Selzentry (Maraviroc) - Oral

What Is Selzentry?

Selzentry (maraviroc) is a medication used to treat human immunodeficiency virus (HIV). HIV is a virus that infects and attacks a person's CD4 T-cells, which are a particular type of white blood cell (WBC) and a part of your immune system.

HIV enters CD4 cells using two binding sites: the CD4 receptor and a co-receptor. HIV can use either the CCR5 co-receptor, the CXCR4 co-receptor, or both, on the surface of the CD4 cells.

Being what is called a CCR5 co-receptor antagonist, Selzentry is effective at treating only the HIV that uses the CCR5 co-receptor. Selzentry won't work if HIV uses only the CXCR4 co-receptor. Selzentry is also ineffective if the HIV strain can use either the CCR5 or CXCR4 co-receptor.

Selzentry needs to be used in combination with other antiretroviral drugs. It is available in prescription tablet or liquid solution dosage forms.

What Is Selzentry Used For?

Selzentry is used to treat HIV-1. It needs to be used with other antiretroviral medications.

Human immunodeficiency virus (HIV) affects approximately 1.4 million people in the United States, with over 10% unaware of their HIV status.

If you have HIV, you typically experience only flu-like symptoms during the first few weeks of infection. Over time, however, HIV—without treatment—can cause acquired immunodeficiency syndrome (AIDS). AIDS is the late stage of HIV infection when your immune system is so weak that you may have trouble fighting off infections.

How to Take Selzentry

Selzentry needs to be taken with other antiretroviral medications. This medication is generally taken by mouth twice daily, with or without food.

Storage

When you receive Selzentry from the pharmacy, store it at room temperature between 68 degrees to 77 degrees Fahrenheit. It has a short-term safety range of 59 degrees to 86 degrees Fahrenheit. After you open the Selzentry liquid solution bottle, the medication is suitable for only 60 days.

To be safe, you can use a locked cabinet or closet to keep your medication out of the reach of children and pets.

If you plan to travel with Selzentry, get familiar with your final destination's regulations. Checking with the U.S. embassy or consulate might be a helpful resource. In general, however, copy your Selzentry prescription. If possible, keep your medication in its original container from your pharmacy with your name on the label. Ask your pharmacist or healthcare provider if you have any questions about traveling with your medicine.

You can also ask your pharmacist or healthcare provider about the best ways to dispose of your medications. The FDA's website is a potentially helpful resource for where and how to discard all unused and expired drugs. You can also find disposal boxes in your area.

What Are the Side Effects of Selzentry?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

The following are common side effects of Selzentry in people who previously received HIV treatment:

• Cough
• Dizziness
• Fever
• Rash
• Upper respiratory tract infection (URTI)—like a common cold

The following are common side effects of Selzentry in people who are new to HIV treatment:

• Bloating and gas
• Slow movement of food through the digestive system
• Swollen lung airways
• URTI or URTI-like symptoms

Common side effects of Selzentry in children may include:

• Diarrhea
• Dizziness
• Nausea or vomiting
• Stomach pain
  

Severe Side Effects

Get medical help right away if you experience the following serious side effects:

• Heart-related effects: In people who previously received HIV treatment, Selzentry is linked to heart-related effects, such as a heart attack.
• Immune reconstitution syndrome: When you take Selzentry, your immune system may become stronger. As your immune system gains strength, it might start fighting infections that have been hiding in your body. So, keep an eye out for symptoms of an infection. The immune system may also become overreactive and attack parts of your body by mistake. General symptoms of these autoimmune diseases may include rash, low energy, joint pain, and concentration difficulties.
• Cancer risk: While more research is needed, Selzentry might increase your cancer risk due to its effects on the immune system.
• Liver toxicity: Selzentry may raise your risk of liver injury. Symptoms of worsening liver function may include dark-colored urine and yellowing of the eyes or skin.
• Postural (positional) low blood pressure: People with low kidney function may experience extremely low blood pressure. This may occur when you're changing positions from sitting down to standing. Symptoms may include feeling lightheaded and faint.
• Severe allergic reaction: If you have a severe allergic reaction to Selzentry, you may experience symptoms of swelling, rash, and breathing difficulties.
• Severe skin rash: Some people taking Selzentry have developed severe rashes, such as Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). SJS and TEN are different names for the same skin condition—with SJS being a slightly less severe but still an emergency situation. TEN, on the other hand, is more severe and life-threatening. If you have SJS or TEN, symptoms may include blistering, peeling, and painful skin.

