Drug Interactions between CCR5 Antagonist and Other Drugs

Last Updated: October 25, 2018;

Last Reviewed: October 25, 2018

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.

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

Concomitant Drug Class/Name	CCR5 Antagonist	Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations	Dosing Recommendations and Clinical Comments
Carbamazepine, Phenobarbital, Phenytoin	MVC	↓ MVC possible	If used without a strong CYP3A inhibitor, use MVC 600 mg BID or an alternative antiepileptic agent.

Concomitant Drug Class/Name	CCR5 Antagonist	Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations	Dosing Recommendations and Clinical Comments
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.

Concomitant Drug Class/Name	CCR5 Antagonist	Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations	Dosing Recommendations and Clinical Comments
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.

Concomitant Drug Class/Name	CCR5 Antagonist	Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations	Dosing Recommendations and Clinical Comments
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.

Concomitant Drug Class/Name	CCR5 Antagonist	Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations	Dosing Recommendations and Clinical Comments
St. John’s Wort	MVC	↓ MVC expected	Do not coadminister.

Concomitant Drug Class/Name	CCR5 Antagonist	Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations	Dosing Recommendations and Clinical Comments
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

Concomitant Drug Class/Name	CCR5 Antagonist	Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations	Dosing Recommendations and Clinical Comments
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.

Concomitant Drug Class/Name	CCR5 Antagonist	Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations	Dosing Recommendations and Clinical Comments
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

Concomitant Drug Class/Name	CCR5 Antagonist	Effect on CCR5 Antagonist and/or Concomitant Drug Concentrations	Dosing Recommendations and Clinical Comments
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.