Liverpool HIV Interactions

No Interaction Expected

Nevirapine (NVP)

Lamivudine (3TC)

Quality of Evidence: Low

Summary:

Lamivudine and nevirapine can be coadministered without dose adjustments. Coadministration revealed no changes to lamivudine apparent clearance and volume of distribution, suggesting no induction effect of nevirapine on lamivudine clearance. Note, the bioavailability of 3TC solution has been shown to be significantly reduced in a dose dependent manner by sorbitol which is present in liquid formulations such as nevirapine oral suspension.

Description:

When nevirapine and lamivudine (150 mg twice daily) were coadministered, there were no changes to lamivudine apparent clearance and volume of distribution, suggesting no induction effect of nevirapine on lamivudine clearance. Lamivudine and nevirapine can be coadministered without dose adjustments.

Viramune Summary of Product Characteristics, Boehringer Ingelheim Ltd, November 2019.

Coadministration of sorbitol solution (3.2 g, 10.2 g, 13.4 g) with a single 300 mg dose of lamivudine oral solution resulted in dose-dependent decreases of 14%, 32%, and 36% in lamivudine exposure (AUC) and 28%, 52%, and 55% in the Cmax of lamivudine in adults. When possible, avoid chronic coadministration of Epivir with medicinal products containing sorbitol. Consider more frequent monitoring of HIV-1 viral load when chronic coadministration cannot be avoided.

Epivir Summary of Product Characteristics, ViiV Healthcare UK Ltd, February 2019.

Coadministration of single doses of lamivudine and sorbitol resulted in a sorbitol dose-dependent reduction in lamivudine exposures. When possible, avoid use of sorbitol-containing medicines with lamivudine. Lamivudine and sorbitol solutions were coadministered to 16 healthy adult subjects in an open-label, randomized-sequence, 4-period, crossover trial. Each subject received a single 300-mg dose of lamivudine oral solution alone or coadministered with a single dose of 3.2 grams, 10.2 grams, or 13.4 grams of sorbitol in solution. Coadministration of lamivudine with sorbitol resulted in dose-dependent decreases of 20%, 39%, and 44% in the AUC(0-24), 14%, 32%, and 36% in the AUC(infinity), and 28%, 52%, and 55% in the Cmax; of lamivudine, respectively.

Epivir US Prescribing Information, ViiV Healthcare, May 2019.

The pharmacokinetics of lamivudine (150 mg twice daily) were determined using non-linear mixed effects modelling on samples from HIV-infected subjects receiving lamivudine alone (n=47) or with nevirapine (200 mg twice daily, n=43). The results of the modelling analysis revealed that nevirapine had no effect on the pharmacokinetics of lamivudine. The pharmacokinetics of nevirapine were consistent with those of several earlier trials.
Pharmacokinetics of nevirapine and lamivudine in patients with HIV-1 infection. Sabo JP et al. AAPS Pharm Sci, 2002, 2: E1.

The effect of sorbitol on the single dose pharmacokinetics of 3TC oral solution was evaluated in 16 HIV-negative subjects. Sorbitol had a dose-dependent effect on 3TC PK with decreases of 28%, 52%, and 55% in Cmax and decreases of 20%, 39%, and 44% in AUC when co-administered with 3.2 g, 10.2 g, and 13.4 g sorbitol, respectively.
Effect of sorbitol on 3TC PK after administration of lamivudine solution in adults. Adkinson KK, McCoig C, Wolstenholm A, et al. CROI 2017, Seattle USA, February 2017, abstract 428.

View all available interactions with Nevirapine (NVP) by clicking here.