References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Nevirapine (brand name Viramune) is one of the oldest non-nucleoside reverse transcriptase inhibitors (NNRTIs) still in clinical use for HIV. It was approved in the 1990s and played a major role in the early days of combination therapy. Today it’s used less often in the UK because newer drugs have fewer side effects, but it still has a place in some regimens.
Here’s what nevirapine does, when it’s used, and what to watch out for.
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How Nevirapine Works
HIV replicates by converting its RNA into DNA using an enzyme called reverse transcriptase. Nevirapine binds directly to this enzyme and blocks it, preventing the virus from making copies of itself. NNRTIs are always used in combination with other HIV drugs, never alone, because resistance develops quickly if they’re used as monotherapy.
When Is Nevirapine Used?
- As part of combination ART for people who cannot tolerate newer drugs
- When drug interactions rule out other options
- In some pregnancy regimens
- In some low and middle income countries where nevirapine is more affordable
In the UK, newer NNRTIs like rilpivirine and doravirine, and integrase inhibitors like dolutegravir and bictegravir, are now the preferred first-line options for most people starting treatment.
Side Effects to Watch For
| Side Effect | When It Happens | Action |
|---|---|---|
| Rash | First 6 weeks | Report promptly — can progress to serious skin reaction |
| Liver inflammation | First 12 weeks mostly | Regular liver blood tests required |
| Fever, flu-like symptoms | First few weeks | Contact clinic |
| Fatigue, nausea | Variable | Usually settles |
The first two are serious and are why nevirapine is started at a lower “lead-in” dose for 14 days before going up to the full dose.
Who Shouldn’t Take Nevirapine?
- Women with a CD4 count above 250 (higher risk of liver problems)
- Men with a CD4 count above 400 (same reason)
- People with existing significant liver disease
- Those starting post-exposure prophylaxis (PEP)
Drug Interactions
Nevirapine is processed through the liver’s CYP3A4 enzyme system and interacts with many medicines including rifampicin, some contraceptives, certain statins, and St John’s Wort. Tell your HIV team and pharmacist about every medicine and supplement you take.
Read more: What is HIV? | HIV and the immune system
Frequently Asked Questions
Is nevirapine still used in the UK?
Yes, but less often than in the past. Newer drugs have fewer side effects and simpler dosing. Nevirapine remains an option for people who cannot tolerate or take other medicines.
Why is there a lead-in dose?
Starting at half the normal dose for 14 days reduces the risk of serious rash and liver problems. You must never skip or shorten the lead-in phase.
Can nevirapine be used in pregnancy?
Yes, in certain circumstances. Your HIV specialist will weigh the benefits and risks based on your CD4 count and other factors.
Related reading
- Efavirenz for HIV: An Older NNRTI Still in Use
- Eviplera: How This Anti-HIV Drug Works
- Dolutegravir: A Complete Guide to This HIV Medication
- Understanding Efavirenz in HIV Treatment
- Injectable HIV Treatment: Everything You Need to Know
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
