Maraviroc Amarox Limited (Maraviroc)

Maraviroc is a CCR5‑targeting antiretroviral indicated for specific HIV‑1 treatment scenarios.

• HIV‑1 infection (treatment‑experienced): added to a regimen of other antiretrovirals to achieve viral suppression.
• CCR5‑tropic HIV‑1 infection: prescribed when the virus uses the CCR5 co‑receptor, confirmed by tropism testing.
• Combination antiretroviral therapy: incorporated into multi‑drug regimens to reduce HIV viral load and improve immune recovery.

• Maraviroc binds selectively to the CCR5 co‑receptor on the surface of CD4+ T cells, blocking the interaction between the receptor and the HIV‑1 envelope glycoprotein gp120. This inhibition prevents the virus from entering and infecting host cells, thereby reducing viral replication and allowing immune restoration when used with other antiretroviral agents.

Adverse reactions may vary in frequency and severity.

Common Side Effects

• Headache: mild to moderate intensity, often transient.
• Nausea: occasional, may improve with food.
• Diarrhea: watery stools, usually self‑limiting.
• Fatigue: generalized tiredness.
• Cough: dry or productive, non‑specific.

Serious or Rare Side Effects

• Hepatotoxicity: elevated liver enzymes or hepatitis.
• Severe allergic reaction: rash, angioedema, or anaphylaxis.
• QT interval prolongation: cardiac conduction changes.
• Stevens‑Johnson syndrome/toxic epidermal necrolysis: severe skin reactions.
• Immune reconstitution inflammatory syndrome: worsening of opportunistic infections after immune recovery.

Before initiating therapy, clinicians should evaluate patient‑specific factors and monitor for potential risks.

• Liver function monitoring: assess baseline enzymes and repeat periodically.
• CCR5 tropism testing: confirm virus uses CCR5 before prescribing.
• Avoid strong CYP3A4 inducers: may reduce drug exposure and efficacy.
• Pregnancy and breastfeeding: safety not established; weigh benefits against risks.
• Cardiovascular assessment: caution in patients with pre‑existing heart disease.
• Store at below 25°C: keep in the original packaging, protect from moisture and direct sunlight.

Maraviroc may interact with other medicines that affect its metabolism or transport.

Major Interactions (Avoid)

• Rifampin: strong CYP3A4 inducer that markedly lowers maraviroc levels.
• Carbamazepine: induces CYP3A4, reducing antiviral efficacy.
• St. John’s wort: herbal inducer leading to decreased plasma concentrations.

Moderate Interactions (Monitor Closely)

• Protease inhibitors (e.g., atazanavir): CYP3A4 inhibitors that can increase maraviroc exposure.
• Azole antifungals (e.g., ketoconazole): may raise drug levels, requiring dose adjustment.
• Macrolide antibiotics (e.g., erythromycin): can elevate plasma concentrations, necessitating monitoring.