Nevirapine Dosing in Newborns for Prevention of Mother-to-Child HIV Transmission
The recommended dose of nevirapine syrup for newborns to prevent mother-to-child HIV transmission is 2 mg/kg oral suspension as a single dose immediately after birth, which may be combined with zidovudine (AZT) for 4-6 weeks depending on the clinical scenario. 1
Dosing Recommendations Based on Clinical Scenario
When Mother Received Antiretroviral Therapy During Pregnancy:
- Infant: Single dose of nevirapine 2 mg/kg oral suspension immediately after birth
- Plus: Zidovudine 4 mg/kg twice daily for 6 weeks 1
When Mother Received No Antiretroviral Therapy Before or During Labor:
- Infant: Nevirapine 2 mg/kg oral suspension immediately after birth
- Plus: Zidovudine 4 mg/kg twice daily for 4-6 weeks 1
For Infants <2 kg (Preterm/Low Birth Weight):
- Nevirapine 2 mg/kg/day until 14 days of age
- Then increase to 4 mg/kg/day thereafter 2
Timing of Administration
- The nevirapine dose should ideally be given immediately after birth or within 72 hours 1
- Administering the dose as soon as possible after birth and before discharge from the health facility is preferable 1
- Many programs have found immediate administration more practical than waiting until 48-72 hours after delivery 1
Efficacy and Pharmacokinetics
- A single 2 mg/kg dose of nevirapine maintains serum concentrations above 100 μg/L (10 times the inhibitory concentration against wild-type HIV-1) throughout the first week of life 3
- Nevirapine elimination is prolonged in newborns, which allows for effective prophylaxis with a single dose 3
- When combined with zidovudine, this regimen has been shown to reduce mother-to-child transmission by nearly 50% compared to zidovudine alone 1
Special Considerations
- For therapeutic purposes (rather than prophylaxis), a higher dosage of 6 mg/kg twice daily would be needed to achieve therapeutic concentrations during the first 2 weeks of life 4
- For preterm or low birth weight infants, the 2 mg/kg/day dose until 14 days followed by 4 mg/kg/day has been shown to be safe and effective in achieving target plasma concentrations 2
Important Caveats
- The efficacy of single-dose nevirapine is reduced in breastfeeding populations without additional interventions
- Resistance can develop with single-dose regimens, which may impact future treatment options
- When possible, combination regimens that include zidovudine are preferred over nevirapine alone to reduce the risk of resistance 1
- In settings with limited resources or where more comprehensive regimens are not available, single-dose nevirapine is still recommended as a minimum intervention 1
This dosing recommendation represents the current standard of care based on international guidelines and has been shown to significantly reduce the risk of HIV transmission when properly administered.