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Guidelines for the Use of Antiretroviral Agents in HIV-1-Infected Adults and Adolescents

Drug Interactions

Drug Interactions between CCR5 Antagonist and Other Drugs

(Last updated: April 8, 2015; last reviewed: April 8, 2015)

Table 19e. Drug Interactions Between CCR5 Antagonist (Maraviroc) and Other Drugs (Including Antiretroviral Agents)
Concomitant Drug
Class/Name 
CCR5 Antagonist  Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations Dosing Recommendations and Clinical Comments 
Anticonvulsants
Carbamazepine

Phenobarbital

Phenytoin
MVC  ↓ MVC possible If used without a strong CYP3A inhibitor, use MVC 600 mg BID or an alternative antiepileptic agent.
Antifungals
Itraconazole MVC  ↑ MVC possible Dose:
  • MVC 150 mg BID
Voriconazole MVC  ↑ MVC possible Consider dose reduction to MVC 150 mg BID.
Antimycobacterials
Clarithromycin MVC  ↑ MVC possible Dose:
  • MVC 150 mg BID
Rifabutin MVC  ↓ MVC possible If used without a strong CYP3A inducer or inhibitor, use MVC 300 mg BID.

If used with a strong CYP3A inhibitor, use MVC 150 mg BID.
Rifampin MVC  MVC AUC ↓ 64% Coadministration is not recommended.

If coadministration is necessary, use MVC 600 mg BID.

If coadministered with a strong CYP3A inhibitor, use MVC 300 mg BID.
Rifapentine MVC  ↓ MVC expected Do not coadminister.
Hepatitis C Direct Acting Antivirals
Boceprevir
MVC MVC AUC ↑ 202% Dose:
  • MVC 150 mg BID
Dasabuvir plus Ombitasvir/Paritaprevir/RTV
MVC ↑ MVC expected
Do not coadminister.
Ledipasvir/Sofosbuvir MVC  ↔ MVC expected Dose:
  • MVC 300 mg BID
Simeprevir MVC  ↔ MVC expected Dose
  • MVC 300 mg BID
Herbal Products
St. John’s Wort MVC MVC possible Coadministration is not recommended.
Hormonal Contraceptives
Hormonal Contraceptives MVC No significant effect on ethinyl estradiol or levonorgestrel Safe to use in combination.
ARV Drugs
INSTIs
EVG/c/TDF/FTC
MVC ↑ MVC possible
Do not coadminister.
EVG plus PI/r MVC No data Refer to PIs listed below for dosing recommendations when MVC is used with a PI/r.
RAL MVC MVC AUC ↓ 21%
RAL AUC ↓ 37%
Dose:
  • Standard
NNRTIs
EFV MVC  MVC AUC ↓ 45%
Dose:
  • MVC 600 mg BID
ETR MVC MVC AUC ↓ 53%
Dose:
  • MVC 600 mg BID in the absence of a potent CYP3A inhibitor
NVP MVC MVC AUC ↔
Without HIV PI
  • MVC 300 mg BID
With HIV PI (except TPV/r)
  • MVC 150 mg BID
PIs
ATV
+/-
RTV or COBI


MVC With Unboosted ATV
  • MVC AUC ↑ 257%
With (ATV 300 mg Plus RTV 100 mg) Once Daily
  • MVC AUC ↑ 388%
Dose:
  • MVC 150 mg BID
DRV/c 
or 
DRV/r
MVC With (DRV 600 mg Plus RTV 100 mg) BID: 
  • MVC AUC ↑ 305%
With (DRV 600 mg Plus RTV 100 mg) BID and ETR
  • MVC AUC ↑ 210%
Dose:
  • MVC 150 mg BID
FPV
+/-
RTV


MVC With (FPV 700 mg Plus RTV 100 mg) BID and MVC 300 mg BID:
  • MVC AUC ↑ 149%, Cmin ↑ 374%
With (FPV 1400 mg Plus RTV 200 mg) Once Daily and MVC 300 mg Once Daily
  • MVC AUC ↑ 126%, Cmin ↑ 80%
Dose:
  • MVC 150 mg BID
LPV/r
MVC MVC AUC ↑ 295%

With LPV/r and EFV
  • MVC AUC ↑ 153%
Dose:
  • MVC 150 mg BID
RTV MVC
With RTV 100 mg BID
  • MVC AUC ↑ 161%
Dose:
  • MVC 150 mg BID
SQV/r MVC
With (SQV 1000 mg Plus RTV 100) mg BID
  • MVC AUC ↑ 877%
With (SQV 1000 mg Plus RTV 100 mg) BID and EFV
  • MVC AUC ↑ 400%
Dose:
  • MVC 150 mg BID
TPV/r MVC
With TPV 500 mg Plus RTV 200 mg) BID
  • MVC AUC ↔
Dose:
  • MVC 300 mg BID
Note: FPV is a pro-drug of APV.

Key to Symbols: ↑ = increase, ↓ = decrease, ↔ = no change

Key to Acronyms: ARV = antiretroviral; ATV = atazanavir; ATV/r = atazanavir/ritonavit; AUC = area under the curve; BID = twice daily; COBI = cobicistat; CYP = cytochrome P; DRV/c = darunavir/cobicistat; DRV/r = darunavir/ritonavir; EFV = efavirenz; ETR = etravirine; EVG = elvitegravir; FPV = fosamprenavir; FTC = emtricitabine; INSTI = integrase strand transfer inhibitor; LPV/r = lopinavir/ritonavir; MVC = maraviroc; NVP = nevirapine; PI = protease inhibitor; PK = pharmacokinetic; RAL = raltegravir; RTV = ritonavir; SQV/r = saquinavir/ritonavir; TDF = tenofovir disoproxil fumarate; TPV/r = tipranavir/ritonavir

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