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Herbal preparations containing StJohn’s Wort and Viramune must not be co-administeredsee section 4.3If a patient is already taking StJohn’s Wort check nevirapine and if possible viral levels and stop StJohn’s WortNevirapine levels may increase on stopping StJohn’s WortThe dose of Viramune may need adjustingThe inducing effect may persist for at least 2 weeks after cessation of treatment with StJohn’s Wort.
Coadministration of Viramune with elvitegravir in combination with cobicistat is not recommendedsee section 4.4
Post-Exposure-ProphylaxisSerious hepatotoxicityincluding liver failure requiring transplantationhas been reported in HIV-uninfected individuals receiving multiple doses of Viramune in the setting of post-exposure-prophylaxisPEPan unapproved useThe use of Viramune has not been evaluated within a specific study on PEPespecially in term of treatment duration and thereforeis strongly discouraged.
An increase in weight and in levels of blood lipids and glucose may occur during antiretroviral therapySuch changes may in part be linked to disease control and life styleFor lipidsthere is in some cases evidence for a treatment effectwhile for weight gain there is no strong evidence relating this to any particular treatmentFor monitoring of blood lipids and glucose reference is made to established HIV treatment guidelinesLipid disorders should be managed as clinically appropriate.
Patients with rare hereditary problems of galactose intolerance e.ggalactosaemiathe Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine.
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