Drug-Drug Interactions
Drug Interactions between CCR5 Antagonist and Other Drugs
Table 21e. Drug Interactions between the CCR5 Antagonist Maraviroc and Other Drugs (Including Antiretroviral Agents)
In the table below, “No dose adjustment needed” indicates that the FDA-approved dose of MVC 300 mg twice daily should be used. Recommendations for managing a particular drug interaction may differ depending on whether a new 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 |
---|---|---|
Antibacterial Agents | ||
Antimycobacterials | ||
Rifabutin | ↓ MVC possible | If Used Without a Strong CYP3A Inhibitor:
|
Rifampin | MVC AUC ↓ 63% | If Used Without a Strong CYP3A Inhibitor:
|
Rifapentine | ↓ MVC expected | Do not coadminister. |
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 |
Hepatitis C Direct-Acting Antivirals | ||
Daclatasvir | ↔ MVC expected ↔ daclatasvir expected |
No dose adjustment needed. |
Dasabuvir plus Ombitasvir/Paritaprevir/RTV | ↑ MVC expected | Do not coadminister. |
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 | ||
INSTIs | ||
BIC, 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 | ↔ 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, 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 |
TPV/r | With (TPV/r 500 mg/200 mg) Twice Daily:
|
No dose adjustment needed. |
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; CYP = cytochrome P; DOR = doravirine; DRV/c = darunavir/cobicistat; DRV/r = darunavir/ritonavir; DTG = dolutegravir; EFV = efavirenz; ETR = etravirine; EVG/c = elvitegravir/cobicistat; FDA = Food and Drug Administration; INSTI = integrase strand transfer inhibitor; LPV/r = lopinavir/ritonavir; MVC = maraviroc; NNRTI = non-nucleoside reverse transcriptase inhibitor; NVP = nevirapine; PI = protease inhibitor; RAL = raltegravir; RPV = rilpivirine; RTV = ritonavir; TPV/r = tipranavir/ritonavir |
Drug-Drug Interactions
Drug Interactions between CCR5 Antagonist and Other Drugs
Table 21e. Drug Interactions between the CCR5 Antagonist Maraviroc and Other Drugs (Including Antiretroviral Agents)
In the table below, “No dose adjustment needed” indicates that the FDA-approved dose of MVC 300 mg twice daily should be used. Recommendations for managing a particular drug interaction may differ depending on whether a new 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 |
---|---|---|
Antibacterial Agents | ||
Antimycobacterials | ||
Rifabutin | ↓ MVC possible | If Used Without a Strong CYP3A Inhibitor:
|
Rifampin | MVC AUC ↓ 63% | If Used Without a Strong CYP3A Inhibitor:
|
Rifapentine | ↓ MVC expected | Do not coadminister. |
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 |
Hepatitis C Direct-Acting Antivirals | ||
Daclatasvir | ↔ MVC expected ↔ daclatasvir expected |
No dose adjustment needed. |
Dasabuvir plus Ombitasvir/Paritaprevir/RTV | ↑ MVC expected | Do not coadminister. |
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 | ||
INSTIs | ||
BIC, 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 | ↔ 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, 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 |
TPV/r | With (TPV/r 500 mg/200 mg) Twice Daily:
|
No dose adjustment needed. |
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; CYP = cytochrome P; DOR = doravirine; DRV/c = darunavir/cobicistat; DRV/r = darunavir/ritonavir; DTG = dolutegravir; EFV = efavirenz; ETR = etravirine; EVG/c = elvitegravir/cobicistat; FDA = Food and Drug Administration; INSTI = integrase strand transfer inhibitor; LPV/r = lopinavir/ritonavir; MVC = maraviroc; NNRTI = non-nucleoside reverse transcriptase inhibitor; NVP = nevirapine; PI = protease inhibitor; RAL = raltegravir; RPV = rilpivirine; RTV = ritonavir; TPV/r = tipranavir/ritonavir |
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