Viramune tablets, prolonged-release tablets and suspension all contain the active ingredient nevirapine, which is a type of medicine called a non-nucleoside reverse transcriptase inhibitor.

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Serum levels of nevirapine can be reduced by concomitant use of the herbal preparation StJohn’s WortHypericum perforatumThis is due to induction of medicinal product metabolism enzymes and/or transport proteins by StJohn’s Wort.

If clinical hepatitis occurscharacterised by anorexianauseavomitingicterus AND laboratory findingssuch as moderate or severe liver function test abnormalitiesexcluding GGTnevirapine must be permanently stoppedViramune must not be readministered to patients who have required permanent discontinuation for clinical hepatitis due to nevirapine.

The concomitant administration of Viramune with NNRTIs is not recommendedsee section 4.4

Herbal preparations containing StJohn’s Wort and Viramune must not be co-administeredsee section 4.3If a patient is already taking StJohn’s Wort check nevirapine and if possible viral levels and stop StJohn’s WortNevirapine levels may increase on stopping StJohn’s WortThe dose of Viramune may need adjustingThe inducing effect may persist for at least 2 weeks after cessation of treatment with StJohn’s Wort.

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