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Apretude

cabotegravir
Used for HIV Prevention
Used for HIV Prevention

Apretude (cabotegravir) is a newer, long-acting injection used to lower the risk of getting an HIV infection. It was approved by the FDA in 2021 for pre-exposure prophylaxis (PrEP). It's injected into the gluteal muscle (buttock muscle) every other month by a healthcare provider, but the injections can be painful.

Reviewed by:
reviewer
Kristianne Hannemann, PharmD
reviewer
Allison Gourley, PharmD
Last reviewed on August 24, 2022
BasicsSide effectsPros & consPharmacist tipsFAQsWarningsDosageContraindicationsAlternativesLatest newsPricesMedicare
basics-icon

What is Apretude (cabotegravir)?

What is Apretude (cabotegravir) used for?

  • HIV pre-exposure prophylaxis (PrEP)

How Apretude (cabotegravir) works

Apretude (cabotegravir) is an integrase inhibitor. Integrase is an enzyme (protein) that the HIV virus uses to enter your cells and make more copies of itself. When integrase is stopped, the virus can't grow and spread.

Are you looking for information on the Vocabria (cabotegravir) tablets or the Cabenuva (cabotegravir / rilpivirine) injection instead?

Drug Facts

Common BrandsApretude
Drug ClassAntiretroviral
Controlled Substance ClassificationNot a controlled medication
Generic StatusNo lower-cost generic available
AvailabilityPrescription only
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What are the side effects of Apretude (cabotegravir)?

The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.

Common Side Effects

  • Injection site reaction (38-82%)
  • Headache (4-12%)
  • Diarrhea (4%)
  • Nausea (3-4%)
  • Dizziness (2-4%)
  • Fever (up to 4%)
  • Upper respiratory tract infection (e.g., common cold, up to 4%)

Other Side Effects

  • Feeling tired
  • Trouble sleeping
  • Abnormal dreams
  • Stomach pain
  • Vomiting
  • Muscle pain
  • Rash
  • Lower appetite
  • Drowsiness

Serious Side Effects

Contact your healthcare provider immediately if you experience any of the following.
  • Serious allergic reaction: rash, trouble breathing, swelling in your lips, tongue, or throat
  • Suicidal thoughts and behaviors

Source: DailyMed

The following side effects have also been reported

Side effects that you should report to your care team as soon as possible:

  • Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
  • Liver injury—right upper belly pain, loss of appetite, nausea, light-colored stool, dark yellow or brown urine, yellowing skin or eyes, unusual weakness or fatigue
  • Thoughts of suicide or self-harm, worsening mood, feelings of depression

Side effects that usually do not require medical attention (report to your care team if they continue or are bothersome):

pros-and-cons

Pros and cons of Apretude (cabotegravir)

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Pros

Only FDA-approved injection for HIV PrEP

After the first two injections, only need to get one injection every other month

Works well to prevent HIV-1 infection in people at high risk

Good option for people who can't tolerate pills

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Cons

Injections can be painful; 90-98% of people reported pain or tenderness with the injection

Must be injected by a healthcare provider

Unknown if safe in pregnancy

Brand only, so might be expensive

pharmacist-tips

Pharmacist tips for Apretude (cabotegravir)

pharmacist

  • In addition to getting Apretude (cabotegravir) injections, there are other things you can do to help lower your risk of HIV infection. For example, know if your partner has HIV, get tested for sexually transmitted diseases (STDs), and wear a latex condom during sexual activity.

    • Apretude (cabotegravir) doesn't always work to prevent HIV. Getting injections on time can lower your risk of infection. Speak to your provider if you have concerns.

      • Call your provider if you think you were exposed to HIV. They might want to do tests to make sure you're HIV negative, since you can only take Apretude (cabotegravir) if you're negative.

        • Let your provider know if you have symptoms of HIV infection, including fever, muscle pain, feeling tired, or rash so you can be tested right away. Apretude (cabotegravir) isn't a complete treatment for HIV infection.

