Adult Antiretroviral Guidelines

US DHHS Guidelines with Australian Commentary

CCR5 Antagonist Drug Interactions

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Drug Interactions Between the CCR5 Antagonist Maraviroc and Other Drugs (Including Antiretroviral Agents)

DHHS Last Updated: May 2022Australian Commentary Last Updated: July 2023

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 expectedNo dose adjustment needed.
Clarithromycin↑ MVC possibleMVC 150 mg twice daily
Erythromycin↑ MVC possibleNo dose adjustment needed.
Anticonvulsants
Carbamazepine, Phenobarbital, Phenytoin↓ MVC possibleIf 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 possibleConsider alternative ARV or anticonvulsant.
Oxcarbazepine↓ MVC possibleConsider alternative ARV or anticonvulsant.
Antifungals
Fluconazole↑ MVC possibleNo dose adjustment needed.
Isavuconazole↑ MVC possibleNo dose adjustment needed.
Itraconazole↑ MVC possibleMVC 150 mg twice daily
Posaconazole↑ MVC possibleMVC 150 mg twice daily
Voriconazole↑ MVC possibleMVC 150 mg twice daily
Antimycobacterials
RifabutinMVC 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
RifampinMVC 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 expectedDo not coadminister.
Antivirals - Orthopoxviruses (Smallpox, Mpox)
Brincidofovir↔ MVC expectedNo dose adjustment needed.
Cidofovir↔ MVC expectedNo dose adjustment needed.
TecovirimatWhen 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
Elbasvir/Grazoprevir↔ MVC expectedNo dose adjustment needed.
Ledipasvir/Sofosbuvir↔ MVC expectedNo dose adjustment needed.
Glecaprevir/Pibrentasvir↔ MVC expectedNo dose adjustment needed.
Simeprevir↔ MVC expectedNo dose adjustment needed.
Sofosbuvir↔ MVC expectedNo dose adjustment needed.
Sofosbuvir/Velpatasvir↔ MVC expectedNo dose adjustment needed.
Sofosbuvir/Velpatasvir/Voxilaprevir↔ MVC expectedNo dose adjustment needed.
Herbal Products
St. John’s Wort↓ MVC expectedDo not coadminister.
Hormonal Therapies
Hormonal Contraceptives↔ ethinyl estradiol or levonorgestrelNo dose adjustment needed.
Menopausal Hormone Replacement Therapy↔ MVC or hormone replacement therapies expectedNo dose adjustment needed.
Gender-Affirming Hormone Therapies↔ MVC or gender-affirming hormones expectedNo dose adjustment needed.
Antiretroviral Drugs
Attachment Inhibitor
FTRaMVC AUC ↑ 25%

↔ TMRa
No dose adjustment needed.
Capsid Inhibitor
LEN (SQ and PO)↑ MVC possibleNo dose adjustment needed.
INSTIs
BIC, CAB (IM and PO), DTG↔ MVC expectedNo dose adjustment needed.
EVG/c↑ MVC possibleMVC 150 mg twice daily
RALMVC AUC ↓ 21%

RAL AUC ↓ 37%
No dose adjustment needed.
NNRTIs
DOR, RPV (IM and PO)↔ MVC expectedNo dose adjustment needed.
EFVMVC 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
ETRMVC 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 AUCIf 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/rWith 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/rWith (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/rMVC AUC ↑ 295%

With LPV/r and EFV

  • MVC AUC ↑ 153%
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; 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; 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; SQ = subcutaneous; TMR = temsavir
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