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Antimicrobials during Pregnancy
Published in “Bert” Bertis Britt Little, Drugs and Pregnancy, 2022
Nevirapine is a non-nucleoside reverse transcriptase inhibitor used to treat HIV. 1148 women used it during the first trimester of pregnancy, and there was no increased frequency of birth defects in babies born (Antiretroviral Registry, 2018). In one study of nevirapine in 1229 pregnant women was associated with a low (<15 percent) rate of liver toxicity, but in an adjusted model the risk was not significantly related to the drug (Ouyang et al., 2009).
Pregnancy, Delivery and Postpartum
Published in Miriam Orcutt, Clare Shortall, Sarah Walpole, Aula Abbara, Sylvia Garry, Rita Issa, Alimuddin Zumla, Ibrahim Abubakar, Handbook of Refugee Health, 2021
Zahra Ameen, Katy Kuhrt, Kopal Singhal Agarwal, Chawan Baran, Rebecca Best, Maria Garcia de Frutos, Miranda Geddes-Barton, Laura Bridle, Black Benjamin
Ultrasound scanning should be as per normal guidance. Invasive testing should be deferred until the viral load is suppressed. A single dose of nevirapine should be given at the beginning of the procedure (2–4 hours before).
Human immunodeficiency virus (HIV)
Published in Hung N. Winn, Frank A. Chervenak, Roberto Romero, Clinical Maternal-Fetal Medicine Online, 2021
Richard Basilan, William Salzer
A simplified dosing regimen has been developed for use in resource-limited settings for infant prophylaxis. This regimen includes the use of zidovudine 10mg twice a day for infants weighing less than 2.5kg at birth, and 15mg twice a day for infants weighing more than 2.5kg at birth. Another alternative approach has been to give a daily dose of nevirapine for 4 to 6 weeks. Use of combination therapy has been used, but has not been proven to be additional benefit.
“High” antiretroviral deintensification, a strategy to avoid drug interactions and unfavourable long-term effects of HAART
Published in Infectious Diseases, 2018
Massimiliano Lanzafame, Daniela Piacentini, Emanuela Lattuada, Sebastiano Rizzardo, Sheila Chiesi, Sandro Vento
The nine patients on nevirapine 200 mg stopped abacavir after a mean length of viral suppression of 35.11 months. As for the eight patients on efavirenz 400 mg, the dose was reduced to 200 mg after a mean time of viral suppression of 38.1 months. The last step for the eight patients on efavirenz was to stop tenofovir (3) or abacavir (5) after a mean time of viral suppression, on a 200 mg efavirenz regimen, of 36.1 months. All the patients, on lamivudine plus nevirapine 200 mg once daily and on lamivudine plus efavirenz 200 mg once a day were virally suppressed (HIV RNA <20 copies/ml) at the last test, with a mean length of viral suppression of 11.9 months. Pharmacokinetics analysis was performed in six patients on nevirapine and seven patients on efavirenz (Table 1). Ctrough of nevirapine was measured twice: 6 months after dose reduction from 400 to 200 mg and six months after stopping abacavir.
Prevention and treatment of HIV infection in neonates: evidence base for existing WHO dosing recommendations and implementation considerations
Published in Expert Review of Clinical Pharmacology, 2018
Diana F Clarke, Martina Penazzato, Edmund Capparelli, Tim R Cressey, George Siberry, Nandita Sugandhi, Mark Mirochnick
While there is extensive experience with nevirapine in neonates receiving regimens designed to meet the prophylaxis target trough concentration of 0.1 mg/L, there is limited experience with nevirapine as part of combination antiretroviral regimens in neonates infected with HIV with the goal of achieving the typical therapeutic trough nevirapine concentration target of 3.0 mg/L. It is important to note that nevirapine is the only antiretroviral for which there are different prophylactic and treatment doses. Recent population pharmacokinetics analyses[53,54] and case reports[55,56] suggest that a nevirapine dose of 6 mg/kg twice daily started at birth attains target therapeutic levels during the first 2 weeks of life with acceptable safety, but more data are needed.
Long-acting approaches for delivery of antiretroviral drugs for prevention and treatment of HIV: a review of recent research
Published in Expert Opinion on Drug Delivery, 2020
Denise A. Cobb, Nathan A. Smith, Benson J. Edagwa, JoEllyn M. McMillan
Another technology being explored for sustained release of ART to improve patient adherence is implantable ART [8,76]. The first and most notable successful clinical use of implants is that for hormonal therapy to prevent pregnancies, typically given as intrauterine devices and subcutaneous implants [77,78]. Based upon the successful use of such devices, numerous antiretroviral implant technologies have been designed; however, they have met with little clinical success. In 2005 an implantable version of the non-nucleoside reverse transcriptase inhibitor (NNRTI) nevirapine was developed [79]. Nevirapine was shaped into 2.0 or 4.5 mm granular pellets coated with 5% poly(vinyl alcohol)(PVA) and subcutaneously implanted into rats for three months. However, the level of active pharmaceutical compound in blood was lower than the therapeutic drug concentration and a large drug burst release upon implantation was observed. Additional NNRTI work includes clinical studies on a removable implant consisting of dapivarine loaded into a circular silicone-based matrix VR [80,81]. Recent works with biodegradable removable implants have used DTG co-formulated with poly(lactic-co-glycolic acid) (PLGA) and N-methyl-2-pyrrolidone (NMP). The formulation solidifies upon administration, allowing removal, and provides therapeutic drug concentrations for up to nine months in mice [82]. Long-acting iterations of up to six drugs, based upon solubility with NMP, have been reported using similar technologies [83]. While erodible implants are promising, drug release rates, amounts of organic solvents required to solubilize hydrophobic drugs during scale-up, and implant degradation kinetics need to be optimized for safety and efficacy.