Instructions for Nevirapine Use in Prevention of HIV Transmission from Mothers to Infants

Fact Sheet

The dose of nevirapine for the mother is 200 mg (one tablet) as a single dose at the onset of labor or at least 2 hours prior to a Cesarean section. It is very important to administer the nevirapine at the onset of labor and not during delivery since adequate levels of nevirapine may not be achieved in the mother for placental transfer to the infant if the dose is too close to the time of delivery. If more than 48 hours have elapsed since the dose of nevirapine and delivery has not yet occurred, a second dose of nevirapine should be administered.

Many health-care professionals give a single capsule of nevirapine to the mother to keep at home to take as soon as labor begins. If a mother has taken nevirapine at the onset of labor and delivery has not occurred within 48 hours, a second dose of 200 mg of nevirapine should be taken when labor is progressing. The nevirapine capsule should be kept in a safe location, kept away from light, and instructions should be given that the nevirapine is not to be used for any purpose other than prevention of HIV transmission to the infant.

The nevirapine dose for the infant is a single dose given between 48 and 72 hours after birth to maximize the duration of adequate nevirapine blood levels in the infant (see below for dose based on infant weight). If the mother and infant are to go home before 48 hours, then the infant's nevirapine dose can be administered just before the mother and infant leave. If the mother received her nevirapine dose less than 2 hours before delivery, then the infant should be given a dose of nevirapine immediately after birth, followed by the usual infant postnatal dose as described below.( 1 )

Infant dosing of nevirapine:

• If infant weighs 2000 grams or more, give nevirapine solution 0.6 mL (6 mg) by mouth.
• If infant weighs less than 2000 grams, give nevirapine solution 0.2 mL/kg (2 mg/kg) by mouth.

The concentration of nevirapine syrup is 50 mg/5 mL (10 mg/mL). To measure the amount for an infant, a sterile syringe should be used with care not to contaminate the bottle. The nevirapine syrup is stable at room temperature but should not be kept in the light. To prevent contamination of the bottle it is preferable to divide the contents into smaller containers since the bottle contains sufficient nevirapine syrup for more than 100 infants. However, the stability of nevirapine in small containers is unknown at this time.

In the clinical trial of nevirapine for prevention of mother-to-infant transmission in Uganda, breast-feeding was continued.( 2 ) Follow-up studies indicated that the beneficial effect of nevirapine in HIV prevention was observed even when breast-feeding continued until 18 months of age.( 3 ) However if there is an option to safely formula feed the infant, doing so will decrease the likelihood of the infant becoming infected with HIV.

In studies conducted in the United States, Europe, and Africa, the use of this nevirapine regimen to reduce mother-to-child transmission has not been associated with adverse side effects in women and infants. However, the development of viral resistance to nevirapine has been observed in approximately 19% of women and 46% of their HIV-infected infants 6 to 8 weeks after single-dose nevirapine treatment.( 4 ) The long-term consequences of this observation are unknown at this time.

Drugs of the non-nucleoside reverse transcriptase inhibitor (NNRTI) class, which includes nevirapine, are not active against HIV-2, and should not be used to treat or prevent HIV-2 infection.

Infant Weight/Dose Calculation Chart

References