at baseline and during the first 18 weeks of treatment with nevirapine oral suspension. The optimal frequency of monitoring during this period has not been established. Some experts recommend clinical and laboratory monitoring more often than once per month, and in particular, would include monitoring of liver enzyme tests at baseline, prior to dose escalation, and at two weeks post-dose escalation. After the initial 18-week period, frequent clinical and laboratory monitoring should continue throughout nevirapine oral suspension treatment [see Warnings and Precautions (5)]. In some cases, hepatic injury has progressed despite discontinuation of treatment.
2.4 Dosage AdjustmentPatients with Rash
Discontinue nevirapine oral suspension if a patient experiences severe rash or any rash accompanied by constitutional findings [see Boxed Warning and Warnings and Precautions (5.2)].Do not increase nevirapine oral suspension dose if a patient experiences mild to moderate rash without constitutional symptoms during the 14-day lead-in period of 200 mg/day (150 mg/m2/day in pediatric patients) until the rash has resolved [see Warnings and Precautions (5.2)]. The total duration of the once daily lead-in dosing period should not exceed 28 days at which point an alternative regimen should be sought.
Patients with Hepatic Events
If a clinical (symptomatic) hepatic event occurs, permanently discontinue nevirapine oral suspension. Do not restart nevirapine oral suspension after recovery [see Warnings and Precautions (5.1)].
Patients with Dose Interruption
For patients who interrupt nevirapine oral suspension dosing for more than 7 days, restart the recommended dosing, 200 mg daily (150 mg/m2/day in pediatric patients) for the first 14 days (lead-in) followed by 200 mg twice daily (150 mg/m2 twice daily for pediatric patients).
Patients with Renal Impairment
Patients with CrCL greater than or equal to 20 mL per min do not require an adjustment in nevirapine oral suspension dosing. The pharmacokinetics of nevirapine have not been evaluated in patients with CrCL less than 20 mL per min. An additional 200 mg dose of nevirapine oral suspension following each dialysis treatment is indicated in patients requiring dialysis. Nevirapine metabolites may accumulate in patients receiving dialysis; however, the clinical significance of this accumulation is not known [see Clinical Pharmacology (12.3)].
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