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Nevirapine, marketed as Viramune, is associated with significant safety warnings. It is crucial for patients and healthcare professionals to be aware of these potential risks and take appropriate precautions. Below are important considerations for the safe use of this medication:

• Liver Problems: Nevirapine can cause serious, potentially fatal liver issues, especially within the first four months of treatment. Women, individuals with high white blood cell counts, and those with hepatitis B or C are at higher risk. It is essential to conduct liver function tests before and during treatment. If you have a history of moderate to severe liver problems, do not use this medication. Watch for symptoms like persistent nausea, loss of appetite, vomiting, abdominal pain, dark urine, pale stools, yellowing of the eyes or skin, and unusual fatigue. Immediate medical attention is necessary if these symptoms arise.

• Skin and Allergic Reactions: Severe skin and allergic reactions, occasionally life-threatening, may occur, particularly within the first six weeks of treatment. Women are more susceptible. Initial doses are lower to monitor tolerance. If you experience symptoms such as a severe rash with fever, body aches, mouth sores, blisters, or facial swelling, discontinue use and seek medical help immediately.

• Immune System Changes: Starting nevirapine in combination with other HIV medications may lead to immune reconstitution syndrome, where the immune system becomes overactive, potentially attacking normal cells. Symptoms can include fever, pain, hair loss, bulging eyes, or sweating. Inform your healthcare provider promptly if these occur.

• Body Fat Changes: Some users of HIV medications, including nevirapine, have reported changes in body fat distribution. These involve fat buildup in areas like the back of the neck or abdomen, and fat loss from limbs or face. The exact cause and long-term health effects are unclear. Report any noticeable changes to your healthcare provider.

• Drug Interactions: Nevirapine's effectiveness and safety can be affected by interactions with other drugs, altering how it is metabolized. Inform your healthcare provider about all medications you are taking to manage potential interactions.

• Contraindications: Do not use nevirapine if you have moderate to severe liver problems or are undergoing post-exposure prophylaxis (PEP) treatment.

• Emergency Actions: If an overdose is suspected, seek emergency medical attention immediately.

Always keep all medical and lab appointments to ensure your response to nevirapine is closely monitored. If you have discontinued nevirapine due to liver or allergic reactions, never restart it. Inform all healthcare providers of any past adverse reactions to this medication.

Common side effects:

• Tiredness
• Nausea
• Vomiting
• Diarrhea

• Rash

  Less common but important to monitor:

• Drowsiness

• Changes in body fat distribution

  Serious side effects:

• Unexplained weight loss
• Persistent fatigue
• Muscle weakness
• Severe headaches
• Joint pain
• Numbness
• Vision changes
• Signs of infection such as fever and swollen lymph nodes
• Severe allergic reaction

Certain drugs may interact with nevirapine, impacting its effectiveness or the effectiveness of other medications. Specifically, Orlistat, Rifabutin, and Warfarin can interact with nevirapine. Additionally, medications like rifamycins (e.g., Rifampin) and herbal supplements such as St. John's wort can alter the way nevirapine is removed from the body, potentially affecting its performance.

Nevirapine can also accelerate the elimination of several other drugs, which might reduce their effectiveness. These drugs include antiarrhythmics like Amiodarone, HIV medications such as Atazanavir and cobicistat, seizure treatments including Clonazepam, azole antifungals like Itraconazole and Ketoconazole, macrolide antibiotics such as Clarithromycin, and methadone.

It's important to note that Prednisone should not be used to prevent a rash during the initial six weeks of nevirapine treatment, as it may increase the risk of developing one. Consult your healthcare provider for further guidance.

Additionally, nevirapine may reduce the effectiveness of hormonal birth control methods, such as pills, patches, or rings, which could lead to pregnancy. It is advisable to discuss reliable backup birth control options with your healthcare provider. Report any unusual spotting or breakthrough bleeding to your doctor, as these could indicate reduced birth control efficacy.