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Nevirapine (Viramune) is associated with several serious risks and requires careful monitoring. Below are important safety precautions and warnings to consider:

• Liver Problems: Nevirapine can cause severe liver issues, potentially leading to liver failure. This risk is highest within the first four months of treatment. If you have a history of moderate to severe liver problems, you should not take this medication. Regular blood tests are necessary to monitor liver health. Women, individuals with high white blood cell counts, or those with Hepatitis B or C are at increased risk. If liver issues occur, discontinue use immediately and contact your healthcare provider.

• Skin and Allergic Reactions: There is a risk of serious and sometimes life-threatening skin reactions, particularly in the first six weeks of treatment. Women are more susceptible to these reactions. Symptoms include severe rash, fever, muscle or joint pain, mouth sores, blisters, or facial swelling. If these occur, stop taking nevirapine and seek medical help right away. Starting treatment with a lower dose can help assess tolerance.

• Immune System Changes: Nevirapine, when used with other HIV medications, may cause immune reconstitution syndrome, where the immune system becomes overactive. This can lead to the body attacking normal cells. Symptoms such as fever, pain, hair loss, bulging eyes, or excessive sweating should be reported to a healthcare provider immediately.

• Body Fat Changes: Some patients on HIV medications, including nevirapine, have experienced changes in body fat distribution. This includes fat accumulation in certain areas or fat loss from others. While the cause and future health effects are unclear, notify your provider if you notice these changes.

• Drug Interactions: Certain medications may alter how nevirapine is metabolized in the body, impacting its effectiveness and the risk of side effects. Discuss all medications you are taking with your healthcare provider.

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

• Emergency Actions: If you experience symptoms of liver problems, severe skin reactions, or immune system changes, seek immediate medical attention.

Always keep your healthcare provider informed of your medical history and any new symptoms that arise during treatment with nevirapine. Regular follow-ups and lab tests are crucial in ensuring your safety and the effectiveness of the treatment.

When taking this medication, you might experience some common side effects like tiredness, nausea, vomiting, or diarrhea, which are usually mild and may not require medical attention unless they persist or worsen. A rash may also occur, affecting a small percentage of users, and while typically not serious, it should be monitored as it may indicate a more severe reaction. If you experience drowsiness, this is considered rare but can happen.

As your immune system strengthens, it might initially respond to infections you previously had, causing symptoms to reappear or new ones to arise due to an overactive immune response. Should you notice unexplained weight loss, severe fatigue, persistent muscle aches or weakness, severe headaches, joint pain, numbness, vision changes, or signs of infection such as fever or swollen lymph nodes, seek medical help promptly.

In rare cases, severe side effects can occur, including severe allergic reactions characterized by fever, rash, muscle or joint pain, and facial swelling. Liver injury is another serious concern, with symptoms like persistent nausea, vomiting, abdominal pain, yellowing of the skin or eyes, dark urine, and light-colored stools. Changes in body fat distribution might also happen, but their cause and long-term effects remain uncertain.

Always be observant of any changes in your health and contact your healthcare provider if you encounter symptoms that are severe or unusual. While most people do not experience serious side effects, staying informed and vigilant can help manage your health effectively while on this medication.

Nevirapine can interact with several medications, potentially altering their effectiveness. Drugs such as orlistat, rifabutin, and warfarin may have interactions with nevirapine. Some medications can impact how nevirapine is removed from your body, influencing its efficacy. These include rifamycins like rifampin and herbal supplements such as St. John's wort.

Nevirapine itself can accelerate the removal of various other drugs, possibly reducing their effectiveness. Affected medications include antiarrhythmics like amiodarone; HIV treatments such as atazanavir, cobicistat, and elvitegravir; certain seizure medications like clonazepam; azole antifungals, including 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 of treatment. Consult your doctor for more information.

Additionally, nevirapine may decrease the effectiveness of hormonal birth control methods such as pills, patches, or rings, which could lead to pregnancy. It is advisable to discuss with your healthcare provider whether a backup contraceptive method is necessary. If you experience any new spotting or breakthrough bleeding, inform your doctor, as these could indicate that your birth control is less effective.