maraviroc: clinical use

Prescribing considerations

• Confirm only CCR5-tropic HIV-1 on a newly collected sample and commence soon after testing because tropism can change.
• Use only within an optimised combination antiretroviral regimen under an HIV-experienced clinician.
• Review CYP3A inhibitors and inducers whenever medicines are started, stopped or changed.
• Exercise caution with hepatic impairment, severe renal impairment, postural hypotension, significant cardiovascular disease, active tuberculosis or invasive fungal infection.

Contraindications and cautions

• Hypersensitivity to maraviroc or a formulation excipient.
• CELSENTRI film-coated tablets contain soya lecithin and are contraindicated with peanut or soya hypersensitivity; this excipient-specific restriction does not automatically apply to other formulations.

Monitoring

• HIV viral load, treatment response and adherence within routine specialist care.
• Liver function, particularly with pre-existing liver disease, hepatitis coinfection, rash or systemic hypersensitivity symptoms.
• Renal function and interaction risk, especially where potent CYP3A inhibitors are used.
• Blood pressure and symptoms of postural hypotension in susceptible patients.

Clinical pharmacology

Maraviroc is a selective CCR5 antagonist, principally metabolised by CYP3A4 and transported by P-glycoprotein.

Formulation and product differences

• Film-coated tablets and a clear oral solution are available; the solution is suitable when tablets cannot be swallowed reliably.
• CELSENTRI tablets contain soya lecithin, whereas the selected Waymade tablet has a different excipient profile.
• The oral solution contains sodium benzoate and is measured with the supplied oral applicator.

Oral solution

Route: Oral

Strengths: 20 mg/mL

Tablet

Route: Oral

Strengths: 150 mg, 300 mg