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maraviroc (Selzentry)

Indications: - adjunctive treatment of multi-drug resistant HIV - susceptibility testing required prior to initiating treatment Contraindications: - use during pregnancy (data insufficient) [4] Dosage: start 300 mg PO BID Pharmacokinetics: - metabolized by Cyt P450 3A4 Adverse effects: - hypersensitivity - hepatotoxicity masquerading as systemic allergic reaction Drug interactions: - drugs that inhibit CYP3A4 inhibitors - some antifungals, most protease inhibitors half the maraviroc dose - drugs that induce CYP3A4 - some seizure meds, rifampin, efavirenz - double the maraviroc dose - avoid St John's wort, can lower maraviroc level Laboratory: - CCR5 receptor testing [3] - maraviroc in serum/plasma Mechanism of action: - inhibits entry of HIV1 into cells when HIV1 uses CCR5 to gain entry into cells (50-60% of HIV1 strains)

Interactions

drug adverse effects of antiretroviral agents

General

viral fusion inhibitor; viral entry inhibitor CCR5 antagonist

Database Correlations

PUBCHEM cid=3002977

References

  1. Prescriber's Letter 14(9): 2007 New Drug: Selzentry (Maraviroc) Detail-Document#: 230904 (subscription needed) http://www.prescribersletter.com
  2. Gulick RM et al Maraviroc for Previously Treated Patients with R5 HIV-1 Infection NEJM 359:1429-1441 PMID: 18832244
  3. Aberg JA et al Primary care guidelines for the management of persons infected with human immunodeficiency virus: 2009 update by the HIV medicine Association of the Infectious Diseases Society of America. PMID: 19640227
  4. Zuger A Use of Antiretroviral Drugs in Pregnancy. Physician's First Watch, April 22, 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Panel on Treatment of HIV-Infected Pregnant Women and Prevention of Perinatal Transmission. Recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV transmission in the United States. 2014. AIDSinfo. Clinical Guidelines Portal. March 28, 2014. http://aidsinfo.nih.gov/Guidelines/HTML/3/perinatal-guidelines/0 (corresponding NGC guideline withdrawn March 2016)
  5. Medical Knowledge Self Assessment Program (MKSAP) 17, American College of Physicians, Philadelphia 2015