II. Indications
- HIV Infection Treatment (Cabenuva), as part of combination therapy
- HIV Pre-exposure Prophylaxis or PReP (Apretude)
III. Contraindications
- Age <12 years
- Weight <35 kg
- Pregnancy
- Neural Tube Defects with Dolutegravir (Tivicay), unknown if class effect
IV. Medications: Cabotegravir Oral (Vocabria)
- Lead in Dosing prior to IM dosing (Cabenuva) for HIV Treatment
- Cabotegravir (Vocabria) 30 mg orally daily AND
- Rilpivirine (Edurant) 25 mg orally daily
- Lead in Dosing prior to IM dosing (Apretude) for HIV Pre-exposure Prophylaxis (PREP)
- Cabotegravir (Vocabria) 30 mg orally daily
V. Medications: Cabenuva (Cabotegravir and Rilpivirine)
- Cabenuva combines Integrase Inhibitor and Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)
- Dosing
- Two Intramuscular Injections in gluteal Muscle (one for each drug) once monthly
- Administered in clinic, at $4000 per month
- Requires one month of oral "lead-in" daily therapy to evaluate tolerability before IM Injection
- Efficacy
- Appears as effective as triple therapy combinations
-
Drug Interactions
- Less effective when combined with CYP 3A4 inducers (e.g. Phenytoin)
- References
- Orkin (2020) N Engl J Med 382(12):1124-35 [PubMed]
- Swindells (2020) N Engl J Med 382(12):1112-23 [PubMed]
- (2021) presc lett 28(3): 18
VI. Medications: Cabotegravir (Apretude)
- Cabotegravir Monthly to Bimonthly IM injection Integrase Inhibitor
- Indications: HIV Pre-exposure Prophylaxis (PREP)
- See HIV Preexposure Prophylaxis (HIV PrEP)
- Teens over age 12 years and Adults >35 kg who are HIV negative, but high risk for HIV Infection
- Contraindications
- Do NOT use as single therapy for HIV Infection
- Dosing
- Give 600 mg IM on days 1 and 30 of initial month, then every 2 months
- Consider a one month lead in period of Cabotegravir 30 mg orally daily to assess tolerability
- Cost $4000 per dose
- Renal Disease
- Adverse effects may increase at Creatinine Clearance <30 ml/min
- However, may be used in Stage 4 and 5 Chronic Kidney Disease
- Efficacy
- Higher efficacy than Emtricitabine/Tenofovir
- References
VII. Adverse Effects
VIII. Resources
- Cabotegravir Oral (Vocabria, DailyMed)
- Cabenuva IM for Treatment (Cabotegravir and Rilpivirine Kit, DailyMed)
- Cabotegravir IM for PReP (Apretude)