Rilpivirine

Aka: Rilpivirine, Edurant

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II. Indications

  1. HIV Infection (part of combination therapy)
    1. FDA approved in 2011 for treatment-naive HIV patients (with HIV RNA <100,000 copies)
    2. High risk of induced HIV resistance
      1. Never use NNRTIs as monotherapy in HIV Infection

III. Mechanism

  1. See Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)
  2. Second-generation Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)
  3. Rilpivirine is a diarylpyrimidine

IV. Medications

  1. Oral: 25 mg tablets
  2. Combination agents
    1. Cabenuva (Cabotegravir/Rilpivirine) monthly IM Injections
    2. Juluca (Dolutegravir/Rilpivirine)

V. Dosing: HIV Infection

  1. For treatment naive patients and HIV RNA <100,000 copies
  2. Administer in combination with other Antiretrovirals
  3. Protect medication from light (keep in original packaging)
  4. Adult (and child age >12 years or weight >35 kg)
    1. Take 25 mg orally daily with food

VI. Efficacy

  1. Higher failure rates than Efavirenz when HIV RNA >100,000 copies
  2. Higher failure rates when CD4 Count <200 cells/mm3

VII. Adverse Effects

  1. See Non-Nucleoside Reverse Transcriptase Inhibitor
  2. QTc Prolongation
    1. Increased risk with high serum levels of Rilpivirine
    2. Avoid with known QTc Prolongation or other medications that cause Drug-Induced QTc Prolongation
  3. Hepatotoxicity
    1. Obtain Liver Function Tests at baseline and periodically (esp. in known liver disease)

VIII. Safety

  1. Avoid in Lactation
  2. Pregnancy
    1. May use in pregnancy if risk outweighs benefit
    2. Monitor viral loads in pregnancy
    3. Pregnancy registry exists

IX. Drug Interactions

  1. Rifabutin
    1. Increase Doravirine dose to 50 mg orally daily with food
  2. Drug-Induced QTc Prolongation
    1. Avoid with other agents that prolong QTc
  3. Metabolized by CYP3A4
    1. Avoid with strong CYP3A4 Inducers (e.g. Carbamazepine, Phenobarbital, Phenytoin, Rifampin)
  4. Antacids
    1. Antacid Salts (e.g. Aluminum and Magnesium Salt Antacid, Calcium Carbonate)
      1. Take at least 2 hours before or 4 hours after Rilpivirine
    2. H2 Blockers
      1. Take at least 12 hours before or 4 hours after Rilpivirine
  5. Methadone
    1. Rilpivirine may reduce Methadone effects

X. Resources

  1. Rilpivirine (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=03880372-2c68-45c6-a53a-f420c49541d6

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Cost: Medications

edurant (on 1/19/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
EDURANT 25 MG TABLET $41.36 each
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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