Drug interactions- summary-

+Maraviroc-

Atazanavir-
increased maraviroc inhibition

Atazanavir/ritonavir-
increased maraviroc inhibition

Efavirenz -
decreased maraviroc inhibition

Ketoconazole -
increased maraviroc inhibition

Lopinavir/ritonavir-
increased maraviroc inhibition

Rifampicin-
decreased maraviroc inhibition

Squanvir/ritonavir-
increased maraviroc inhibition

St Johns wort-
coadmin is not recommended.

 Maraviroc -   Cellular Chemokine Receptor (CCR5) antagonist - Antiviral agents

HIV infection

Adverse reactions-

Cardiovascular -      vascular hypertensive disorders    3%

CNS-          depressive disorders  3%   sleep disturbances   6%     dizziness 7%
                   sensory anormalites 3%

Dermatologic -  dermatitis/eczema   3%   pruritus  2%  rash  3%

GI -               constipation    5%  stomatitis , ulceration 8%

GU-              bladder and urrethral symptoms  4%   urinary tract signs 2%

Musculoskeletal - joint related signs and symptoms    6% 
                               musculoskeletal and connective tissue  signs/symptoms 7%

Respiratory -   breathing anormalites 3% bronchitis 5%  coughing 11%   sinusitis 6%

Miscellaneous -  appetite disorders  6%  herpes infection 6%   pyrexia   11%

Special precautions-
Cardiovascular effects-  use caution while administering maraviroc in patients with history of
hypotension or on concomittant medication known to lower blood pressure

Risk of infection- closely monitor patients for evidence of infections while receiving maraviroc

Renal function impairment - patients with CrCl of less than 50mL/min should receive maraviroc
and CYP3A inhibitors  only if the potential benefit is felt to out weigh the risk,
Monitor patients for adverse reactin-

Hazardous tasks - instruct patients  who experience dizziness  while taking maraviroc,
 to avoid driving or opeating machinery

Pregnancy- use maraviroc only if needed

Lactation- instruct mother not to breast feed while taking maraviroc

Children-  safety and efficacy not established in children below 16 years of age,

Elderly- excecise caution when administering to elderly patients because of 
frequency of decreased renal function and concomittant disease and other drugs

Monitoring- monitor liver function at base line and periodically during treatment.
Monitor blood pressure in patients with a history of hypotension or on hypertensive drugs
Monitor closely for infectios

For the treatment of Patients infected with CCR5-Tropihic HIV-1

HIV infection

Dosage-

Maraviroc can be taken with or without food
Recommended dose -
Concomittant medications-

Protease inhibitors (except tiprnavir/ritonavir, delavardine )
 ketoconazole, itraconazole, clarithromycin
Other strong CYP3A inhibitor eg nefazodone, telithromycin

150mg twice daily
 
other concomittant medications including tipranavir/ritonavir, nevirapine, all NRTs
and enfluvirtide

300mg twice daily

 CYP3A inducers ( without a strong CYP3A inhibitors )
carbamazepine, phenobarbital, phenytoin
Efavirenz, rifampicin

600mg twice daily

1. Advice patients to- remain under the supervision of their doctor

2. To take  maraviroc every day as prescribed by the doctor

3. To report of the use of any other prescription or non prescription medicines or herbal products

4. To inform their doctor if they are pregnant or hoping to become pregnant

5. Not change the dosing schedule of maravioc or any other medicines  prescribed by the doctor

Can be taken with food

Pregnancy-
Use maraviroc only if needed

Lactation-
Instruct mother not to breast feed while taking maraviroc

Children- 
Safety and efficacy not established in children below 16 years of age,

Elderly-
Excercise caution when administering to elderly patients because of greater
frequency of renal function and concomittant disease and other drugs