Nevirapine
=============

**PD Dialyzability**: Likely

Pharmacokinetic Parameters [1]_ [2]_ [3]_
------------------------------------------

======= ======
/////// |pk|
======= ======
|pk1|   |v1|
|pk2|   |v2|
|pk3|   |v3|
|pk4|   |v4|
|pk5|   |v5|
|pk6|   |v6|
|pk7|   |v7|
======= ====== 

CAPD/CCPD Dosing:
------------------------------

No large studies are available to provide dosing recommendations for nevirapine in PD patients. Two case reports suggest nevirapine 200 mg PO BID can be recommended in the PD population [4]_ [5]_. However, given extensive hepatic metabolism and minimal renal elimination of unchanged drug, it is unlikely that dosage adjustment is required.  

Literature Summary:
---------------------------

+----------+------------+----------------+--------------+---------------------+
| Title    | Patient    | Intervention   | Outcome      | Note                |
+==========+============+================+==============+=====================+
| |L1|     | * |L2|     | * |L3|         | * |L4|       | * |L5|              |
| [4]_     |            |                | * |L6|       |                     |
|          |            |                | * |L7|       |                     |
|          |            |                | * |L8|       |                     |
+----------+------------+----------------+--------------+---------------------+
| |L9|     | * |L10|    | * |L11|        | * |L12|      | * |L13|             |
| [5]_     |            |                | * |L14|      |                     |
|          |            |                | * |L15|      |                     |
+----------+------------+----------------+--------------+---------------------+ 


References
------------

.. [1] Foisy M, Tseng A. Selected properties of nevirapine. Immunodeficiency clinic [Internet]. 2014 Dec [cited 2018 Feb 25]. 1-8. Available from www.hivclinic.ca. 

.. [2] Wishart DS, Knox C, Guo AC, Shrivastava S, Hassanali M, Stothard P, et al. Drugbank: a comprehensive resource for in silico drug discovery and exploration. Nucleic Acids Res. 2006 Jan 1: 34(database issue):D668-672.

.. [3] Adult Drug Book. Kidney Disease Program [Internet]. Unknown [cited 2018 Feb 20]. Available from: https://kdpnet.kdp.louisville.edu/drugbook/adult/

.. [4] Taylor S, Little J, Halifax K, Drake S, Back D. Pharmacokinetics of nelfinavir and nevirapine in a patient with end-stage renal failure on continuous ambulatory peritoneal dialysis. J Antimicrob Chemother 2000;45(5):716-717. 

.. [5] Izzedine H, Launay-Vacher V, Deray G. Pharmacokinetics of ritonavir and nevirapine in peritoneal dialysis. Nephrol Dial Transplant 2001;16(3):643. 

.. |pk| replace:: Nevirapine
.. |pk1| replace:: Molecular Weight (Da)  
.. |pk2| replace:: Plasma Protein Binding (%)
.. |pk3| replace:: Volume of Distribution (L/Kg) 
.. |pk4| replace:: Hepatic Metabolism 
.. |pk5| replace:: Excreted Unchanged (%) 
.. |pk6| replace:: Half-Life; Normal Renal Function (hours)
.. |pk7| replace:: Half-Life; ESRD (hours) 
.. |v1| replace:: 266.3
.. |v2| replace:: 50 - 60
.. |v3| replace:: 1.2 - 1.4
.. |v4| replace:: > 95% metabolism via CYP3A4 (major), CYP2B6 (minor)
.. |v5| replace:: < 3
.. |v6| replace:: 23
.. |v7| replace:: 23 
.. |L1| replace:: Pharmacokinetics of nelfinavir and nevirapine in a patient with end-stage renal failure on continuous ambulatory peritoneal dialysis
.. |L2| replace:: 34 year old HIV postive female. CrCl < 10 mL/min. ESRD secondary to chronic pyelonephritis on CAPD.
.. |L3| replace:: Nevirapine 200mg BID + nelfinavir 1250mg BID +  zidovudine 250mg BID
.. |L4| replace:: Concentrations in dialysate were ~50% of those in plasma
.. |L5| replace:: No adverse effects reported over 16 weeks
.. |L6| replace:: Approximately 16 mg of nevirapine lost through dialysate in 24-hour period. 
.. |L7| replace:: Following 12 weeks of treatment: CD4+ (x103 cells/L): 110🡪 240 Viral load (RNA copies/mL): 88000 at baseline 🡪 <50 
.. |L8| replace:: Plasma trough concentrations were similar to those found in study where patients received nevirapine 200mg once daily.
.. |L9| replace:: Pharmacokinetics of ritonavir and nevirapine in peritoneal dialysis 
.. |L10| replace:: 40 year old HIV positive male. On CAPD, ESRD secondary to HIV-associated nephropathy
.. |L11| replace:: Nevirapine 200mg q12h + ritonavir 600mg q12h + zidovudine 100mg q8h + didanosine 100mg q24h
.. |L12| replace:: No change in PK parameters in comparison to normal renal function, except AUC was increased. 
.. |L13| replace:: No adverse effects seen during study 
.. |L14| replace:: Extraction ratio (%): 51.9%
.. |L15| replace:: PD Clearance (ml/min): 3.3mL/min