Updated
Reviewed
Jun. 03, 2021

Drug-Drug Interactions

Drug Interactions between CCR5 Antagonist and Other Drugs

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 Food and Drug Administration–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 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.

Table 24e. Drug Interactions between the CCR5 Antagonist Maraviroc and Other Drugs (Including Antiretroviral Agents)
Concomitant Drug Class/Name Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations Dosing Recommendations and Clinical Comments
Antibacterial Agents
Antimycobacterials
Rifabutin MVC AUC ↔ and Cmin  ↓ 30%  If Used Without a Strong CYP3A Inhibitor:
  • MVC 300 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • MVC 150 mg twice daily
Rifampin MVC AUC ↓ 63% If Used Without a Strong CYP3A Inhibitor:
  • MVC 600 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • Consider alternative ARV or antimycobacterial.
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:
  • MVC 600 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • MVC 150 mg twice daily
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
Attachment Inhibitor
FTRa MVC AUC ↑ 25% ↔ TMRa No dose adjustment needed.
INSTIs
BIC, CAB PO and IM, 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:
  • MVC 600 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • MVC 150 mg twice daily
ETR MVC AUC ↓ 53% If Used Without a Strong CYP3A Inhibitor:
  • MVC 600 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • MVC 150 mg twice daily
NVP ↔ MVC AUC If Used Without a Strong CYP3A Inhibitor:
  • MVC 300 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • MVC 150 mg twice daily
  • With TPV/r, use MVC 300 mg twice daily
PIs
ATV, ATV/c, ATV/r With Unboosted ATV:
  • MVC AUC ↑ 257%
With (ATV/r 300 mg/100 mg) Once Daily:
  • MVC AUC ↑ 388%
 MVC 150 mg twice daily
DRV/c, DRV/r With (DRV/r 600 mg/100 mg) Twice Daily:
  • MVC AUC ↑ 305%
With (DRV/r 600 mg/100 mg) Twice Daily and ETR:
  • MVC AUC ↑ 210%
 MVC 150 mg twice daily
LPV/r MVC AUC ↑ 295%

With LPV/r and EFV:
  • MVC AUC ↑ 153%
 MVC 150 mg twice daily

a Fostemsavir (FTR) is a prodrug metabolized to its active moiety, temsavir (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; 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; 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; TMR = temsavir; TPV/r = tipranavir/ritonavir.

Drug-Drug Interactions

Drug Interactions between CCR5 Antagonist and Other Drugs

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 Food and Drug Administration–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 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.

Table 24e. Drug Interactions between the CCR5 Antagonist Maraviroc and Other Drugs (Including Antiretroviral Agents)
Concomitant Drug Class/Name Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations Dosing Recommendations and Clinical Comments
Antibacterial Agents
Antimycobacterials
Rifabutin MVC AUC ↔ and Cmin  ↓ 30%  If Used Without a Strong CYP3A Inhibitor:
  • MVC 300 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • MVC 150 mg twice daily
Rifampin MVC AUC ↓ 63% If Used Without a Strong CYP3A Inhibitor:
  • MVC 600 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • Consider alternative ARV or antimycobacterial.
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:
  • MVC 600 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • MVC 150 mg twice daily
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
Attachment Inhibitor
FTRa MVC AUC ↑ 25% ↔ TMRa No dose adjustment needed.
INSTIs
BIC, CAB PO and IM, 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:
  • MVC 600 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • MVC 150 mg twice daily
ETR MVC AUC ↓ 53% If Used Without a Strong CYP3A Inhibitor:
  • MVC 600 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • MVC 150 mg twice daily
NVP ↔ MVC AUC If Used Without a Strong CYP3A Inhibitor:
  • MVC 300 mg twice daily
If Used With a Strong CYP3A Inhibitor:
  • MVC 150 mg twice daily
  • With TPV/r, use MVC 300 mg twice daily
PIs
ATV, ATV/c, ATV/r With Unboosted ATV:
  • MVC AUC ↑ 257%
With (ATV/r 300 mg/100 mg) Once Daily:
  • MVC AUC ↑ 388%
 MVC 150 mg twice daily
DRV/c, DRV/r With (DRV/r 600 mg/100 mg) Twice Daily:
  • MVC AUC ↑ 305%
With (DRV/r 600 mg/100 mg) Twice Daily and ETR:
  • MVC AUC ↑ 210%
 MVC 150 mg twice daily
LPV/r MVC AUC ↑ 295%

With LPV/r and EFV:
  • MVC AUC ↑ 153%
 MVC 150 mg twice daily

a Fostemsavir (FTR) is a prodrug metabolized to its active moiety, temsavir (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; 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; 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; TMR = temsavir; TPV/r = tipranavir/ritonavir.

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