Nevirapine: HIV treatment, dosing, and side effects
Last updated September 6, 2026.
Nevirapine is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used with other antiretroviral drugs to treat HIV-1 infection. It works by blocking an enzyme HIV needs to copy its genetic material, slowing the virus when combined with other HIV medicines that attack it in different ways. Nevirapine carries a boxed warning for severe, sometimes fatal liver damage and severe skin reactions, both most likely in the first 18 weeks of treatment, so close monitoring at the start matters.
What does it treat?
Nevirapine is used as part of a combination antiretroviral regimen to treat HIV-1 infection in adults and children. It is never prescribed alone, because HIV develops resistance quickly to a single drug; it is paired with at least two other antiretrovirals, often nucleoside reverse transcriptase inhibitors like tenofovir or lamivudine. It is not approved for post-exposure prophylaxis after a possible HIV exposure because of its liver toxicity risk, and it does not cure HIV or prevent transmission on its own.
How do you take it?
Nevirapine comes as an immediate-release tablet (200 mg), an oral suspension (50 mg per 5 mL), and an extended-release tablet, Viramune XR (100 mg and 400 mg). Adults start with a 14-day lead-in period of 200 mg once daily; this lower starting dose lowers the chance of rash. If no rash or other problem develops, the dose increases to the maintenance dose: 200 mg twice daily with immediate-release tablets, or a switch to 400 mg once daily with the XR tablet. The daily ceiling is 400 mg. It can be taken with or without food, and the XR tablet must be swallowed whole, never crushed or chewed. If you miss a dose, take it as soon as you remember unless it is almost time for the next one, in which case skip the missed dose and continue your regular schedule; never double up. Stop nevirapine and call your doctor the same day if you develop a rash, especially with fever, blistering, mouth sores, or eye irritation, or any signs of liver problems such as yellowing skin or eyes, dark urine, or unusual tiredness.
Side effects to know
- Common: Rash, headache, nausea, fatigue, and diarrhea are common, especially during the first weeks of treatment.
- Serious: Severe liver damage can occur with or without a rash and can be fatal, so yellowing of the skin or eyes, dark urine, loss of appetite, or right-upper-belly pain needs same-day medical attention. Severe skin reactions, including Stevens-Johnson syndrome and toxic epidermal necrolysis, can also be life-threatening; any rash with fever, blistering, peeling skin, or mouth or eye sores means stop the drug and get emergency care.
Who should not take it?
Do not start nevirapine if you have moderate to severe liver disease, have previously had a severe reaction to it, or take ketoconazole or St. John's wort, both of which interact with it. Women with a CD4 count above 250 cells per mm3 and men with a CD4 count above 400 cells per mm3 at the start of treatment have a higher risk of serious liver toxicity, so doctors generally avoid starting nevirapine in that situation unless the benefit clearly outweighs the risk. Nevirapine reduces the effectiveness of hormonal birth control pills, so a backup or non-hormonal method is needed. Tell your doctor about any liver disease, hepatitis B or C, or other medicines you take, since nevirapine interacts with several protease inhibitors and other drugs processed by the liver. If you are pregnant, nevirapine may still be used when the benefit outweighs the risk, but liver monitoring is more intensive; talk with your doctor about current first-line options. Breastfeeding is generally not recommended for people with HIV in the United States because of the risk of transmitting HIV through breast milk, regardless of which antiretroviral is used. Heavy alcohol use adds to liver strain and should be discussed with your doctor.
When is it an emergency?
There is no specific antidote for nevirapine overdose. Signs to watch for include severe rash, swelling of the face or throat, unusual tiredness or confusion, yellowing skin or eyes, and dark urine. If someone takes more than prescribed or shows signs of a severe reaction, call Poison Control at 1-800-222-1222. Call 911 or go to the nearest emergency room for collapse, trouble breathing, facial or throat swelling, or widespread blistering or peeling skin, which can signal a severe allergic or skin reaction.
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Common questions
What is the maximum daily dose of nevirapine?
The maximum is 400 mg per day. Most adults take 200 mg twice daily with the immediate-release tablet, or 400 mg once daily with the extended-release (XR) tablet after completing the 14-day lead-in period. Taking more than this does not improve HIV control and raises the risk of liver toxicity.
Can I drink alcohol while taking nevirapine?
Heavy or regular alcohol use adds extra strain to a liver that nevirapine can already affect, so it's worth discussing your actual drinking pattern with your doctor rather than assuming any amount is fine. If you have any history of liver disease or hepatitis, alcohol should generally be avoided while on this drug. Occasional light drinking is a conversation to have directly with your prescriber based on your liver function tests.
Is nevirapine safe during pregnancy?
Nevirapine can be used during pregnancy when the benefit is judged to outweigh the risk, but it is no longer a preferred first-line option and requires closer liver monitoring because pregnancy itself can add hepatic risk. If you become pregnant while on nevirapine or are planning a pregnancy, talk to your doctor about whether to continue it or switch to a different antiretroviral. Do not stop or change your HIV medicine on your own without medical guidance.
Should I take nevirapine with food?
You can take nevirapine with or without food; there is no requirement to take it on an empty stomach or with a meal. What matters more is taking it at consistent times each day and swallowing the extended-release tablet whole without crushing or chewing it. Consistency helps keep drug levels steady, which matters for both effectiveness and avoiding resistance.
What are the signs of a nevirapine overdose?
Watch for severe rash, swelling of the face or throat, confusion, unusual tiredness, or yellowing of the skin or eyes. These can signal either an overdose or a severe liver or skin reaction, both of which need urgent evaluation. Call Poison Control at 1-800-222-1222 for guidance, and call 911 or go to an emergency room for breathing trouble, facial swelling, or collapse.
Does nevirapine interact with birth control pills?
Yes. Nevirapine speeds up how your liver breaks down hormonal contraceptives, which can make birth control pills, patches, or rings less effective at preventing pregnancy. If you rely on hormonal birth control, use a backup method such as condoms or discuss a non-hormonal option like an IUD with your doctor while taking nevirapine.