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Once-daily Nevirapine Has More Side-effects Than Twice-daily Dose

arable between the once-daily and twice-daily treated patients.

However, they also found that there was a trend for patients who were taking the drug once daily to be more likely to change therapy than those who were taking a twice-daily dose of nevirapine (29% versus 22%). They suggest that this could be because of a greater incidence of side-effects.

More patients experienced liver abnormalities in the once-daily group compared with twice-daily nevirapine (14% versus 8%; p=0.036). Also more patients in the once-daily group temporarily or permanently discontinued therapy because of rash (12% versus 7%).

Other smaller clinical trials were considered in the review. Each found that there was no statistically significant difference in the efficacy of once-daily and twice-daily nevirapine. In two of these studies there were also no differences in the frequency of adverse events between once and twice-daily regimens. A further study did, however, highlight a difference in frequency of adverse events between once- and twice-daily dosing of nevirapine.

This study involved 196 patients to investigate the safety and efficacy of switching from various twice-daily regimens (with or without nevirapine) to once-daily nevirapine (400mg), ddI (400mg) and tenofovir (300mg). In this study, adverse events leading to treatment discontinuation were more common in the once-daily group. After 48 weeks, three patients (4%) who continued twice-daily dosing stopped therapy versus twelve individuals (14%) who switched to once-daily dosing. The reasons for treatment discontinuation were: five cases of nevirapine-related hepatitis, two of acute pancreatitis, two of skin rash, two of dry mouth and one of peripheral neuropathy.

“Unfortunately, when compared with twice-daily dosing, antiretroviral regimens in which nevirapine is dosed at 400mg once daily immediately after a 2-week lead-in period are associated with an increased risk
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