Call 911 if your symptoms feel life threatening.

Long-Term Side Effects

Selzentry's long-term side effects are similar to its severe side effects, which may include the following:

• Cancer risk
• Heart-related effects
• Immune reconstitution syndrome (inflammatory disorders that occur after starting HIV treatment)
• Liver toxicity
• Severe skin rash

Dosage: How Much Selzentry Should I Take?

Modifications

The following modifications should be kept in mind when using Selzentry:

Severe allergic reaction: Avoid using Selzentry if you have a known allergy to it or its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy: In animal studies, Selzentry wasn't linked to adverse effects on the fetus. We don't know enough about the safety and effectiveness of Selzentry in pregnant people and their unborn fetuses.

Consider enrolling in the Antiretroviral Pregnancy Registry (APR) by calling 1-800-258-4263. Discuss with your healthcare provider if you plan to become pregnant or are pregnant. Your healthcare provider may help you weigh the benefits and risks of taking Selzentry during pregnancy.

Breastfeeding: In animal studies, Selzentry was present in rat breast milk. We don't know enough about the safety and effects of Selzentry in human breast milk and nursing babies. Breastfeeding, however, isn't recommended, to limit the chances of HIV passing onto an HIV-negative baby. Avoiding breastfeeding may also prevent treatment-resistant HIV in HIV-positive babies.

Talk with your healthcare provider if you plan to breastfeed. Your healthcare provider will help you weigh the benefits and harms of taking Selzentry while nursing. They can also discuss the different ways available to feed your baby.

Adults over 65: Clinical studies haven't included a large enough number of people in this age group to see whether they respond differently from younger adults. In adults that take several medications and have kidney or liver impairment, use Selzentry with caution.

Children: The Food and Drug Administration (FDA) approved Selzentry for children between zero to 18 years old. The child taking Selzentry must weigh at least 2 kilograms (4.4 pounds). However, Selzentry isn't recommended for a preterm newborn.

Kidney problems: Selzentry is linked to a higher likelihood of postural (positional) low blood pressure in people with severe kidney impairment or end-stage renal disease (ESRD). If you experience this side effect, your healthcare provider will adjust your Selzntry dosage. Selzentry isn't recommended if you have one of these severe kidney conditions and/or if you take medications—like St. John's wort for depression—that strongly affect CYP3A liver proteins.

Liver problems: The liver is responsible for breaking down Selzentry and clearing the medication out of the body. If you have liver impairment, Selzentry may build up in your body. This raises your risk for side effects. Therefore, your healthcare provider may adjust your Selzentry dosage and closely monitor for side effects.

Missed Dose

If you accidentally forgot your Selzentry dose, take it as soon as you remember. However, if it's less than six hours before your next scheduled dose, skip the missed dose and take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose.

Find ways to help yourself remember to keep your appointments and take your medication. If you miss too many doses, Selzentry might be less effective at treating HIV. In fact, there's a higher chance of developing treatment-resistant HIV.

Overdose: What Happens If I Take Too Much Selzentry?

A suspected overdose of Selzentry will likely result in dangerously low postural blood pressure (after sitting or lying down). Symptoms may include:

• Dizziness
• Fainting
• Lightheadedness

If you think you're experiencing an overdose or life-threatening symptoms, seek immediate medical attention.

Precautions

What Are Reasons I Shouldn’t Take Selzentry?

Before taking Selzentry, talk with your healthcare provider if any of the following applies to you.

