AEGiS-GMHC: Treatment Briefs: Nevirapine and Delavirdine Plus Protease Inhibitors

Important note: Information in this article was accurate in 1996. The state of the art may have changed since the publication date.

Treatment Briefs: Nevirapine and Delavirdine Plus Protease Inhibitors

GMHC Treatment Issues, Vol. 10, No. 4 - April 1996

Expanded access programs for the two nonnucleoside reverse transcriptase inhibitors (NNRTIs) nevirapine and delavirdine are now up and running (call 800/595-5494 for nevirapine and 800/779-0070 for delavirdine), and an FDA advisory committee hearing is scheduled for June 7 to review nevirapine's marketing application. People may be tempted to combine the NNRTIs with protease inhibitors to achieve greater, more durable HIV suppression. Like the protease inhibitors, nevirapine and delavirdine are metabolized by the liver, though, and so such combinations may alter the normal blood levels of each component drug.

Delavirdine inhibits the way the liver breaks down certain drugs and may raise blood levels of protease inhibitors. Nevirapine, an inducer of liver activity, could have the opposite effect. Changing protease inhibitor blood levels can sharply alter their activity and side effects, thus, necessitating dose adjustments (as with the ritonavir/saquinavir combination above).

Pharmacia & Upjohn, the maker of delavirdine, and Boehringer Ingelheim, maker of nevirapine, both predict that their drugs will most likely affect the blood levels of saquinavir and are now conducting pharmacokinetic studies of these combinations. More information will be available by this summer.

Co-administration of delavirdine and ritonavir may increase blood levels of either drug. Given the toxicity of ritonavir, it is advisable to wait before trying the combination until safety and the necessary dose adjustments are established. The pharmacokinetic study to accomplish this should be underway in May, Pharmacia & Upjohn says.

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