Generic Name

Maraviroc

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Classification

FDA Approved Indications

• HIV-1 infection in treatment-experienced patients with CCR5-trophic virus

Mechanism of Action

Maraviroc selectively binds to the CCR5 receptor on CD4 T-cells, preventing the CCR5-tropic HIV from entering and infecting the cells.

Dosage and Administration

Adult: 300 mg orally twice daily, adjust according to drug interactions and renal function

Pediatric: Not established for children under 16 years

Geriatric: Use with caution; adjust for renal impairment

Renal Impairment: Reduce dose in patients with moderate to severe renal impairment (creatinine clearance < 80 mL/min)

Hepatic Impairment: No specific recommendations; use caution in severe hepatic impairment

Pharmacokinetics

Absorption: Well absorbed, bioavailability approximately 23-33%

Distribution: Extensive; protein binding approximately 76-87%

Metabolism: Metabolized primarily via CYP3A4 enzyme

Excretion: Primarily through feces (~76%), some unchanged in urine

Half Life: Approximately 14-18 hours

Contraindications

• Use with CYP3A4 inducers (e.g., rifampin, phenobarbital) which can decrease efficacy

Precautions

• Monitor for hepatotoxicity, especially in patients with underlying liver disease
• Assess baseline hepatic function

Adverse Reactions - Common

• Musculoskeletal symptoms (e.g., myalgia, arthralgia) (Common)
• Upper respiratory tract infections (Common)
• Fever (Common)

Adverse Reactions - Serious

• Hepatotoxicity, including cases of hepatic failure (Rare)
• Cardiovascular events (Rare)

Drug-Drug Interactions

• CYP3A4 inhibitors (e.g., ketoconazole, ritonavir) increase maraviroc levels; dose adjustment required.
• CYP3A4 inducers decrease maraviroc levels; avoid or adjust dose.

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Take medication exactly as prescribed.
• Report any signs of liver problems (e.g., jaundice, dark urine).
• Inform healthcare provider before starting new medications or herbal supplements.

Special Considerations

Black Box Warnings:

• Hepatotoxicity can occur; monitor liver function.
• Potential for drug interactions leading to treatment failure or toxicity.

Genetic Factors: Pharmacogenomic testing for CCR5-tropic virus is recommended before initiation.

Lab Test Interference: May affect certain laboratory tests, such as liver function tests.

Overdose Management

Signs/Symptoms: Nausea, vomiting, dizziness, malaise.

Treatment: Supportive care, activated charcoal if ingestion is recent, and monitoring of vital signs. No specific antidote.

Storage and Handling

Storage: Store at room temperature (20°C to 25°C), protected from moisture and light.

Stability: Stable for at least 2 years when stored properly.