maribavir: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
maribavir: clinical details
Prescribing considerations
- Reserve for the licensed refractory post-transplant CMV setting and initiate through an experienced transplant clinician.
- Assess previous anti-CMV exposure, virological response and resistance results.
- Expected CNS penetration is low; maribavir was not studied for CMV CNS infection and is not expected to be effective in that setting.
- Safety and efficacy have not been established below 18 years.
- End-stage renal disease and dialysis, and severe hepatic impairment, have not been adequately studied.
Contraindications and cautions
- Hypersensitivity to maribavir or an excipient.
- Concurrent ganciclovir or valganciclovir.
Monitoring
- Follow CMV DNA during treatment and after completion because virological failure and relapse can occur.
- Investigate resistance when response is inadequate; discontinue if maribavir-resistance mutations are detected.
- Frequently monitor tacrolimus, ciclosporin, sirolimus or everolimus concentrations during treatment and around initiation or discontinuation.
- Monitor gastrointestinal tolerability, hydration, appetite and weight where clinically appropriate.
Clinical pharmacology
Maribavir competitively inhibits CMV UL97 kinase. It is highly protein-bound, primarily metabolised hepatically through CYP3A4 with a secondary CYP1A2 contribution, and has minimal urinary excretion as unchanged medicine.
Formulation and product differences
- The selected product is a film-coated oral tablet that may be swallowed whole, crushed, or administered crushed through a nasogastric or orogastric tube.
- Food and gastric acid-reducing medicines do not produce a clinically relevant change in maribavir exposure.
maribavir preparations and strengths
Tablet
Route: Oral
Strengths: 200 mg
maribavir interactions
The transplant team should review all prescription, non-prescription and herbal products before treatment.
Ganciclovir or valganciclovir
Concurrent use is contraindicated because maribavir can oppose the UL97-dependent activation and antiviral effect of these medicines.
Tacrolimus, ciclosporin, sirolimus or everolimus
Maribavir can raise concentrations, so levels require frequent monitoring when maribavir is started and stopped.
Rifampicin, rifabutin or St John’s wort
These can substantially reduce maribavir exposure and effectiveness; concurrent use is not recommended.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.