Nevirapine

Hepatic impairment; chronic hepititis B or C; high CD4 cell count, and women (all greatest risk of hepatic side effects); pregnancy. HEPATIC DISEASE. Potentially life-threatening hepatotoxicity including fatal hepititis reported in first 6 weeks; close monitoring required during first 18 weeks; monitor liver function before treatment then every 2 weeks for 2 months then after 1 month and then regularly; discontinue permanently if abnormalities in liver function test accompanied by hypersensitivity reactions (rash, fever, arthralgia, myalgia, lymphadenopathy, hepatitis, renal impairment, eosinophilia, granulocytopenia); suspended if severe abnormalities in liver function test but no hypersensitivity reaction ---discontinue permanently if significant liver function abnormalities recur; monitor patient closely if mild to moderate abnormalities in LFT with no hypersensitivity reaction. RASH: rash usually in 6 weeks, is most common side effect; incidence reduced if introduced at low dose and dose increase gradually; monitor closely for skin reaction during first 18 weeks; discontinue permanently if severe rash or if rash accompanied by blistering, oral lesions, conjunctivitis, facial oedema, general malaise, or hypersensitivity reaction; if rash mild to moderatemay continue without interruption but dose should not be increased until rash resolves.COUNSELLING: Patients should be told how to recognise hypersensitivity reactionsand advised to seek immediate medical attention if symptoms develop.