• Severe allergic reaction: Avoid this medication if you have a severe allergic reaction to Selzentry or any of its components.
• Pregnancy: There's limited information about the effects and safety of Selzentry on the unborn fetus. Consider enrolling in the Antiretroviral Pregnancy Registry (APR) by calling 1-800-258-4263. You can also talk with your healthcare provider to help weigh the benefits and risks of taking Selzentry during pregnancy.
• Breastfeeding: There is little information about the effects and safety of Selzentry on nursing babies. In general, however, breastfeeding should be avoided to prevent passing HIV on to an HIV-negative infant or developing treatment-resistant HIV in an HIV-positive baby.
• Children: The Food and Drug Administration (FDA) approved Selzentry use in children between zero to 18 years old—as long as the child weighs at least 2 kilograms (4.4 pounds). Selzentry, however, isn't recommended in preterm newborns.
• Adults over 65: There's not enough data to assess the differences between Selzentry's safety and effectiveness between older and younger adults.
• Kidney or liver problems: Selzentry isn't recommended for people with severe kidney impairment or end-stage renal disease (ESRD)—or who are also taking medications (e.g., St. John's wort for depression) that strongly affect CYP3A liver proteins.
  

What Other Medications Interact With Selzentry?

Selzentry has numerous possible interactions with medications that affect CYP3A and P-glycoprotein (P-gp).

CYP3A is part of the cytochrome P450 (CYP450) family of proteins responsible for breaking down medications. P-gp, on the other hand, is a protein that moves drugs around the body.

If a medication is a CYP3A or P-gp inhibitor, it prevents these proteins from working. As a result, there's a higher chance of Selzentry building up in your body. This can also lead to a higher risk of side effects. So, if you need to take a CYP3A or P-gp inhibitor with Selzentry, your healthcare provider will likely lower your Selzentry dosage.

If a medication is a CYP3A or P-gp inducer, on the other hand, it encourages these proteins to do their jobs quickly. This may lead to lower amounts of Selzentry in the body and decrease its effectiveness. Therefore, your healthcare provider will likely raise your Selzentry dosage.

The following are some examples of medications that will likely interact with Selzentry:

• Carbamazepine is an anti-seizure medication. It's also a potent CYP3A inducer.
• Ketoconazole antifungal is a CYP3A and P-gp inhibitor.
• Phenobarbital is another anti-seizure medication. It's a moderate CYP3A inducer.
• Phenytoin is also an anti-seizure medication. Like carbamazepine, phenytoin is considered a potent CYP3A inducer.
• Rifampin is typically used with other medications for tuberculosis (TB). It's also considered a potent CYP3A inducer.
• St. John's wort is a natural medication commonly used for depression. It's also a potent CYP3A inducer. Taking St. John's wort with Selzentry should be avoided.
• Verapamil is a medication with many uses, including abnormal heart rhythm and migraines. It's considered to be a moderate CYP3A and P-gp inhibitor.

Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Selzentry.

And be sure to talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter, nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

Several medications are available to treat HIV. Selzentry, however, is the only member of the CCR5 co-receptor antagonist medication class.

Compared to some other HIV treatment options, experts don't typically support Selzentry as an initial go-to choice for most people. Recommendations are based on the following disadvantages of Selzentry.

• Inconvenience: Selzentry is dosed twice daily.
• Additional testing requirement: Before starting Selzentry, further testing is required to determine whether HIV uses CCR5 or CXCR4 to enter CD4 cells.
• Less effectiveness: Selzentry-based treatments don't lower HIV levels as well as other first-choice HIV combination treatments.
  

How Can I Stay Healthy While Taking Selzentry?

While living with HIV may have its challenges, there are ways to help improve quality of life. Refer below for some general tips:

• Take HIV-related medications as recommended by your healthcare provider.
• Keep up with labs and appointments with your healthcare provider.
• Learn more about HIV.
• Share with your loved ones about your HIV status when you are ready. While this is a difficult step, building your social support network is essential.
• Stop smoking. HIV-positive smokers are more likely to have heart disease and cancer than the general public.
• Routinely exercising lowers your heart disease risk and bone loss.
• Practice safe sex to limit the spread of HIV.
• Stay up to date with your vaccines.
• Consider joining support groups or working with a mental health professional to help you find coping strategies to change how you think, feel, react, or respond to living with HIV.