IUPAC name 11-cyclopropyl-4-methyl-5,11-dihydro-6H-dipyrido 1,4diazepin-6-one. Formula C15H14N4O. Nevirapine, also marketed under the trade name Viramune by Boehringer Ingelheim, is a non-nucleoside reverse transcriptase inhibitor (NNRTI) used to treat HIV-1 infection and AIDS.
As with other antiretroviral drugs, HIV rapidly develops resistance if nevirapine is used alone, so recommended therapy consists of combinations of three or more antiretrovirals.
Nevirapine in triple combination therapy has been shown to suppress viral load effectively when used as initial antiretroviral therapy. Some clinical trials have demonstrated comparable HIV suppression with nevirapine-based regimens to that achieved with protease inhibitors or efavirenz. Although concerns have been raised about nevirapine-based regimens in those starting therapy with high viral load or low CD4 count, some analyses suggest that nevirapine may be effective in these patients.
Nevirapine may also form a useful component of salvage regimens after virological failure, usually in combination with one or more PIs as well as nRTIs, especially in those who have not previously taken an NNRTI.
The most common adverse effect of nevirapine is the development of mild or moderate rash, observed in 13% of patients. Severe or life-threatening skin reactions have been observed in 1.5% of patients, including Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity. Nevirapine may cause severe or life-threatening liver toxicity, usually emerging in the first six weeks of treatment. All prior information have been sourced from Wikipedia.
At the RITM, I was initially put on a once-a-day dosage of Nevirapine. I had surpassed the two week trial period, and had graduated onto a twice-a-day regimen, at which point I had started experiencing low-grade fevers in the first couple of days. On the fifth day, however, my fever went up into the 40s, and at that point I was instructed to stop taking it, and to report as soon as possible to the RITM. Apparently I had begun experiencing allergic reactions to the drug, which was later on replaced with Efavirenz. I was able to observe rashes as well, even around five days after stopping the Nevirapine. The rash has subsided since, not really being too noticeable to begin with. Dealing with Nevirapine is not impossible, as I had met at least one other person who was well into the treatment, and not experiencing any allergic reactions.
One thing I was looking forward to with Nevirapine, is that people who were on it are said to tend to gain weight, a huge fantasy for a hard gainer as myself. Too bad it didn't work out.
Tuesday, September 16, 2008
Nevirapine
Tuesday, September 09, 2008
Oh Efa, My Efa
Efavirenz. We’d actually met long before it became part of my own regimen.
The first time U and I met, we watched a movie together. The movie time just happened to encompass the time he was supposed to take his medicines. He had accidentally dropped his Efavirenz inside the theater, and he couldn’t figure out where it went. We waited for the end of the movie when all the other people in our row had stood and left. With our cellphones as lights, we started searching under the seats for his tablet. I asked him what it looked like, having no idea. He said it was a small, yellow tablet. I picked up something small and yellow. Good thing I didn’t shout that I’d found it, because I realized all I had in my hand was an unpopped kernel of corn which just may have come from heaven knows whose mouth. Recalling that incident still makes me giggle, with a bit of embarrassment as well.
So how was my first night through Efavirenz? I can’t really say. It’s a pretty cloudy picture. Here’s the deal, I took my first tablet last night at 9:30, along with the Lamivudine+Zidovudine. I was lights out by 10:00 pm. I left a small night light on in the room, just in case I wake up suddenly wondering where I am.
All I can recall is a whole lot of tossing and turning. I even remember telling myself I’d have to kill someone for keeping me up that late. The last time I checked the time it was past 1:00 am. At some point, I was lying in a plate of food, trying to split it into four portions... with my body. And of all things, it was adobo... chicken adobo. I do not have any particular addiction to chicken adobo. I found it a bit weird that I could recall it that vividly.
I’m not sure for which parts of the night I was actually awake or not, but I never ever recalled losing sight of my night light. So it’s either I had carried it over into my dream, or I hadn’t slept a wink. I honestly cannot figure it out. If only based on the headache I have right now and the bags under my eyes, I don’t think I slept a minute. Everything is just so fuzzy.
Hopefully, with the wear of still recovering from the Nevirapine, plus the possibility of two whole days without rest behind me by tonight, I’ll surely be seeing the sandman.
Monday, September 08, 2008
Dream, Dream, Dream
I haven’t really been able to blog lately, not by any choice of my own, I was just literally physically unable to blog.
I had taken the trip out to the RITM mid-week last week. Half of my purpose was to introduce my new friend to the RITM, as he’d be starting his own journey very soon. The other half of my purpose was to update them on how I was doing with my meds.
I had started my double dose September 2nd, and was experiencing low-grade fevers the two days following. Sadly we didn’t catch the doctor, since she had a personal emergency she had needed to take care of. Instead Ate contacted her via mobile, and it was agreed that I’d try to continue the medication, and if anything else comes up or gets worse, I’d just inform them and they’d decide whether I was to stop or not.
And indeed, worse was it. Friday caught me down with the weather at work, where I was struggling to get through even the final few hours at work. I had a fever, which felt worse than my usual. I didn’t have my thermometer with me, so I had no way of telling. I had even gone up to the lobby of an upper floor to rest my eyes. I was feeling that bad.
Getting home, I locked myself in my room, and my trusty thermometer read a 39-degree fever. Still I wouldn’t give up and continued taking my medicines that evening.
Saturday morning came, and I still had the fever, this time it was up to 40 degrees. I realized that my thermometer could only read up to 42 degrees, so I was pretty alarmed. I didn’t even mind that it was just 7 in the morning, I sent a text message to Ate, to which she immediately replied for me to stop the Nevirapine and report to the RITM come Monday.
You’d think my problems were over, but the fever was hell. I felt half-dead and half-dying. Having no airconditioning, no fan, layered with a sweater and a blanket did nothing. The chills were coming from deep inside. I felt I needed to swallow a blanket or kill whatever vents were inside me. I just felt helpless.
I was locked in my room most of the weekend, tossing and turning in discomfort, sneaking in an occasional cold shower to disperse the fever I was experiencing. Monday, I called in to work sick, and just headed to the RITM in the afternoon. I still had a significant fever, and my body just felt so heavy. Each step felt ten times more of an effort to make. I figure I must’ve been walking like I had a hangover.
The verdict? The doctor concluded I was showing allergic reactions to the Nevirapine. Though I didn’t really see signs of being counted as the 103rd Dalmatian, the doctor did notice I was reddish around the face, something which I do not normally get, as I can only be dark or darker. I was just lucky enough I guess that it was an even color, something less noticeable that the kinds of rashes I’ve seen.
I ended up surrendering what Nevirapine I had left, which was one unopened bottle and about half of another, trading it in for my new best friend, Efavirenz. Yes, yes, the dreaming drug. One huge difference is that it’s only taken once a day. Some things I was told to watch out for are dizziness and the dreams, of course. Some people describe the dreams as very realistic, in full-color, plus they say the dreams are usually resumed in cases where you wake up in the middle of one. The doctor also warned me that in standard drug tests, Efavirenz causes false positives for Marijuana, which is never a good thing. So if ever the need arises, it should be advised to the laboratory prior, so they can proceed to a confirmatory test, for which it should turn out negative. Good thing I’m not due to get my license renewed for another three years.
As I’m writing this, I’m feeling a bit better. Less of a headache, and lower fever. I’m hoping this is a good sign, so I can report back to work tomorrow. For now, I’m almost due for my first dose of my new regimen. And boy, am I ready to dream!
