Nevirapine

Indications HIV infection in combination with other antiretroviral drugs

Cautions hepatic impairment (see below and Appendix 2); chronic hepatitis B or C, high CD4
cell count, and women (all at greater risk of hepatic sideeffects manufacturer advises avoid in
women with CD4 cell count greater than 250 cells/mm3 or in men with CD4 cell count greater
than 400 cells/mm3 unless potential benefit outweighs risk); pregnancy (Appendix 4);
interactions: Appendix 1 (nevirapine)
Hepatic disease Potentially life-threatening hepatotoxicity including fatal fulminant hepatitis
reported usually 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 tests accompanied by hypersensitivity
reaction (rash, fever,arthralgia, myalgia, lymphadenopathy, hepatitis, renal impairment,
eosinophilia, granulocytopenia); suspend if severe abnormalities in liver function tests but no
hypersensitivity reactiondiscontinue permanently if significant liver function abnormalities
recur; monitor patient closely if mild to moderate abnormalities in liver function tests with no
hypersensitivity reaction
Rash Rash, usually in first 6 weeks, is most common sideeffect; incidence reduced if introduced
at low dose and dose increased gradually; monitor closely for skin reactions during first 18
weeks; discontinue permanently if severe rash or if rash accompanied by blistering, oral lesions,
conjunctivitis, facial oedema, general malaise or hypersensitivity reactions; if rash mild or
moderate may continue without interruption but dose should not be increased until rash resolves
Counselling Patients should be told how to recognise hypersensitivity reactions and advised to
discontinue treatment and seek immediate medical attention if severe skin reaction,
hypersensitivity reactions, or symptoms of hepatitis develop
Contra-indications acute porphyria (but see section 9.8.2); breast-feeding (Appendix 5); severe
hepatic impairment; post-exposure prophylaxis
Side-effects rash including Stevens-Johnson syndrome and rarely, toxic epidermal necrolysis (see
also Cautions above); nausea, hepatitis (see also Hepatic Disease above), headache; less
commonly vomiting, abdominal pain, fatigue, fever, and myalgia; rarely diarrhoea, angioedema,

anaphylaxis, hypersensitivity reactions (may involve hepatic reactions and rash, see Hepatic
Disease above), arthralgia, anaemia, and granulocytopenia (more frequent in children); very
rarely neuropsychiatric reactions; see also Osteonecrosis, p. 341
Dose
ADULT and CHILD over 16 years, 200 mg once daily for first 14 days then (if no rash present)
200 mg twice daily; NEONATE and CHILD under 8 years, 150 mg/m2 (max. 200 mg) once
daily for first 14 days, then (if no rash present) 150 mg/m2 (max. 200 mg) twice daily or 4 mg/kg
(max. 200 mg) once daily for first 14 days then (if no rash present) 7 mg/kg (max. 200 mg) twice
daily; CHILD 816 years, 150mg/m2 (max. 200 mg) once daily for first 14 days then (if no rash
present) 150 mg/m2 (max. 200 mg) twice daily or 4 mg/kg (max. 200 mg) once daily for first 14
days then (if no rash present) 4 mg/kg (max. 200 mg) twice daily
Note Dose titration should be repeated if treatment interrupted for more than 7 days
STAVUDINE (d4T)
Indications HIV infection in combination with other antiretroviral drugs
Cautions see notes above; also history of peripheral neuropathy (see under Side-effects); history
of pancreatitis or concomitant use with other drugs associated with pancreatitis; interactions:
Appendix 1 (stavudine)
Contra-indications breast-feeding (Appendix 5)
Side-effects see notes above; also peripheral neuropathy (switch to another antiretroviral if
peripheral neuropathy develops), abnormal dreams, cognitive dysfunction, drowsiness,
depression, pruritus; less commonly anxiety, gynaecomastia
Dose
. ADULT under 60 kg, 30 mg every 12 hours preferably at least 1 hour before food; 60 kg and
over, 40 mg every 12 hours; NEONATE under 2 weeks, 500 micrograms/kg every 12 hours;
CHILD over 2 weeks, body-weight under 30 kg, 1 mg/kg every 12 hours; body-weight 30 kg and
over, adult dose
Stavudine . Antivirals: increased risk of side-effects when stavudine given with .didanosine;
effects of stavudine possibly inhibited by .ribavirin; effects of stavudine possibly inhibited
by .zidovudine (manufacturers advise avoid concomitant use)
ZIDOVUDINE
(Azidothymidine, AZT)

Note The abbreviation AZT which is sometimes used for zidovudine has also been used for
another drug
Indications HIV infection in combination with other antiretroviral drugs; prevention of maternalfetal HIV transmission (see notes above under Pregnancy and Breast-feeding)
Cautions see notes above; also haematological toxicity particularly with high dose and advanced
disease monitor full blood count after 4 weeks of treatment, then every 3 months; vitamin B12
deficiency (increased risk of neutropenia); if anaemia or myelosuppression occur, reduce dose or
interrupt treatment according to product literature, or consider other treatment; elderly;
interactions: Appendix 1 (zidovudine)
Contra-indications abnormally low neutrophil counts or haemoglobin concentration (consult
product literature); neonates with hyperbilirubinaemia requiring treatment other than
phototherapy, or with raised transaminase (consult product literature); acute porphyria (section
9.8.2); breast-feeding (Appendix 5)
Side-effects see notes above; also anaemia (may require transfusion), taste disturbance, chest
pain, influenza-like symptoms, paraesthesia, neuropathy, convulsions, dizziness, drowsiness,
anxiety, depression, loss of mental acuity, myopathy, gynaecomastia, urinary frequency,
sweating, pruritus, pigmentation of nails, skin and oral mucosa
Dose
. By mouth, ADULT and CHILD body-weight over 30 kg, 250300 mg twice daily; CHILD
body-weight 49 kg, 12 mg/kg twice daily; body-weight 930 kg, 9 mg/kg twice daily or bodyweight 814 kg, 100 mg twice daily; body-weight 1421 kg, 100 mg in the morning and 200 mg
in the evening; body-weight 2128 kg, 200 mg twice daily; body-weight 2830 kg, 200250 mg
twice daily. Prevention of maternal-fetal HIV transmission, seek specialist advice (combination
therapy preferred). Patients temporarily unable to take zidovudine by mouth, by intravenous
infusion over 1 hour, 12 mg/kg every 4 hours (approximating to 1.5 3 mg/kg every 4 hours by
mouth) usually for not more than 2 weeks; CHILD 3 months12 years, 80 160 mg/m2 every 6
hours (120 mg/m2 every 6 hours approximates to 180 mg/m2 every 6 hours by mouth)