Itraconazole and Nevirapine: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Nevirapine
Itraconazole
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Reduced itraconazole exposure and reduced efficacy of itraconazole
Interaction Deep Dive
Concomitant use of itraconazole (a CYP3A4 substrate) and nevirapine (a CYP3A4 inducer) is not recommended because of reduced itraconazole exposure and efficacy123. In a study in 12 healthy volunteers, coadministration of itraconazole and nevirapine significantly decreased itraconazole exposure, while nevirapine pharmacokinetics were not significantly altered 5. A retrospective study indicated that patients treated with nonnucleoside reverse transcriptase inhibitors and itraconazole had subtherapeutic itraconazole concentrations. In patients who receive itraconazole therapy, protease inhibitor-based highly-active antiretroviral therapy (HAART) is suggested 4. Nevirapine is not recommended 2 weeks before and during itraconazole treatment 3.
Why it happens (mechanism)
Induction of CYP3A4-mediated metabolism of itraconazole
Literature reports
3 reports — tap to read
a) Coadministration of itraconazole and nevirapine resulted in significantly decreased itraconazole exposure and plasma concentrations in a randomized, cross-over, pharmacokinetic study in 12 healthy volunteers. Subjects (mean age 28.9 +/- 5.4 years) received itraconazole 200 mg once daily for 7 days, nevirapine 200 mg once daily for 7 days, and the combination of itraconazole 200 mg and nevirapine 200 mg once daily for 7 days. Each regimen was separated by a 14-day washout period and plasma samples were collected at set time intervals after the 7th dose of each regimen. The combination regimen of itraconazole and nevirapine resulted in significantly decreased itraconazole Cmax (38%), area under the curve (61%), and elimination half-life (31%) compared with itraconazole alone and non-significant nevirapine increases in Cmax (5%), area under the curve (3%), and elimination half-life (8%) compared with nevirapine alone. The study showed nevirapine had a strong inducing effect on the metabolism of itraconazole when both drugs were administered together at 200 mg daily, while nevirapine pharmacokinetics were not significantly altered by itraconazole coadministration. Further study may be warranted to evaluate whether a higher daily dosage of itraconazole may have an inhibitory effect 5.
b) A case report described suboptimal plasma levels with the concomitant use of itraconazole in a 42-year old male with HIV (CD4 cell count of 13 cells/mcL). The patient, treated with a regimen of efavirenz, lamiVUDine, and stavudine, was admitted to the hospital for respiratory distress and hypotension. Examination and laboratory tests revealed tachycardia, 100% oxygen saturation, maculopapular lesions consistent with Histoplasma capsulatum, confirmed hypotension, pancytopenia, increased alkaline phosphatase and lactate dehydrogenase levels, and an elevated urine Histoplasma polysaccharide antigen level (15 units). Bilateral interstitial infiltrates were found on chest radiograph. Treatment with amphotericin B was initiated and after two weeks, the patient was discharged on maintenance therapy of itraconazole 200 mg daily. The patient's pancytopenia, CD4 cell count (140 cells/mcL), and urine Histoplasma antigen level (4.28 units) improved over several months. At one year, itraconazole concentration levels were undetectable (less than 0.05 mcg/mL), therefore, a dosing increase to 200 mg twice daily was initiated. Urine Histoplasma antigen levels remained unchanged and plasma itraconazole concentration remained below the level of detection. Switching to the solution formulation of itraconazole had no effect. The patient's antiretroviral regimen was then changed to atazanavir 300 mg daily, ritonavir 100 mg daily, and emtricitabine 200 mg/tenofovir 300 mg daily. Itraconazole plasma concentration increased to 3 mcg/mL 2 months following the antiretroviral regimen change, and the patient's urine histoplasma decreased to 0.6 units at 3 months 6.
c) A retrospective cohort study described 10 patients with disseminated histoplasmosis receiving itraconazole (200 mg to 400 mg daily) with concomitant HAART therapy who experienced suboptimal itraconazole plasma concentrations. Four of the 10 were receiving concomitant protease inhibitors (PI), 4 patients were receiving concomitant nonnucleoside reverse transcriptase inhibitors (NNRTIs), and 2 patients were receiving both PI- and NNRTI-based antiretroviral regimens. All but 1 patient receiving PI-based therapy reached therapeutic itraconazole concentrations (greater than 1 mcg/mL). The four patients receiving NNRTI-based HAART therapy had undetectable itraconazole concentrations (less than 0.05 mcg/mL) and the two patients receiving concomitant PI-and NNRTI-based regimen had itraconazole concentrations of 0.5 mcg/mL and 0.7 mcg/mL. Three patients who switched to PI-based antiretroviral therapy subsequently reached therapeutic itraconazole concentration levels 4.
Common questions
Can I take Itraconazole and Nevirapine together?
Reduced itraconazole exposure and reduced efficacy of itraconazole Always confirm with your pharmacist or prescriber before making any change.
How serious is the Itraconazole and Nevirapine interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "delayed". Effects tend to build up gradually over days to weeks.
How strong is the evidence for this interaction?
The evidence is graded "established". Well documented — supported by controlled studies or strong clinical data.
From our Q&A
Real reader questions about these medications, each personally answered by our pharmacist:
Questions for your pharmacist
- Does my dose of Itraconazole or Nevirapine need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (6)
- Product Information: VIRAMUNE(R) oral suspension, nevirapine oral suspension. Boehringer Ingelheim Pharmaceuticals Inc (per FDA), Ridgefield, CT, 2024. DailyMed
- Product Information: VIRAMUNE XR(R) oral extended-release tablets, nevirapine oral extended-release tablets. Boehringer Ingelheim Pharmaceuticals Inc (per FDA), Ridgefield, CT, 2024. DailyMed
- Product Information: SPORANOX(R) oral capsules, itraconazole oral capsules. Janssen Pharmaceuticals Inc (per FDA), Titusville, NJ, 2022. DailyMed
- Andrade RA, Evans RT, Hamill RJ, et al: Clinical evidence of interaction between itraconazole and nonnucleoside reverse transcriptase inhibitors in HIV-infected patients with disseminated histoplasmosis. Ann Pharmacother 2009; 43(5):908-913. PubMed
- Jaruratanasirikul S & Sriwiriyajan S: Pharmacokinetic study of the interaction between itraconazole and nevirapine. Eur J Clin Pharmacol 2007; 63(5):451-456. DOI
- Koo HL, Hamill RJ, & Andrade RA: Drug-drug interaction between itraconazole and efavirenz in a patient with AIDS and disseminated histoplasmosis. Clin Infect Dis 2007; 45(6):e77-e79. PubMed
Keep reading about Nevirapine
Keep reading about Itraconazole
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
Check another combination
Our instant two-drug interaction checker is almost here.
Still have questions about this combination?
Every question gets a real answer from a licensed pharmacist — free, and usually within a day.
Ask the pharmacist