MEDICATION GUIDE

Nevirapine Tablets USP, 200mg

(ne-VIR-a-peen)

What is the most important information I should know about nevirapine?

Nevirapine can cause severe liver and skin problems that may lead to death. These problems can happen at any time during treatment, but your risk is higher during the first 18 weeks of treatment.

Nevirapine can cause serious side effects, including:

• Severe liver problems. Some people taking nevirapine may develop severe liver problems that can lead to liver failure and the need for a liver transplant, or death. If you have liver problems you may get a rash
  • Women have a higher risk of developing liver problems during treatment with nevirapine than men.
  • People who have abnormal liver test results before starting nevirapine and people with hepatitis B or C also have a greater risk of getting liver problems.

People who have higher CD4+ cell counts when they begin nevirapine have a higher risk of liver problems, especially:

•   Women with CD4+counts higher than 250 cells/mm3. This group has the highest risk.
•   Men with CD4+counts higher than 400 cells/mm3.

Stop taking nevirapine and call your doctor right away if you have any of the following symptoms of liver problems with or without a skin rash:

•   dark (tea colored) urine
•   yellowing of your skin or whites of your eyes
•   light-colored bowel movements (stools)
•   fever
•   feeling sick to your stomach (nausea)
•   feel unwell or like you have the flu
•   pain or tenderness on your right side below your ribs
•   tiredness
•   loss of appetite

• Severe skin reactions and rash. Some skin reactions and rashes may be severe, life-threatening, and in some people, may lead to death. Most severe skin reactions and rashes happen in the first 6 weeks of treatment with nevirapine.
  • Women have a higher risk of developing a rash during treatment with nevirapine than men.

Stop taking nevirapine and call your doctor right away if you get a rash with any of the following symptoms:

          blisters

          muscle or joint aches

          red or inflamed eyes, like "pink eye" (conjunctivitis)

• mouth sores

          swelling of your face

          fever

          feel unwell or like you have the flu

          tiredness

•   Your doctor should do blood tests often to check your liver function and check for severe skin reactions during the first 18 weeks of treatment with nevirapine. You should continue to see your doctor and have your liver checked regularly during your treatment with nevirapine. It is important for you to keep all of your doctor appointments.
•   If your doctor tells you to stop treatment with nevirapine because you have had any of the severe liver or skin symptoms listed above, you should never take nevirapine again.

See "What are the possible side effects of nevirapine?" for more information about side effects.

What is nevirapine?

Nevirapine is a prescription HIV-1 medicine used with other HIV-1 medicines to treat HIV-1 (Human Immunodeficiency Virus 1) in adults and in children 15 days of age or older. HIV is the virus that causes AIDS (Acquired Immune Deficiency Syndrome).

• If you are a woman with CD4+ counts higher than 250 cells/mm3or a man with CD4+ counts higher than 400 cells/mm3, you and your doctor will decide if starting nevirapine is right for you.

Do not take nevirapine:

• if you have liver problems.
• as part of occupational and non-occupational post-exposure prophylaxis (PEP) regimens. Nevirapine is only for people diagnosed with HIV-1. If you have not been diagnosed as HIV positive, then do not take nevirapine.

Before taking nevirapine, tell your doctor about all your or your child's medical conditions, including if you or your child:

• have or have had hepatitis (inflammation of your liver) or problems with your liver. See "What is the most important information I should know about nevirapine?"
• receive dialysis
• have trouble swallowing pills
• are pregnant or plan to become pregnant. It is not known if nevirapine will harm your unborn baby.
• Pregnancy Registry: There is a pregnancy registry for women who take nevirapine during pregnancy. The purpose of the registry is to collect information about the health of you and your baby. Talk to your doctor about how you can take part in this registry.
• are breastfeeding or plan to breastfeed. Nevirapine can pass into your breast milk and may harm your baby. You should not breastfeed if you have HIV-1 because of the risk of passing HIV-1 to your baby. Do not breastfeed during treatment with nevirapine. Talk to your doctor about the best way to feed your baby.

Tell your doctor about all the medicines you take, including prescription and over-the-counter medicines, vitamins and herbal supplements. Especially tell your doctor if you take St. John's wort.

