Children

Nevirapine (Viramune) is licensed in Europe and the United States for the treatment of HIV infection in infants and children. In 2008, the US Food and Drug Administration (FDA) advised that babies and children receive nevirapine dosing according to body surface area rather than weight.1

Recommended oral dosing during the lead-in (or induction) stage is 150mg per metre2 of body surface area once daily for 14 days. Following induction, the same dose is given every 12 hours. Younger children may require a higher dosage (e.g. 200mg per metre2 of body surface area twice daily), as clearance in children under the age of nine is faster than it is in older children or adults. The maximum daily limit should not exceed 400mg.

The Mosteller formula is used to calculate dosing: BSA(m2) = √Height (cm) x Wt (kg)/3600. Body surface area calculations for the use of the nevirapine oral suspension (50mg/5ml) are as follows:

  • 0.06 to 0.12 m2      12.5mg
  • 0.12 to 0.25 m2       25mg
  • 0.25 to 0.42 m2       50mg
  • 0.42 to 0.58 m2       75mg
  • 0.58 to 0.75 m2      100mg
  • 0.75 to 0.92 m2      125mg
  • 0.92 to 1.08 m2      150mg
  • 1.08 to 1.25 m2      175mg
  • 1.25+ m2                200mg

Nevirapine appears to be safe, effective and well tolerated in children from birth, although no large, randomised studies comparing a NVP-based regimen to other regimens have been reported.2 3 4 Side-effects are similar in children and adults.5

References

  1. Klein R et al. Important changes to Viramune (nevirapine) oral solution and tablets. FDA release, 27 June 2008, 2008
  2. Verweel G et al. Nevirapine use in HIV-1-infected children. AIDS 17: 1639-1647, 2003
  3. Luzuriaga K et al. Combination treatment with zidovudine, didanosine, and nevirapine in infants with human immunodeficiency virus type 1 infection. N Engl J Med 336: 1343-1349, 1997
  4. Janssens B et al. Effectiveness of highly active antiretroviral therapy in HIV-positive children: evaluation at 12 months in a routine program in Cambodia. Pediatrics 120(5): e1134-1140, 2007
  5. Baylor M et al. Hepatotoxicity associated with nevirapine use in HIV-infected children. Twelfth Conference on Retroviruses and Opportunistic Infections, Boston, abstract 776, 2005
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