Updated
Reviewed
Sep. 01, 2022

Drug-Drug Interactions

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

  • 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

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.

Antivirals - Orthopoxviruses (Smallpox, Monkeypox)

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

  • ↓ MVC possible but not expected to be clinically relevant

When Given With MVC Plus a Boosted PI or Other Potent CYP3A4 Inhibitors

  • ↑ MVC expected

If Used Without a Strong CYP3A Inhibitor

  • No dose adjustment needed.

If Used With a Strong CYP3A Inhibitor

  • 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 PO and IM

↔ 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

PIs

ATV Unboosted, 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 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; 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; 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

Drug-Drug Interactions

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
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

  • 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

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.

Antivirals - Orthopoxviruses (Smallpox, Monkeypox)

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

  • ↓ MVC possible but not expected to be clinically relevant

When Given With MVC Plus a Boosted PI or Other Potent CYP3A4 Inhibitors

  • ↑ MVC expected

If Used Without a Strong CYP3A Inhibitor

  • No dose adjustment needed.

If Used With a Strong CYP3A Inhibitor

  • 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 PO and IM

↔ 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

PIs

ATV Unboosted, 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 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; 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; 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

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