•   Some medicines interact with nevirapine. Keep a list of your medicines to show your doctor or pharmacist.
•   You can ask your doctor or pharmacist for a list of medicines that interact with nevirapine.
•   Do not start taking a new medicine without telling your doctor . Your doctor can tell you if it is safe to take nevirapine with other medicines.

How should I take nevirapine?

•   Take nevirapine exactly as your doctor tells you to take it. Do not change your dose unless your doctor tells you to.
•   Nevirapine is always taken in combination with other antiretroviral medicines
•   You should not take more than one form of nevirapine at the same time. Talk to your doctor if you have any questions.
•   If your child is prescribed nevirapine, your child's doctor will tell you exactly how nevirapine should be taken.
•   Nevirapine can be taken with or without food.
•   Do not miss a dose of nevirapine. If you miss a dose of nevirapine, take the missed dose as soon as you remember. If it is almost time for your next dose, do not take the missed dose. You should take the next dose at your regular time. Do not take 2 doses at the same time.
•   If you stop taking nevirapine for more than 7 days, ask your doctor how much to take before you start taking it again. You may need to begin taking the nevirapine starting dose again, which is taken 1 time each day for 14 days.

Starting nevirapine tablets:

1. Your doctor should start you with 1 dose each day to lower your chance of getting a serious rash. It is important that you only take 1 dose of nevirapine each day for the first 14 days.
   • Call your doctor right away if you get a skin rash during the first 14 days of nevirapine treatment.
   • Do not increase your dose to 2 times a day if you have a rash.
   • You should never take your starting dose for longer than 28 days. If after 28 days you are still receiving this starting dose because you have a rash, you and your doctor should talk about prescribing another HIV-1 medicine for you instead of nevirapine.
2. Day 15, you will take 1 nevirapine tablet 2 times a day.

Switching from nevirapine tablets to nevirapine extended-release tablets:

•   Take nevirapine extended-release tablet 1 time a day as prescribed by your doctor.
•   You may sometimes pass a soft mass in your stools (bowel movement) that looks like your nevirapine extended-release tablets. This will not affect the way your medicine works.

What are the possible side effects of nevirapine?

Nevirapine may cause serious side effects, including:

See "What is the most important information I should know about nevirapine?"

•   Changes in your immune system (Immune Reconstitution Syndrome) can happen when you start taking HIV-1 medicines. Your immune system may get stronger and begin to fight infections that have been hidden in your body for a long time. Tell your doctor right away if you start having new symptoms after starting your HIV-1 medicine.
•   Changes in body fat can happen in people who take HIV-1 medicines. These changes may include increased amount of fat in the upper back and neck ("buffalo hump"), breast, and around the middle of your body (trunk). Loss of fat from your legs, arms, and face may also happen. The exact cause and long-term health effects of these conditions are not known.

The most common side effect of nevirapine is rash.

Nevirapine may cause decreased fertility in females. Talk to your doctor if you have concerns about fertility.

These are not all the possible side effects of nevirapine. For more information, ask your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

How should I store nevirapine tablets?

•   Store nevirapine tablets at room temperature, between 20°C to 25°C (68°F to 77°F).
•   Throw away nevirapine tablets that are no longer needed or out-of-date.

Keep nevirapine tablets and all medicines out of the reach of children.

General information about the safe and effective use of nevirapine tablets

Medicines are sometimes prescribed for purposes other than those listed in a Medication Guide. Do not take nevirapine for a condition for which it was not prescribed. Do not give nevirapine tablets to other people, even if they have the same condition you have. It may harm them. You can ask your pharmacist or doctor for information about nevirapine that is written for health professionals.

For more information, go to www.cipla.com or call Cipla Limited at 1-866-604-3268.

What are the ingredients in nevirapine tablets?

Active Ingredient: Nevirapine

Inactive ingredients:

Nevirapine Tablets USP 200 mg: microcrystalline cellulose (Avicel pH 101), corn starch, lactose monohydrate (lactose 200), sodium starch glycolate (primojel) and magnesium stearate.

This Medication Guide has been approved by the U.S. Food and Drug Administration.

CIPLA LTD.

Verna Industrial Estate,

Goa 403722

INDIA

Revised: 10/ 2018