Maraviroc and Apalutamide: Interaction Details
AI-assisted, pharmacist-reviewed · Source data updated Aug 8, 2026 · Sources: FDA labeling, DDInter 2.0, cited literature
Apalutamide
Maraviroc
How we grade severity & evidence
Severity levels
- Contraindicated: These should generally not be used together.
- Major: Potentially serious — often needs a change or close monitoring.
- Moderate: Can be significant — usually manageable with monitoring.
- Minor: Usually limited clinical impact.
Evidence grades
- Established: Well documented — supported by controlled studies or strong clinical data.
- Probable: Good supporting evidence, though not definitively proven.
- Suspected: Some evidence suggests this interaction, but it is not well established.
- Possible: Limited or conflicting evidence; the interaction may occur.
- Theoretical: Predicted from the drugs' pharmacology; not yet confirmed in people.
Ratings come from the documented interaction literature and are reviewed by a pharmacist. They describe the documented risk of the combination, not what will necessarily happen to you — your dose, timing, and health picture all matter.
What happens
Reduced maraviroc exposure and reduced efficacy of maraviroc
Interaction Deep Dive
Concomitant use of apalutamide with maraviroc (OATP1B1/P-gp/CYP3A4 substrate) may result in reduced maraviroc exposure and reduce the efficacy of maraviroc2. The concomitant use of maraviroc with a strong CYP3A4 inducer is contraindicated in adult and pediatric patients with CrCl less than 30 mL/min and in those with ESRD on regular hemodialysis. In adults with CrCl 30 mL/min or greater treated with maraviroc and a concurrent strong CYP3A4 inducer (and no strong CYP3A4 inhibitors), increase the maraviroc dose to 600 mg orally twice daily. In pediatric patients with CrCl 30 mL/min or greater, concomitant use of maraviroc and strong CYP3A4 inducers is not recommended 1. Consider alternative agents when possible or evaluate for loss of activity of the substrate if concomitant use cannot be avoided 2.
Why it happens (mechanism)
Induction of CYP3A-mediated metabolism of maraviroc; induction of OATP1B1-mediated efflux transport of apalutamide; induction of P-gp-mediated efflux transport of apalutamide
Literature reports
4 reports — tap to read
a) Concomitant administration of maraviroc and rifAMPin, a strong CYP3A inducer, resulted in decreased maraviroc AUC and plasma concentrations. When rifAMPin 600 mg once daily was administered concurrently with maraviroc 100 mg twice daily in 12 patients, the ratio of maraviroc pharmacokinetic parameters with rifAMPin to without rifAMPin was: Cmin 0.22 (90% confidence interval (CI), 0.17 to 0.28), AUC 0.37 (90% CI, 0.33 to 0.41), and Cmax 0.34 (90% CI, 0.26 to 0.43) 1.
b) Coadministration of a single dose of apalutamide with midazolam, a CYP3A4 substrate, resulted in a 92% decrease in the midazolam AUC 2.
c) Coadministration of apalutamide with single oral doses of transporter substrates resulted in a 30% decrease in the AUC of (a P-gp substrate) 2.
d) Coadministration of apalutamide with single oral doses of transporter substrates resulted in a 41% decrease in the AUC of rosuvastatin (a OATP1B1 substrate) 2.
Common questions
Can I take Maraviroc and Apalutamide together?
Reduced maraviroc exposure and reduced efficacy of maraviroc Always confirm with your pharmacist or prescriber before making any change.
How serious is the Maraviroc and Apalutamide interaction?
It is rated major. Potentially serious — often needs a change or close monitoring.
How quickly could this interaction happen?
The documented onset is "unspecified". The timing of this interaction is not well characterized.
How strong is the evidence for this interaction?
The evidence is graded "probable". Good supporting evidence, though not definitively proven.
Questions for your pharmacist
- Does my dose of Maraviroc or Apalutamide need adjusting while I take them together?
- What symptoms should prompt me to call you or my prescriber right away?
- Does the timing of my doses matter for this combination?
- Is there a safer alternative to one of these medications for me?
References (2)
- Product Information: SELZENTRY(R) oral tablets, oral solution, maraviroc oral tablets, oral solution. Viiv Healthcare (per manufacturer), Research Triangle Park, NC, 2016. DailyMed
- Product Information: ERLEADA® oral tablets, apalutamide oral tablets. Janssen Products LP (per FDA), Horsham, PA, 2026. DailyMed
Keep reading about Apalutamide
Keep reading about Maraviroc
These medications also interact with supplements
Prescription drugs aren't the whole picture — herbal and dietary supplements can interact with them too. From the evidence-graded Natural Medicines database:
major · moderate · minor — check everything you take with our drug–supplement interaction checker.
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