Nevirapine Precautions Published

New instructions tell physicians who is most at risk for rare but serious side effects when starting this important drug -- for example, women with a CD4 count above 250.

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Physicians starting patients on nevirapine (Viramune[R]) need to be aware of new precautions published in February 2004 by Boehringer Ingelheim. A nevirapine combination is recommended as an "alternative" antiretroviral starting regimen in the current U.S. treatment guidelines,(1) but may be the best starting regimen for some patients -- for example, because of its favorable effect in raising HDL ("good cholesterol"). The new warning is paradoxically good news, because it helps avoid problems with nevirapine, including identifying which patients should use it very cautiously or not at all. For example, women with a CD4+ count above 250 have a 12 times greater risk of liver toxicity than other patients. And patients need special monitoring when they start nevirapine treatment, because the risk of problems is greatest then.

For more information see the following at

http://www.viramune.com/

* The "Dear Health Care Professional" letter from Boehringer Ingelheim;

* The new "black box" warning in the Viramune prescribing information; and

* "Guidelines for the Management of Rash with Viramune," and "Guidelines for the Management of Hepatitic Events with Viramune."

References

1. http://www.aidsinfo.nih.gov/guidelines/

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