Definitions

Mild or moderate rash may include:

• Erythema
• Diffuse erythematous or maculopapular rash

Severe rash may include:

• Extensive erythematous or maculopapular rash
• Rash with moist desquamation
• Rash with angioedema
• Serum sickness-like reaction
• Stevens-Johnson Syndrome
• Toxic Epidermal Necrolysis (TEN)

Urticaria: Pruritic raised rash with welts (may be mild, moderate, or severe)

Constitutional symptoms include fever, blistering, oral erosive lesions, conjunctivitis, facial edema and myalgia/arthralgia

Time to Onset of Rash1

 

The risk of rash of any severity was greatest in the first 6 weeks

Incidence of Rash1

In controlled clinical trials, the frequency of rash was 14.8% compared with 5.9% in controls

The overall frequency of severe rash is 1.5%

Stevens-Johnson Syndrome (SJS) is estimated to occur in 0.3% (C.I. 0-0.5%)

Risk Factors for Rash Development1

 

Women appear to be at higher risk of developing rash than men

Patient Management

The recommended 14-day, 200 mg once-daily lead-in dose, prior to escalation to200 mg twice daily, has been shown to reduce the frequency of rash and must be strictly followed

Do not increase the dose of Nevirapine in the presence of rash

If Nevirapine is interrupted for >7days, reintroduce with the 14-day, 200 mg once-daily lead-in dose

It is suggested that Nevirapine and other medications that often cause rash {e.g., Abacavir, trimethoprim-sulfamethoxazole} should not be started simultaneously

Prednisone should not be used to prevent rash. Prednisone administration during the first 2 weeks of therapy with Nevirapine appears to increase the incidence of rash

Antihistamines do not appear to be effective in preventing rash with Nevirapine