Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) are used in combination with the nucleosides and are slightly stronger and have more side effects. The HIV virus can develop resistance to these medications fairly easily if the medications are not taken exactly as prescribed. Once a person develops resistance to one of the medications in this family, they often will be resistant to all the medications in this family, even those they have never received.

1. Nevirapine - also called viramune.
   1. Dosing: Dosing:Viramune comes as a 200 mg tablet that is bluish in color. Is can also be given in liquid form. It is usually given 1 time per day for the first week and then increased to twice per day after that. It can be given with or without food.
   2. Side effects: Severe rash, nausea, headaches, liver irritation, diarrhea and vomiting.
   3. Medications that can cause problems when they are taken with viramune include birth control pills, rifampin, rifabutin, and methadone.
   4. Discuss with the doctor before taking the medication if your child has liver problems including hepatitis or if they are pregnant or planning to become pregnant.
   5. Comment: Rash is most common in young children and usually happens when the dose is doubled in the second week on the medication. If you get a rash, the medication should be stopped and the doctor notified immediately.
2. Sustiva - also called efavirenz.
   1. Dosing: Sustiva comes in different size capsules called geltabs, which are brownish in color. It can take several pills to equal the right dose in any patient and may be a combination of 50 mg, 100 mg, 200 mg or 600 mg geltabs. This medication is taken only one time per day. It is not generally used in children less than three years old or 29 pounds and it cannot be used in patients who are unable to swallow a fairly large pill. It may be given through a feeding tube placed in the stomach, although not easily. It can be taken with some foods but high fat foods should be avoided two hours before and after the dose.
   2. Side effects: Rash, nausea, vomiting, dizziness, headache, change in moods, decrease in sleep, abnormal or vivid dreams, and difficulty concentrating.
   3. Medications that should not be taken with Sustiva include cisapride, terfenadine, loratidine, midazolam, triazolam.
   4. Medications that need to be monitored closely when taken with Sustiva include clarithromycin,methadone, rifabutin, rifampin, warfarin, seizure medications, itraconazole, ketoconazole, protease inhibitors (see below), or herbal remedies such as St. John’s Wort. Please talk to the health care team if the patient is using any of these medications.
   5. Comment: Sustiva is sometimes given with benadryl to avoid rash. Due to this and some of the side effects of Sustiva, it is usually given at bedtime. Any female taking Sustiva should use birth control if they are sexually active since it could cause birth defects in an unborn baby. If a patient discovers she is pregnant while on Sustiva, she should contact the care team immediately but should not stop the medication on her own without a new plan in place.