Safety profile of nevirapine, a nonnucleoside reverse transcriptase inhibitor for the treatment of human immunodeficiency virus infection

Nevirapine (NVP) is a nonnucleoside reverse transcriptase inhibitor widely used in combination with other antiretroviral agents for the treatment of h uman immunodeficiency virus disease. To establish its safety profile, we co nducted a review of data from prospective US and international clinical tri als involving a total of 906 adult patients and 468 pediatric patients trea ted with NVP. Drug-related adverse events were similar in adults and childr en, with rash and nausea most frequently reported in adults and rash and gr anulocytopenia most frequently reported in children. A separate analysis of rash based on data from adult patients in controlled trials demonstrated a 16% rate of NVP-attributable rash in these patients. Of patients with NVP- associated rash, 65% developed rash within the first 6 weeks of therapy, an d it has been shown that a lower lead-in dose (200 mg/d vs the standard 400 mg/d) for the first 2 weeks of NVP treatment reduces the frequency of drug -associated rash. Serious rash (Stevens-Johnson syndrome [SJS] or SJS/toxic epidermal necrolysis transition syndrome) occurred with an incidence of 0. 3% and clinical hepatitis with an incidence of 1.0% among NVP-treated patie nts in clinical trials. Adverse event data from long-term clinical trials d emonstrated a lower incidence of NVP-related adverse events than in short-t erm trials of NVP therapy. An analysis of abnormal laboratory findings usin g thresholds similar to those found in the prescribing information for othe r commonly used antiretroviral agents and data from controlled trials in ad ults showed that the most frequently observed laboratory abnormalities were elevations in liver function test results. Approximately 50,000 patients i n the United States had been treated with marketed NVP at the time of writi ng, and postmarketing surveillance has supported the overall safety profile observed in clinical trials. NVP has been shown to be well tolerated in bo th adult and pediatric patients.