          • If you decide to stop taking Apretude (cabotegravir) and are still at risk for getting infected with HIV, speak with your provider about starting alternative treatment within 2 months of your last injection.

            • Even though Apretude (cabotegravir) can stay in your body for up to 12 months, it has only been shown to prevent HIV infection when taken every 2 months. If you need to miss or already missed your injection, discuss options with your provider right away.

              • If you're pregnant or breastfeeding, speak to your provider about the risks and benefits of Apretude (cabotegravir).

                • Apretude (cabotegravir) doesn't prevent other STDs. Always practice safe sex to lower your risk of getting STDs.

                  faqs

                  Frequently asked questions about Apretude (cabotegravir)

                  What's the difference between post-exposure prophylaxis (PEP) and PrEP?
                  PEP, or post-exposure prophylaxis, helps prevent HIV infection after a high-risk event has already happened. It must be started as soon as possible after the event, within 72 hours of exposure. PrEP, or pre-exposure prophylaxis, includes medications that are taken to lower your risk of getting HIV from sex or injection drug use. If you might be at high risk for getting HIV, speak to your provider to see if PrEP is an option for you.
                  What happens if I miss my Apretude (cabotegravir) injection?
                  It's very important to get your injections on time so they work the best for you. But if you miss your Apretude (cabotegravir) injection, your provider will decide if you can continue getting your injections or if you'll need to start a new medication. How many injections you'll need to make up for your missed injection will depend on how long it's been since you got your last injection. If you're planning on missing your injection by more than 7 days after it was due, you might be able to take the tablet form of this medication until your next injection. However, it's not recommended to use the tablet form of cabotegravir for PrEP for longer than 2 months.
                  What's the difference between Apretude (cabotegravir) and Vocabria (cabotegravir)?
                  Although both medications have the same active ingredient, they're available in different forms and used for different purposes. Apretude (cabotegravir) is an injection and can only be used to prevent HIV infection in people who are at high risk for getting HIV. Each injection contains 600 mg of cabotegravir. Vocabria (cabotegravir) is only available as 30 mg tablets. It's used together with Edurant (rilpivirine) for short-term treatment of HIV-1 infection in adults whose infection is controlled with HIV medications and who want to switch to a long-acting injection called Cabenuva (cabotegravir / rilpivirine). Vocabria (cabotegravir) tablets are used for one month to see how the medication is tolerated before switching to one of the injectable forms. It can also be used by people who will miss injections with Cabenuva (cabotegravir / rilpivirine) or Apretude (cabotegravir).
                  What do I need to do before I can take Apretude (cabotegravir)?
                  It's important for you to get tested for HIV before using Apretude (cabotegravir) to prevent HIV resistance. Resistance happens when the virus changes in a way that stops certain HIV medications from working well against it. This makes the virus harder to treat. If you test positive for HIV, contact your provider so you can begin proper treatment.
                  Is Apretude (cabotegravir) safe to use during pregnancy?
                  There isn't enough information available to know if Apretude (cabotegravir) is safe to take during pregnancy. But birth defects of the brain, spine, or spinal cord have occurred with similar medications. In some animal studies, high doses of Apretude (cabotegravir) caused harm to unborn babies. It's also important to know that this medication can stay in your body for up to 12 months after stopping injections. There's a pregnancy registry to monitor the safety of Apretude (cabotegravir) during pregnancy. If you're currently pregnant and taking this medication, it is encouraged that you enroll in the registry by calling the Antiretroviral Pregnancy Registry (APR) at 1-800-258-4263.
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                  What are the risks and warnings for Apretude (cabotegravir)?

