AntiretroviralUS FDA Database Verified

maraviroc (Rx)

Generic: Maraviroc

Brand: Selzentry

(mah- rav'er- rock)

Pregnancy Category: B

Pharmacological Action

Interferes with entry into HIV- 1 by inhibiting the fusion of the virus and cell membrane

Therapeutic outcome: Improvement in CD4, viral load, T- cell count

Uses

CCR5- tropic HIV in combination with other antiretroviral agents in treating experienced patients

Contraindications

Hypersensitivity, dialysis, renal impairment

Precautions: Pregnancy B, breastfeeding, Asian patients, renal/hepatic/cardiac disease, electrolyte imbalance, dehydration, immune re- . constitution syndrome, infection, MI, orthostatic hypotension, children, geriatric

BLACK BOX WARNING: Hepatitis/hepatotoxicity, fever, serious rash; eosinophilia, or elevated IgE prior to hepatotoxicity may occur

Dosage & Routes

Those not taking CYP3 A inducers/inhibitors Adult/adolescent ≥ 16 yr:PO 300 mg bid Those taking CYP3 A4 inhibitors with/without a CYP3 A inducer Adult/adolescent ≥ 16 yr:PO 150 mg bid Those taking CYP3 A4 inducers without a strong CYP3 A inhibitor Adult/adolescent ≥ 16 yr:PO 600 mg bid Renal dose

Adult: PO ≤ 30 ml/min, reduce dose to 150 mg bid

Available forms: Tabs 150, 300 mg

Implementation May give without regard to meals, with 8 oz of water Store at room temperature

Adverse Effects

CNS: Dizziness, depression, viral meningitis, disturbances in consciousness, peripheral neuropathy, paresthesia, dysesthesia, fever

CV: MI, cardiac ischemia, orthostatic hypotension

EENT: Gingival hyperplasia

GI: Diarrhea, constipation, dyspepsia, pseudo- membranous colitis, hepatotoxicity

INTEG: Rash, urticaria, pruritus, folliculitis

MS: Joint pain, leg pain, muscle cramps

RESP: Cough, URI, sinusitis, bronchitis, pneumonia, bronchospasm, obstruction

SYST: Herpes virus

Pharmacokinetics

Absorption: Unknown

Distribution: Unknown

Metabolism: By P450 system, CYP3 A metabolism

Excretion: Urine 20%, feces 76%

Half-life: Unknown

Pharmacodynamics

Unknown

Interactions

Drug classifications CYP3 A inhibitors (amiodarone, aprepitant, chloramphenicol, clarithromycin, conivaptan, cycloSPORINE, dalfopristin, danazol, diltiazem, erythromycin, estradiol, fluconazole, fluvoxaMINE, imatinib, isoniazid, itraconazole, ketoconazole, miconazole, nefazodone, niCARdipine, propoxyphene, RU- 486, tamoxifen, telithromycin, troleandomycin, verapamil, voriconazole, zafirlukast); reduce dose: increased maraviroc levels CYP3 A4 inducers (aminoglutetthimide, barbiturates, bexaroten, bosentan, carBAMazepine, dexamethasone, efavirenz, fosphenytoin, griseofulvin, modafinil, nafcillin, OXcarbazepine, phenytoin, rifabutin, rifampin, rifapentine, topiramate, tipranavir): increase dose; decreased maraviroc effect

Drug/food High- fat meal: decreased absorption 33%

Drug/herb St. John's wort: decreased maraviroc effect

Nursing Considerations

Assessment

HIV: CD4 T- cell count, plasma HIV RNA, CCR5- tropic HIV- 1; assess for change in symptoms, other infections during treatment Monitor renal tests: serum creatinine Assess bowel pattern before, during treatment

Allergies: skin eruptions: rash, urticaria, itching; assess allergies before treatment and before each dose

BLACK BOX WARNING:

Hepatitis: assess for dark urine, abdominal pain, vomiting, yellowing of skin/eyes, hepatomegaly: if present, discontinue product; monitor LFs

Patient/family education Advise patient to take as prescribed; if dose is missed, take as soon as remembered up to 1 hr before next dose; do not double dose Teach patient that product does not cure infection, just controls symptoms, and does not prevent infecting others Teach patient to report sore throat, fever, fatigue; may indicate superinfection; yellow skin/eyes, abdominal pain, vomiting (hepatitis); itching, dyspnea (allergic reaction) Advise patient that product must be taken in equal intervals around the clock to maintain blood levels for duration of therapy Instruct patient to notify prescriber of side effects Advise patient to avoid driving or other hazardous activities until reaction is known; dizziness may occur Teach patient to make position changes slowly to prevent postural hypotension Inform patient to notify prescriber if pregnancy is planned or suspected, not to breastfeed

Evaluation - Improvement in CD4, viral load, T- cell count

Reference

Mosby's Drug Guide; Davis Drug Guide

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