PI Perspective #26

December 1998     View PDF     En español

Nevirapine in Children

Nevirapine (Viramune), a non-nucleoside reverse transcriptase inhibitor, has recently been approved for use in children. Like other antivirals, the optimal use of this drug is as part of a three-drug combination. Nevirapine should never be used alone, and its use even in two-drug combinations is discouraged because of the risk of rapid development of drug resistance.

In adult studies, nevirapine has been combined with two nucleoside analogues, such as AZT and ddI, and AZT and 3TC, in a “protease sparing” regimen. Presumably, it can also be combined with d4T and 3TC or ddI and d4T, though it has not been formally studied in this fashion. Other common adult uses include salvage therapy, in which nevirapine is added along with other new drugs after a protease inhibitor combination has failed.

The recommended dose of nevirapine for children aged two months to eight years is 4.0mg/kg once a day for the first 14 days followed by 7.0mg/kg given twice a day thereafter. For children eight years or older, the recommended dose is 4.0mg/kg once a day for fourteen days followed by 4.0mg/kg given twice a day thereafter. Children generally experience the same side effects seen in the adult studies. Rash, usually mild to moderate in severity, is the most common. Other possible side effects include fever, nausea, headache and abnormal liver function tests. One side effect only seen in children was an anemia called granulocytopenia (a reduction in granulocytes, a type of white blood cell).