What Is Nevirapine? Uses, Dosage, and What You Need to Know in 2026

Nevirapine is one of the oldest HIV medications still in use today. First approved by the FDA in 1996, it was a landmark achievement in HIV treatment — and for many years was a cornerstone of antiretroviral therapy worldwide. While newer options have largely replaced it in current U.S. guidelines, nevirapine remains an important drug for specific patient populations. Here's what you need to know.

What Is Nevirapine?

Nevirapine is an antiviral prescription medication used to treat HIV-1 (human immunodeficiency virus type 1) infection. It belongs to a class of drugs called non-nucleoside reverse transcriptase inhibitors (NNRTIs). It was originally sold under the brand names Viramune (immediate-release) and Viramune XR (extended-release), both now discontinued, with multiple generic versions available from manufacturers like Aurobindo, Camber, and Macleods.

Nevirapine is always taken in combination with other HIV medications — never alone. Using it as monotherapy leads to rapid development of HIV resistance.

What Is Nevirapine Used For?

The FDA-approved uses of nevirapine include:

HIV-1 treatment: Approved for adults and pediatric patients as young as 15 days old (for the suspension) or 6 years old (for extended-release tablets), in combination with other antiretrovirals

Prevention of mother-to-child HIV transmission: Can be used during labor and in newborns to reduce the risk of perinatal HIV transmission

Nevirapine is NOT approved for HIV post-exposure prophylaxis (PEP), HIV pre-exposure prophylaxis (PrEP), or treatment of HIV-2.

Available Dosage Forms

Nevirapine is available in three forms:

Immediate-release tablet (200 mg): For adults and pediatric patients ≥15 days old; taken once or twice daily depending on stage of therapy

Extended-release tablet (400 mg): For adults and pediatric patients ≥6 years old; taken once daily; swallow whole — do not crush or chew

Oral suspension (10 mg/mL): For infants (≥15 days), children, and adults who cannot swallow tablets; shake well before each use

How to Take Nevirapine: The 14-Day Lead-In

One of the most distinctive aspects of nevirapine dosing is the mandatory 14-day lead-in period:

Days 1–14: Take nevirapine 200 mg once daily (immediate-release tablet or suspension)

Day 15 and beyond: Increase to 200 mg twice daily (immediate-release) OR switch to 400 mg once daily (extended-release)

This gradual start has been proven to reduce the frequency of rash. If you develop a rash during the lead-in period, do not increase your dose until the rash resolves and your provider evaluates it. The total daily dose should never exceed 400 mg.

Nevirapine can be taken with or without food.

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Is Nevirapine Still Used in 2026?

Yes — but its role has narrowed. Nevirapine is no longer a preferred or recommended alternative for treatment-naive adults in current U.S. (DHHS) guidelines due to its hepatotoxicity risk and the availability of better-tolerated options. However, it remains important in:

Patients who have been virologically suppressed on nevirapine for years and are tolerating it well

Pediatric HIV care, particularly in resource-limited settings

Prevention of mother-to-child HIV transmission

Low- and middle-income countries where cost makes it one of the few accessible options

Key Safety Information

Nevirapine carries two FDA boxed warnings — the agency's strongest alert level:

Hepatotoxicity: Potentially fatal liver damage, especially in the first 18 weeks. Higher risk in women with CD4>250 and men with CD4>400.

Severe skin reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis, and hypersensitivity reactions can be life-threatening.

For a full side effects guide, see: nevirapine side effects — what to expect and when to call your doctor.