Table 24e. Drug Interactions Between the CCR5 Antagonist Maraviroc and Other Drugs (Including Antiretroviral Agents)
In the table below, “no dose adjustment needed” indicates that the U.S. Food and Drug Administration–approved dose of maraviroc (MVC) 300 mg twice daily should be used. Recommendations for managing a particular drug interaction may differ, depending on whether a new antiretroviral (ARV) drug is being initiated in a patient on a stable concomitant medication or a new concomitant medication is being initiated in a patient on a stable ARV regimen. The magnitude and significance of drug interactions are difficult to predict when several drugs with competing metabolic pathways are prescribed concomitantly. In cases where an interacting drug needs to be replaced with an alternative, providers should exercise their clinical judgement to select the most appropriate alternative medication to use.
Concomitant Drug Class/ Name | Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations | Dosing Recommendations and Clinical Comments |
|---|---|---|
| Antibacterials—Macrolides | ||
| Azithromycin | ↔ MVC expected | No dose adjustment needed. |
| Clarithromycin | ↑ MVC possible | MVC 150 mg twice daily |
| Erythromycin | ↑ MVC possible | No dose adjustment needed. |
| Anticonvulsants | ||
| Carbamazepine, Phenobarbital, Phenytoin | ↓ MVC possible | If Used without a Strong CYP3A Inhibitor
|
| Eslicarbazepine | ↓ MVC possible | Consider alternative ARV or anticonvulsant. |
| Oxcarbazepine | ↓ MVC possible | Consider alternative ARV or anticonvulsant. |
| Antifungals | ||
| Fluconazole | ↑ MVC possible | No dose adjustment needed. |
| Isavuconazole | ↑ MVC possible | No dose adjustment needed. |
| Itraconazole | ↑ MVC possible | MVC 150 mg twice daily |
| Posaconazole | ↑ MVC possible | MVC 150 mg twice daily |
| Voriconazole | ↑ MVC possible | MVC 150 mg twice daily |
| Antimycobacterials | ||
| Rifabutin | MVC AUC ↔ and Cmin ↓ 30% | If Used without a Strong CYP3A Inhibitor
|
| Rifampin | MVC AUC ↓ 63% | If Used without a Strong CYP3A Inhibitor
|
| Rifapentine | ↓ MVC expected | Do not coadminister. |
| Antivirals - Orthopoxviruses (Smallpox, Mpox) | ||
| Brincidofovir | ↔ MVC expected | No dose adjustment needed. |
| Cidofovir | ↔ MVC expected | No dose adjustment needed. |
| Tecovirimat | When Given with MVC without a Boosted PI or Other Potent CYP3A4 Inhibitors
| If Used without a Strong CYP3A Inhibitor
|
| Hepatitis C Direct-Acting Antivirals | ||
| Elbasvir/Grazoprevir | ↔ MVC expected | No dose adjustment needed. |
| Ledipasvir/Sofosbuvir | ↔ MVC expected | No dose adjustment needed. |
| Glecaprevir/Pibrentasvir | ↔ MVC expected | No dose adjustment needed. |
| Simeprevir | ↔ MVC expected | No dose adjustment needed. |
| Sofosbuvir | ↔ MVC expected | No dose adjustment needed. |
| Sofosbuvir/Velpatasvir | ↔ MVC expected | No dose adjustment needed. |
| Sofosbuvir/Velpatasvir/Voxilaprevir | ↔ MVC expected | No dose adjustment needed. |
| Herbal Products | ||
| St. John’s Wort | ↓ MVC expected | Do not coadminister. |
| Hormonal Therapies | ||
| Hormonal Contraceptives | ↔ ethinyl estradiol or levonorgestrel | No dose adjustment needed. |
| Menopausal Hormone Replacement Therapy | ↔ MVC or hormone replacement therapies expected | No dose adjustment needed. |
| Gender-Affirming Hormone Therapies | ↔ MVC or gender-affirming hormones expected | No dose adjustment needed. |
| Antiretroviral Drugs | ||
| Attachment Inhibitor | ||
| FTRa | MVC AUC ↑ 25% ↔ TMRa | No dose adjustment needed. |
| Capsid Inhibitor | ||
| LEN (SQ and PO) | ↑ MVC possible | No dose adjustment needed. |
| INSTIs | ||
| BIC, CAB (IM and PO), DTG | ↔ MVC expected | No dose adjustment needed. |
| EVG/c | ↑ MVC possible | MVC 150 mg twice daily |
| RAL | MVC AUC ↓ 21% RAL AUC ↓ 37% | No dose adjustment needed. |
| NNRTIs | ||
| DOR, RPV (IM and PO) | ↔ MVC expected | No dose adjustment needed. |
| EFV | MVC AUC ↓ 45% | If Used without a Strong CYP3A Inhibitor
|
| ETR | MVC AUC ↓ 53% | If Used without a Strong CYP3A Inhibitor
|
| NVP | ↔ MVC AUC | If Used without a Strong CYP3A Inhibitor
|
| PIs | ||
| ATV Unboosted, ATV/c, ATV/r | With Unboosted ATV
| MVC 150 mg twice daily |
| DRV/c, DRV/r | With (DRV/r 600 mg/100 mg) Twice Daily
| MVC 150 mg twice daily |
| LPV/r | MVC AUC ↑ 295% With LPV/r and EFV
| MVC 150 mg twice daily |
| aFTR is a prodrug metabolized to its active moiety, TMR. Therefore, the effect on gp120-directed attachment inhibitor in the table refers to TMR concentrations. Key to Symbols ↑ = increase ↓ = decrease ↔ = no change Key: ARV = antiretroviral; ATV = atazanavir; ATV/c = atazanavir/cobicistat; ATV/r = atazanavir/ritonavir; AUC = area under the curve; BIC = bictegravir; CAB = cabotegravir; Cmin = minimum plasma concentration; CYP = cytochrome P; DOR = doravirine; DRV/c = darunavir/cobicistat; DRV/r = darunavir/ritonavir; DTG = dolutegravir; EFV = efavirenz; ETR = etravirine; EVG/c = elvitegravir/cobicistat; FTR = fostemsavir; IM = intramuscular; INSTI = integrase strand transfer inhibitor; LEN = lenacapavir; LPV/r = lopinavir/ritonavir; MVC = maraviroc; NNRTI = non-nucleoside reverse transcriptase inhibitor; NVP = nevirapine; PI = protease inhibitor; PO = orally; RAL = raltegravir; RPV = rilpivirine; RTV = ritonavir; SQ = subcutaneous; TMR = temsavir |
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