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Nevirapine, known as Viramune, is associated with several serious safety risks and requires careful monitoring. Below are key safety warnings and precautions to consider before and during the treatment:

• Liver Problems: Nevirapine can cause severe liver damage, potentially leading to liver failure or the need for a transplant. The risk is particularly high within the first four months of treatment. Individuals, especially women with higher T-cell counts, and those with a history of liver problems or hepatitis B or C, face increased risk. Regular blood tests are necessary to monitor liver function, and those with moderate to severe liver issues should not use nevirapine. If symptoms such as persistent nausea, loss of appetite, yellowing skin/eyes, or dark urine occur, seek medical assistance immediately.

• Severe Skin and Allergic Reactions: Serious skin and allergic reactions can occur, some of which may be life-threatening. These are most likely to manifest within the first six weeks of treatment. Women are at higher risk. It is crucial to start with a lower dose to assess tolerance. If symptoms like rash, fever, mouth sores, or facial swelling appear, discontinue use and contact a healthcare provider right away.

• Overactive Immune System: Nevirapine, when used in combination with other HIV medications, can lead to an overactive immune response known as immune reconstitution syndrome. This condition may cause the immune system to attack healthy cells. Symptoms such as fever, pain, or hair loss should be reported to a healthcare provider immediately.

• Changes in Body Fat: Some individuals on HIV medications, including nevirapine, might experience changes in body fat distribution. These changes include fat accumulation in specific areas like the neck and abdomen or fat loss from the limbs and face. Report any such changes to your healthcare provider.

• Drug Interactions: Certain medications can alter how nevirapine is metabolized, impacting its effectiveness and increasing side effects. Discuss any other drugs you are taking with your healthcare provider.

• Contraindications: Nevirapine is not recommended for individuals with moderate to severe liver problems or for post-exposure prophylaxis (PEP) treatment.

In case of an overdose or severe reaction, seek emergency medical help immediately. Always inform your healthcare providers about any adverse reactions you have experienced with nevirapine in the past. Regular medical and lab appointments are essential to ensure the safety and effectiveness of the treatment.

Common side effects:

• tiredness
• nausea
• vomiting
• diarrhea

• mild rashes

  Less common but important to monitor:

• drowsiness
• headaches
• belly pain
• muscle aches

• changes in body fat distribution

  Serious side effects:

• severe allergic reactions
• liver injury
• overactive immune system

Nevirapine can interact with various medications, which may impact its effectiveness or the effectiveness of other drugs. For example, it can interact with Orlistat, Rifabutin, and Warfarin. Certain drugs, like rifamycins (such as Rifampin) and herbal supplements like St. John's wort, can influence how nevirapine is removed from the body.

Nevirapine may also speed up the elimination of other medications, potentially reducing their effectiveness. Affected drugs include antiarrhythmics such as Amiodarone, Atazanavir, cobicistat, elvitegravir, some seizure medications like Clonazepam, azole antifungals like Itraconazole and Ketoconazole, macrolide antibiotics like Clarithromycin, and methadone.

It's important not to use Prednisone to prevent a rash when starting nevirapine, as it may increase the risk of developing a rash within the first six weeks. Consult your doctor for more information on managing side effects.

Additionally, nevirapine can decrease the effectiveness of hormonal birth control methods such as pills, patches, or rings, potentially leading to pregnancy. Discuss alternative or additional birth control methods with your doctor or pharmacist, and report any new spotting or breakthrough bleeding as these could indicate reduced birth control effectiveness.