VIBROCIL Price

Overview

Welcome to Dwaey, specifically on VIBROCIL page.
This medicine contains an important and useful components, as it consists of
Dimethindene maleate, Phenylephrine, Neomycin sulphateis available in the market in concentration

Name

Maraviroc

Precaution

Before starting **Maraviroc**, it is essential for patients to consult with their healthcare provider, especially considering the following precautions: - **Liver Conditions**: Maraviroc can cause liver issues. It should be used cautiously in patients with pre-existing **liver disease** or elevated liver enzymes. Regular liver function tests are advised, particularly during the first few months of treatment. - **Kidney Function**: Maraviroc is primarily eliminated through the kidneys, so patients with **renal impairment** may need dosage adjustments. Close monitoring of kidney function is important. - **Cardiovascular Risk**: Maraviroc has been associated with a potential increased risk of cardiovascular events, especially in those with underlying heart conditions. A careful risk assessment is needed for individuals with existing **cardiovascular diseases** or those with risk factors. - **Allergy**: Patients with a known hypersensitivity to **Maraviroc** or any of its components should not use it. Symptoms of an allergic reaction might include rash, itching, or swelling, and should be reported immediately. - **Pregnancy and Breastfeeding**: Maraviroc should only be used during pregnancy if the potential benefit outweighs the risk. Women who are pregnant or breastfeeding should consult their doctor to assess risks.

Indication

Maraviroc is indicated for the **treatment of HIV-1 infection** in combination with other antiretroviral agents. It works as a **CCR5 antagonist**, specifically targeting the **CCR5 co-receptor** on CD4 cells, which is used by HIV-1 to enter and infect the cells. The following groups typically receive Maraviroc: - **HIV-infected patients** who are already on antiretroviral therapy (ART) and have **CCR5-tropic HIV**. - **Treatment-naive patients** with confirmed **CCR5-tropic HIV**. - **Treatment-experienced patients** who have **tropism results** confirming the presence of **CCR5-tropic** virus.

Contra indication

The use of **Maraviroc** is contraindicated under the following conditions: - **Hypersensitivity**: Maraviroc should not be used in individuals who have had a previous allergic reaction to the drug or any of its components. - **Severe liver impairment**: Maraviroc should not be used in patients with severe hepatic impairment (Child-Pugh C). - **Dual-tropic HIV**: Maraviroc is only effective against **CCR5-tropic HIV**, so it should not be used for **CXCR4-tropic** or **dual/mixed-tropic HIV**, as it will not be effective. - **Pregnancy (Category C)**: Maraviroc should only be used during pregnancy if the benefits clearly outweigh the risks. This is not an absolute contraindication, but must be carefully considered with a healthcare provider.

Side Effect

Maraviroc can cause both common and serious side effects. Common side effects include: - **Cough**, **fever**, **nasal congestion**, and **upper respiratory infections**. - **Dizziness** and **headache**. - **Nausea** and **diarrhea**. - **Rash**, which may or may not require medical attention. Serious side effects, although rare, include: - **Liver damage**: Hepatotoxicity, including jaundice, dark urine, and liver enzyme elevations. - **Heart problems**: **Orthostatic hypotension** (a sudden drop in blood pressure upon standing) can occur, especially in patients with **cardiovascular issues**. - **Allergic reactions**: Rashes, swelling, or more severe reactions such as **angioedema**. - **Immune reconstitution inflammatory syndrome (IRIS)**: Patients may experience inflammation as the immune system recovers from HIV treatment, which may worsen symptoms of previous infections. Patients should report any **unusual symptoms** promptly to their healthcare provider, especially those involving the liver or cardiovascular system.

Pregnancy Category ID

2

Mode of Action

Maraviroc is a **CCR5 antagonist** that works by blocking the **CCR5 co-receptor** on CD4 cells. The **CCR5 co-receptor** is one of the pathways HIV uses to enter and infect cells. By preventing this interaction, Maraviroc effectively blocks the entry of **CCR5-tropic HIV** into the cells. This helps reduce the viral load in the body and improves immune function in **HIV-infected individuals**. Importantly, Maraviroc is not effective against **CXCR4-tropic HIV** or **dual-tropic HIV**, which use a different co-receptor for entry into cells.

Interaction

Maraviroc can interact with several medications, including: - **CYP3A inhibitors**: Drugs that inhibit the **CYP3A enzyme** (e.g., **ketoconazole**, **clarithromycin**, **ritonavir**) can increase Maraviroc's blood levels, which may lead to **side effects**. Dose adjustments may be necessary. - **CYP3A inducers**: Drugs like **rifampin**, **carbamazepine**, or **phenytoin**, which induce **CYP3A** activity, can decrease the effectiveness of Maraviroc, potentially requiring higher doses. - **Other HIV medications**: When combined with other **antiretroviral drugs**, such as **protease inhibitors** (e.g., **lopinavir/ritonavir**), **NNRTIs**, or **integrase inhibitors**, careful monitoring and dose adjustments are necessary. - **Antifungal or antiviral drugs**: **Fluconazole** or **itraconazole** can also interact with Maraviroc and may require adjustments in treatment regimens. - **Herbal supplements**: Herbal products such as **St. John’s Wort** can reduce the effectiveness of Maraviroc by increasing its metabolism.

Pregnancy Category Note

Information not available

Adult Dose

The recommended **adult dose** for Maraviroc depends on whether the patient is also using **CYP3A inhibitors** or **inducers**: - **Standard Dose**: 300 mg **twice daily**. - **With CYP3A inhibitors**: 150 mg **twice daily**. - **With CYP3A inducers**: 600 mg **twice daily**. - Dosing adjustments based on the patient's **HIV tropism** and **liver function** may be needed, especially for patients with **hepatitis** or **renal impairment**.

Child Dose

Maraviroc is **not recommended** for children under the age of **2 years** or for children who weigh less than **10 kg**. For **pediatric patients** who are **2 years or older** and weigh **greater than 10 kg**, the dosage and regimen are generally similar to the adult dose, but pediatric-specific dosing guidelines should be followed, with careful monitoring. The prescribing doctor will base the dose on the child’s weight, renal function, and concomitant medications. It is crucial to remember that **Maraviroc** should only be prescribed by a healthcare provider who is familiar with the patient's health history and current medications to ensure safe and effective treatment.

Renal Dose

For patients with **renal impairment**, the dose of Maraviroc must be adjusted. In cases of **mild to moderate renal impairment** (creatinine clearance between 30 to 80 mL/min), the dose remains at **300 mg twice daily**. For those with **severe renal impairment** (creatinine clearance less than 30 mL/min), Maraviroc should be reduced to **150 mg twice daily**. It is essential to regularly monitor kidney function during therapy.

Administration

Information not available