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

The information in the brief version is excerpted directly from the full-text guidelines. The brief version is a compilation of the tables and boxed recommendations.

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Drug-Drug Interactions

Drug Interactions between CCR5 Antagonist and Other Drugs

Last Updated: October 25, 2018; Last Reviewed: October 25, 2018

Table 19e. Drug Interactions between CCR5 Antagonist (Maraviroc) and Other Drugs (Including Antiretroviral Agents)

In the table below, “No dose adjustment necessary” indicates that the FDA-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 whether 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 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
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 dose adjustment is necessary.

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

RAL AUC ↓ 37%
No dose adjustment necessary.
NNRTIs
DOR, RPV MVC ↔ MVC expected No dose adjustment necessary.
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 with or without RTV or COBI MVC With Unboosted ATV:
  • MVC AUC ↑ 257%
With (ATV/r 300 mg/100 mg) Once Daily:
  • MVC AUC ↑ 388%
Dose:
  • MVC 150 mg BID
DRV/c or DRV/r MVC With (DRV/r 600 mg/100 mg) BID:
  • MVC AUC ↑ 305%
With (DRV/r 600 mg/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/r 500 mg/200 mg) BID:
  • ↔ MVC AUC
No dose adjustment necessary.
Key to Symbols:
↑ = increase
↓ = decrease
↔ = no change

Key to Acronyms: ARV = antiretroviral; ATV = atazanavir; ATV/r = atazanavir/ritonavir; AUC = area under the curve; BIC = bictegravir; BID = twice daily; COBI = cobicistat; CYP = cytochrome P; DOR = doravirine; DRV = darunavir; DRV/c = darunavir/cobicistat; DRV/r = darunavir/ritonavir; DTG = dolutegravir; EFV = efavirenz; ETR = etravirine; EVG/c = elvitegravir/cobicistat; FDA = Food and Drug Administration; 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; TPV = tipranavir; TPV/r = tipranavir/ritonavir

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