                  Apretude (cabotegravir) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.

                  risk-warning

                  Only for people who are HIV-negative

                  • Risk factors: Unknown if positive or negative for HIV-1

                    Before you can take Apretude (cabotegravir), you must be tested for HIV. This medication can only be used if you've tested negative for HIV because there's a risk of resistance occurring in people who don't know if they're HIV positive or negative. This might make an HIV infection harder to treat over time. Your provider will test you before each injection. If you test positive for HIV, your provider will stop Apretude (cabotegravir) and start you on a more complete treatment.

                    risk-warning

                    Might not prevent HIV

                    Apretude (cabotegravir) might not work well if you develop an HIV infection either before, during, or after treatment. For this reason, you'll be tested for HIV before each Apretude (cabotegravir) injection. This medication should be used along with other methods to reduce your risk of HIV infection. Other things you can do to lower your risk include safe sex practices (e.g., using latex condoms), knowing if your partners are infected with HIV, and getting tested regularly for HIV. Getting Apretude (cabotegravir) injections on time will help lower your risk of getting infected with HIV.

                    Before starting Apretude (cabotegravir), your provider might ask you about your potential exposure to HIV. These events might include recent condomless sex, or if you have a recent history of sexually transmitted diseases (STDs). You'll also be asked to get an HIV test before starting this medication and before every injection. Let your provider know if you have symptoms of HIV before or during your treatment with Apretude (cabotegravir), including fever, feeling tired, muscle pain, and skin rash.

                    risk-warning

                    Serious allergic reaction

                    Life-threatening or severe allergic reactions have occurred with medications similar to Apretude (cabotegravir). This is why your provider might ask you to take a tablet form of this medication before the long-acting injection form to see how you tolerate it. They might also monitor you for at least 10 minutes after your injection. Get medical help right away if you experience shortness of breath, rash, fever, muscle pain, swelling in your face, or tightness in your throat.

                    risk-warning

                    Liver damage

                    In some rare cases, some people have experienced liver damage from Apretude (cabotegravir). Speak to your provider about your medical history before taking this medication. Watch out for signs of liver damage such as stomach pain, yellowing of the skin or whites of your eyes, and nausea or vomiting. If you experience any of these symptoms, get medical help right away.

                    risk-warning

                    Depression and suicidal thoughts

                    Some people have experienced depression and suicidal thoughts or attempt(s) while taking Apretude (cabotegravir). If you notice any mood changes, call your provider so they can determine if your symptoms might be related to this medication. They'll also evaluate whether Apretude (cabotegravir) is still safe for you to continue taking.

                    risk-warning

                    Interactions with other medications

                    It's possible for other medications to interact with Apretude (cabotegravir). Some medications can lower the amount of Apretude (cabotegravir) in your body, which could make it work less well to prevent HIV infection. Examples include some antiseizure medications (e.g., carbamazepine (Tegretol), phenytoin (Dilantin)) and antibiotics (e.g., rifampin (Rifadin), rifabutin (Mycobutin)). Make sure to tell your provider all of the medications you're taking before starting Apretude (cabotegravir) and if you start any new medications. They can help you screen for potential interactions.

                    dosage

                    Apretude (cabotegravir) dosage forms

                    Typical dosing for Apretude (cabotegravir)

                    Adults and adolescents weighing 35 kg or greater: The typical dose is 600 mg injected into the muscle (IM) every month for 2 months. Afterwards, the typical dose is 600 mg every 2 months.

                    contraindications-icon

                    Apretude (cabotegravir) contraindications

                    Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Apretude (cabotegravir) will not be safe for you to take.
                    alternatives

                    What are alternatives to Apretude (cabotegravir)?

                    There are a number of medications that your doctor can prescribe in place of Apretude (cabotegravir). Compare a few possible alternatives below.
                    Apretude (cabotegravir)
                    Used for:

                    • HIV pre-exposure prophylaxis (PrEP)

                    View Prices
                    Truvada
                    Used for:
                    $29.04 Lowest GoodRx priceView Prices
                    Descovy (emtricitabine / tenofovir alafenamide)
                    Used for:

                    • Treatment of HIV infection

                    • Prevention of HIV infection (PrEP) through sexual intercourse, except for receptive vaginal sex

                    $2156.91 Lowest GoodRx priceView Prices

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