Drug-Drug Interactions: CCR5 Antagonist and Other Drugs

Actualizado 12/09/2024 - 12:00 Reviewed Jue, 12/09/2024 - 12:00

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 judgment to select the most appropriate alternative medication.

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
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 C_min ↓ 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	Rifapentine Weekly and Daily ↓ MVC expected	Do not coadminister.
Antiseizure
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.
Antivirals—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.
Antivirals—Miscellaneous (e.g., for CMV, 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 ↓ 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
Antivirals—SARS-CoV-2
Molnupiravir	↔ MVC expected	No dose adjustment needed
Remdesivir	↔ MVC expected	No dose adjustment needed
Ritonavir-Boosted Nirmatrelvir	MVC With Ritonavir 100 mg Twice Daily MVC AUC ↑ 161%	MVC 150 mg twice daily
Herbal Products
St. John’s Wort	↓ MVC expected	Do not coadminister.
Hormonal Therapies
Hormonal Contraceptives	↔ ethinyl estradiol or levonorgestrel	No dose adjustment needed
Gender-Affirming Hormone Therapies	↔ MVC or gender-affirming hormones expected	No dose adjustment needed
Menopausal Hormone Replacement Therapy	↔ MVC or hormone replacement therapies expected	No dose adjustment needed
Antiretroviral Drugs
Attachment Inhibitor
FTR^a	MVC AUC ↑ 25% ↔ TMR^a	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 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
PIs
ATV/c, ATV/r	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
^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; CMV = cytomegalovirus; 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; MVC = maraviroc; NNRTI = non-nucleoside reverse transcriptase inhibitor; PI = protease inhibitor; PO = orally; RAL = raltegravir; RPV = rilpivirine; RTV = ritonavir; SQ = subcutaneous; TMR = temsavir