Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV

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Drug-Drug Interactions

Drug Interactions between CCR5 Antagonist and Other Drugs

Last Updated: October 17, 2017; Last Reviewed: October 17, 2017

Table 18e. Drug Interactions between CCR5 Antagonist (Maraviroc) and Other Drugs (Including Antiretroviral Agents)

In the table below, “no dosage adjustment” 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 ARV is being initiated in a patient on a stable concomitant medication, or if 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.

Table 18e. 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
Isavuconazole MVC ↑ MVC possible Consider dose reduction to MVC 150 mg BID.
Itraconazole MVC ↑ MVC possible Dose:
  • MVC 150 mg BID
Posaconazole 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, no dosage adjustment.

If used with a strong CYP3A inhibitor, use MVC 150 mg BID.
Rifampin MVC MVC AUC ↓ 64% Dose:
  • MVC 600 mg BID
If used with a strong CYP3A inhibitor, use MVC 300 mg BID.
Rifapentine MVC ↓ MVC expected Do not coadminister.
Hepatitis C Direct-Acting Antivirals
Daclatasvir MVC ↔ MVC expected

↔ Daclatasvir expected
No dosage adjustment.
Dasabuvir + Ombitasvir/Paritaprevir/
RTV
MVC ↑ MVC expected Do not coadminister.
Elbasvir/Grazoprevir MVC No data No dosing recommendations at this time.
Ledipasvir/Sofosbuvir MVC ↔ MVC expected No dosage adjustment.
Glecaprevir/Pibrentasvir MVC ↔ MVC expected No dosage adjustment.
Simeprevir MVC ↔ MVC expected No dosage adjustment.
Sofosbuvir MVC ↔ MVC expected No dosage adjustment.
Sofosbuvir/Velpatasvir MVC ↔ MVC expected No dosage adjustment.
Sofosbuvir/Velpatasvir/
Voxilaprevir
MVC ↔ MVC expected No dosage adjustment.
Herbal Products
St. John’s Wort MVC ↓ MVC expected Do not coadminister.
Hormonal Therapies
Hormonal Contraceptives MVC ↔ Ethinyl estradiol or levonorgestrel No dosage adjustment.
Menopausal Hormone Replacement Therapy MVC ↔ MVC or hormone replacement therapies expected No dosage adjustment.
Gender-Affirming Hormone Therapies MVC ↔ MVC or gender-affirming hormones expected No dosage adjustment.
ARV Drugs
INSTIs
EVG/c MVC ↑ MVC possible Dose:
  • MVC 150 mg BID
RAL MVC MVC AUC ↓ 21%

RAL AUC ↓ 37%
No dosage adjustment.
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 + RTV 100 mg) Once Daily:
  • MVC AUC ↑ 388%
Dose:
  • MVC 150 mg BID
DRV/c
or
DRV/r
MVC With (DRV 600 mg + RTV 100 mg) BID:
  • MVC AUC ↑ 305%
With (DRV 600 mg + RTV 100 mg) BID and ETR:
  • MVC AUC ↑ 210%
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
TPV/r MVC With (TPV 500 mg + RTV 200 mg) BID:
  • MVC AUC ↔
No dosage adjustment.
Key to Symbols:
↑ = increase
↓ = decrease
↔ = no change

Key to Acronyms: ARV = antiretroviral; ATV = atazanavir; AUC = area under the curve; BID = twice daily; COBI = cobicistat; CYP = cytochrome P; DRV = darunavir; DRV/c = darunavir/cobicistat; DRV/r = darunavir/ritonavir; EFV = efavirenz; ETR = etravirine; EVG/c = elvitegravir/cobicistat; INSTI = integrase strand transfer inhibitor; LPV/r = lopinavir/ritonavir; MVC = maraviroc; NNRTI = non-nucleoside reverse transcriptase inhibitor; NVP = nevirapine; PI = protease inhibitor; RAL = raltegravir; RTV = ritonavir; TPV = tipranavir; TPV/r = tipranavir/ritonavir

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