Maraviroc Dosage

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Usual Adult Dose for:

Additional dosage information:

Usual Adult Dose for HIV Infection

With potent CYP450 3A inhibitors (with or without a potent CYP450 3A inducer) including protease inhibitors (except tipranavir/ritonavir), delavirdine, ketoconazole, itraconazole, clarithromycin, other potent CYP450 3A inhibitors (e.g., nefazodone, telithromycin), boceprevir, telaprevir: 150 mg orally twice a day

With other concomitant medications, including tipranavir/ritonavir, nevirapine, raltegravir, all NRTIs, enfuvirtide: 300 mg orally twice a day

With potent CYP450 3A inducers (without a potent CYP450 3A inhibitor) including efavirenz, rifampin, etravirine, carbamazepine, phenobarbital, phenytoin: 600 mg orally twice a day

Use: In combination with other antiretroviral agents, for patients infected with only CCR5-tropic HIV-1

Renal Dose Adjustments

CrCl less than 30 mL/min:
With potent CYP450 3A inhibitors (with or without a potent CYP450 3A inducer) including protease inhibitors (except tipranavir/ritonavir), delavirdine, ketoconazole, itraconazole, clarithromycin, other potent CYP450 3A inhibitors (e.g., nefazodone, telithromycin), boceprevir, telaprevir: Not recommended.

With other concomitant medications, including tipranavir/ritonavir, nevirapine, raltegravir, all NRTIs, enfuvirtide: 300 mg orally twice a day; dose should be reduced to 150 mg orally twice a day if there are any symptoms of postural hypotension

With potent CYP450 3A inducers (without a potent CYP450 3A inhibitor) including efavirenz, rifampin, etravirine, carbamazepine, phenobarbital, phenytoin: Not recommended.

Liver Dose Adjustments

Caution is recommended.

Precautions

BOXED WARNING:
-HEPATOTOXICITY: Hepatotoxicity reported. Severe rash or indication of systemic allergic reaction (e.g., fever, eosinophilia, elevated IgE) may precede hepatotoxicity. Patients with signs/symptoms of hepatitis or allergic reaction should be evaluated at once.

Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

ESRD on regular hemodialysis:
With potent CYP450 3A inhibitors (with or without a potent CYP450 3A inducer) including protease inhibitors (except tipranavir/ritonavir), delavirdine, ketoconazole, itraconazole, clarithromycin, other potent CYP450 3A inhibitors (e.g., nefazodone, telithromycin), boceprevir, telaprevir: Not recommended.

With other concomitant medications, including tipranavir/ritonavir, nevirapine, raltegravir, all NRTIs, enfuvirtide: 300 mg orally twice a day; dose should be reduced to 150 mg orally twice a day if there are any symptoms of postural hypotension

With potent CYP450 3A inducers (without a potent CYP450 3A inhibitor) including efavirenz, rifampin, etravirine, carbamazepine, phenobarbital, phenytoin: Not recommended.

Other Comments

Administration advice:
-Must use with other antiretroviral agents.
-May be administered with or without food
-Do not chew the tablets; swallow whole.
-Consult the manufacturer product information regarding missed doses.

General:
-Tropism testing must be performed on a current sample with a highly sensitive tropism assay proven to detect patients appropriate for maraviroc use. Outgrowth of preexisting low-level CXCR4- or dual/mixed-tropic HIV-1 not identified by tropism testing at screening has been associated with virologic failure on this drug.
-This drug is not recommended for patients with CXCR4- or dual/mixed-tropic HIV-1.
-More therapy-naive patients treated with this drug had virologic failure and developed lamivudine resistance compared to efavirenz.

Monitoring:
-General: For infections (during therapy); for maraviroc-associated side effects in patients with moderate liver dysfunction using a potent CYP450 3A inhibitor

Patient advice:
-Avoid potentially hazardous activities (e.g., driving, operating machinery) if dizziness occurs.

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