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Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents with HIV

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Adult and Adolescent ARV
Characteristics of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) (Brief)

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

Appendix B: Drug Characteristics Tables

Characteristics of Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs)

Last Updated: July 10, 2019; Last Reviewed: July 10, 2019

Appendix B, Table 4. Characteristics of Non-Nucleoside Reverse Transcriptase Inhibitors
Generic Name (Abbreviation) Trade Name	Formulations	Dosing Recommendations^a	Elimination/ Metabolic Pathway	Serum Half-Life	Adverse Events^b
Doravirine (DOR) Pifeltro	Pifeltro: 100 mg tablet Also available as part of the STR Delstrigo (DOR/TDF/3TC)^c	Pifeltro: One tablet once daily See Appendix B, Table 1 for dosing information for Delstrigo.	CYP3A4/5 substrate	15 hours	Nausea Dizziness Abnormal dreams
Efavirenz (EFV) Sustiva Note: Generic is available.	Sustiva: 50 and 200 mg capsules 600 mg tablet Generic: 600 mg tablet STRs that Contain EFV:^c Atripla (EFV/TDF/FTC) Symfi (EFV 600 mg/TDF/3TC) Symfi Lo (EFV 400 mg/TDF/3TC)	Sustiva: EFV 600 mg once daily, at or before bedtime Take on an empty stomach to reduce side effects See Appendix B, Table 1 for dosing information for STRs that contain EFV.	Metabolized by CYP2B6 (primary), 3A4, and 2A6 CYP3A4 mixed inducer/inhibitor (more an inducer than an inhibitor) CYP2B6 and 2C19 inducer	40–55 hours	Rash^d Neuropsychiatric symptoms^e Serum transaminase elevations Hyperlipidemia Use of EFV may lead to false-positive results with some cannabinoid and benzodiazepine screening assays QT interval prolongation
Etravirine (ETR) Intelence	Intelence: 25, 100, and 200 mg tablets	Intelence: ETR 200 mg twice daily Take following a meal.	CYP3A4, 2C9, and 2C19 substrate CYP3A4 inducer CYP2C9 and 2C19 inhibitor	41 hours	Rash, including Stevens-Johnson syndrome^d HSRs, characterized by rash, constitutional findings, and sometimes organ dysfunction (including hepatic failure), have been reported. Nausea
Nevirapine (NVP) Viramune or Viramune XR Note: Generic 200-mg tablets and oral suspension are available.	Viramune: 200 mg tablet 50 mg/5 mL oral suspension Viramune XR: 400 mg tablet	Viramune: NVP 200 mg once daily for 14 days (lead-in period); thereafter, NVP 200 mg twice daily, or NVP 400 mg (Viramune XR tablet) once daily Take without regard to meals. Repeat lead-in period if therapy is discontinued for >7 days. In patients who develop mild-to-moderate rash without constitutional symptoms, continue lead-in period until rash resolves, but do not administer for longer than 28 days total.	CYP450 substrate CYP3A4 and 2B6 inducer Contraindicated in patients with moderate to severe hepatic impairment. Dose adjustment is recommended in patients on hemodialysis (see Appendix B, Table 10).	25–30 hours	Rash, including Stevens-Johnson syndrome^d Symptomatic Hepatitis: Symptomatic hepatitis, including fatal hepatic necrosis, has been reported. Rash has been reported in approximately 50% of cases. Symptomatic hepatitis occurs at a significantly higher frequency in ARV-naive female patients with pre-NVP CD4 counts >250 cells/mm³ and in ARV-naive male patients with pre-NVP CD4 counts >400 cells/mm³. NVP should not be initiated in these patients unless the benefit clearly outweighs the risk.
Rilpivirine (RPV) Edurant	Edurant: 25 mg tablet STRs that Contain RPV:^c Complera (RPV/TDF/FTC) Juluca (DTG/RPV) Odefsey (RPV/TAF/FTC)	Edurant: RPV 25 mg once daily Take with a meal. See Appendix B, Table 1 for dosing information for STRs that contain RPV.	CYP3A4 substrate	50 hours	Rash^d Depression, insomnia, headache Hepatotoxicity QT interval prolongation
^a For dose adjustments in patients with renal or hepatic insufficiency, see Appendix B, Table 10. When no food restriction is listed, the ARV drug can be taken with or without food. ^b Also see Table 17. ^c See Appendix B, Table 1 for information about these formulations. ^d Rare cases of Stevens-Johnson syndrome have been reported with the use of most NNRTIs; the highest incidence of rash was seen among patients who were receiving NVP. ^e Adverse events can include dizziness, somnolence, insomnia, abnormal dreams, depression, suicidality (e.g., suicide, suicide attempt or ideation), confusion, abnormal thinking, impaired concentration, amnesia, agitation, depersonalization, hallucinations, and euphoria. Approximately 50% of patients receiving EFV may experience any of these symptoms. Symptoms usually subside spontaneously after 2–4 weeks but may necessitate discontinuation of EFV in a small percentage of patients. Key: 3TC = lamivudine; ARV = antiretroviral; CD4 = CD4 T lymphocyte; CYP = cytochrome P; DOR = doravirine; DTG = dolutegravir; EFV = efavirenz; ETR = etravirine; FDC = fixed-dose combination; FTC = emtricitabine; HSR = hypersensitivity reaction; NNRTI = non-nucleoside reverse transcriptase inhibitor; NVP = nevirapine; RPV = rilpivirine; STR = single-tablet regimen; TAF = tenofovir alafenamide; TDF = tenofovir disoproxil fumarate; XR = extended release

Appendix B, Table 4. Characteristics of Non-Nucleoside Reverse Transcriptase Inhibitors

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