Rilpivirine (Edurant) is a new nonnucleoside reverse-transcriptase inhibitor (NNRTI) that blocks the replication of HIV and is approved for use in patients who've never received HIV drug therapy before. In clinical trials, rilpivirine was found to be as effective in lowering patients' viral load as efavirenz (Sustiva), another approved NNRTI, although patients with a higher viral load at the start of rilpivirine therapy were less likely to respond to it. And in those patients who failed therapy with rilpivirine, there was a greater risk of developing resistance to other NNRTIs than was seen in patients who failed therapy with efavirenz.

Common adverse effects of rilpivirine are depression, insomnia, headache, and rash. Because rilpivirine is metabolized by an isoenzyme in the cytochrome P-450 (CYP) isoenzyme system, CYP3A, any drug that increases or decreases the level of CYP3A will alter the serum level of rilpivirine; nurses should check all other drugs the patient receives for compatibility with rilpivirine in order to prevent a drug interaction.

Nurses should also teach patients the importance of taking rilpivirine with a meal; food is important for maximum absorption. Patients can eat either a normal meal (calorically speaking) or a high-fat, high-calorie meal. However, taking the drug on an empty stomach decreases its absorption by 40%, and taking it with a protein-rich nutritional drink decreases its absorption by 50%.

To read the drug's complete prescribing information from the Food and Drug Administration, go to http://1.usa.gov/kubr8N.