Maribavir
Brand names: Livtencity
Maribavir is an antiviral agent used to treat cytomegalovirus (CMV) infection and disease that is refractory, with or without resistance, to prior anti-CMV therapy, particularly after transplantation.
Adult dose
Dose auto-extracted from US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.
Contraindications
- US label §4 states: None
Side effects
- Taste disturbance (dysgeusia) - most common, all grades >10% (§6.1)
- Nausea (>10%)
- Diarrhoea (>10%)
- Vomiting (>10%)
- Fatigue (>10%)
Interactions
- Ganciclovir and valganciclovir - maribavir may antagonise their antiviral activity by inhibiting CMV pUL97 kinase, which is required for their activation; co-administration is NOT recommended (§5.1, §7.1)
- Strong CYP3A4 inducers - co-administration is not recommended, except with a dose adjustment for selected anticonvulsants: carbamazepine (increase to 800 mg twice daily) and phenytoin (increase to 1,200 mg twice daily) (§7.2, §2.2)
- Moderate CYP3A4 inducers - rifabutin (increase to 800 mg twice daily) and phenobarbital (increase to 1,200 mg twice daily) require a dose adjustment (§7.2, §2.2, §2.3)
- Immunosuppressants with narrow therapeutic margins - maribavir has the potential to increase concentrations of tacrolimus, ciclosporin, sirolimus and everolimus, where minimal concentration changes may lead to serious adverse events; monitor levels frequently throughout treatment, especially after starting and after stopping maribavir, and adjust the dose as needed (§5.3)
Clinical monograph
How it works
It inhibits the CMV UL97 protein kinase, interfering with viral DNA replication, encapsidation and nuclear egress of viral particles.
Prescribing in practice
- Because it inhibits UL97, it antagonises ganciclovir and valganciclovir, which depend on UL97 for activation, so co-administration with these agents should be avoided.
- Resistance can emerge during treatment, so persistent or rising CMV viral load should prompt reassessment.
- It interacts with several drugs as a CYP3A substrate and a P-glycoprotein inhibitor, so co-medication should be reviewed against current prescribing references.
Monitoring
Monitor CMV viral load to assess response and detect possible resistance during treatment.
Counselling the patient
- This medicine treats a CMV infection that did not respond to earlier treatment.
- Taste disturbance is a common side effect and usually settles.
- Attend blood tests to check that the virus is responding.
Evidence & guidelines
A randomised controlled trial demonstrated superiority over investigator-assigned anti-CMV therapy for clearance of refractory or resistant CMV infection.
Reference: NICE TA860; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).
Related
Curated clinical cross-links plus same-class fallbacks.
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- Ho Index for Predicting Response to Medical Therapy in IBD · Inflammatory Bowel Disease
- irAE Hepatitis Grading (CTCAE) · Immunotherapy
- Infective Endocarditis · ESC 2023 Infective Endocarditis Guidelines; NICE NG41
- Eczema Herpeticum · BAD; NICE CKS
- Suspected Bacterial Meningitis (Adult) · NICE NG240 (2024); NICE NG143 (paeds)
- Clostridioides difficile Colitis · NICE NG199 (2021); IDSA/SHEA 2021
- Returning Traveller — Fever · NaTHNaC; PHE; ESCMID 2018
- Malaria — Diagnosis & Management · PHE 2016; WHO 2023