Nevirapine and the Risk of Stevens Johnsons Syndrome

Nevirapine and the risk of Stevens±Johns [attached]

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– Nevirapine Toxicity. Yes, that’s the result of an Aids drug. Yes, we give it to human beings.

The characteristics of the 15 patients exposed to nevirapine are presented in Table 1. They were four women and 11 men aged 21±59 years (median, 35 years), 10 were from France, three were from Germany, one was from the Netherlands and one was from Italy. The most recent counts of CD4 cells ranged from 4 to 1033 3 106/l (median, 234 3 106/l).

All patients had mucous membrane erosions. The detachment of epidermis involved 4±55% of the body surface area (median, 25%). One patient died from SJS/TEN overlap.

The reaction began 10±240 days after the introduction of nevirapine (median 12 days). All patients had initially received a daily dose of 200 mg (one tablet) according to the recommendation of a lead-in period. For 10 out of 15 patients the reaction began when they were still taking this initial dosage.

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Considering the high risks of severe cutaneous adverse reactions associated with nevirapine; the long elimination half-life of this drug (25±30 h); and the existence of alternative drugs with lower risk of severe skin reactions, we suggest reconsideration of the `treating through’ attitude and recommend withdrawing nevirapine if any cutaneous eruption occurs during the first month of treatment.

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