Cabenuva
Cabenuva (cabotegravir / rilpivirine) is a long-acting prescription medication used to treat a human immunodeficiency virus (HIV) infection. It's injected into the gluteal muscle (buttocks) by a healthcare provider and is dosed either once a month or every other month. Cabenuva (cabotegravir / rilpivirine) is the first FDA-approved long-acting injection that offers a complete HIV-1 treatment. The most common side effects of this medication are injection site reactions, such as pain, tenderness, a hardened lump, and swelling at the buttocks muscle.
What is Cabenuva (cabotegravir / rilpivirine)?
What is Cabenuva (cabotegravir / rilpivirine) used for?
HIV treatment
How Cabenuva (cabotegravir / rilpivirine) works
Cabenuva (cabotegravir / rilpivirine) is a combination of 2 medications:
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. Cabotegravir works by blocking integrase, therefore preventing HIV viruses from spreading.
Rilpivirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI). It blocks an enzyme called reverse transcriptase, which prevents the HIV virus from making copies of itself and spreading.
Drug Facts
What are the side effects of Cabenuva (cabotegravir / rilpivirine)?
Common Side Effects
- Injection-site reactions (pain, harden skin, local swelling; 75-83%)
- Fever (8%)
- Higher creatine phosphokinase levels (8%)
- Higher pancreas enzyme levels, suggesting pancreas irritation (5%)
- Feeling tired (5%)
- Headache (4%)
Other Side Effects
- Muscle or bone pain
- Nausea
- Trouble sleeping
- Dizziness
- Rash
Serious Side Effects
- Suicidal thoughts and behaviors
- Serious allergic reactions: mouth sores, trouble breathing, rash, fever, swelling in your face, lips, or tongue
- Liver problems: feeling sleepy, upper right stomach pain, yellowing of the skin or whites of the eyes, dark urine, nausea
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
- Rash, fever, and swollen lymph nodes
- Severe back pain, chest pain, headache, trouble breathing after injection
- 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 of Cabenuva (cabotegravir / rilpivirine)
Pros
Typically needs to be injected once every 1 to 2 months, so it's convenient for people with a busy schedule
Can be used in people with kidney and liver problems
The first and only long-acting, complete HIV injectable medication
Cons
Interacts with a lot of medications such as carbamazepine (Tegretol), phenytoin (Dilantin), and rifampin (Rifadin)
Unknown if safe or works well in children under 12
Likely to cause post-injection reactions
Pharmacist tips for Cabenuva (cabotegravir / rilpivirine)
Each Cabenuva (cabotegravir / rilpivirine) treatment contains two injections, which can be injected into the muscle on each side of your buttocks or on the same side (at least 2 cm apart). Most commonly, you'll receive this medication at a hospital or a provider's office.
If you're switching from oral Vocabria (cabotegravir) and Edurant (rilpivirine) tablets to Cabenuva (cabotegravir / rilpivirine) injections, follow your provider's instructions on how to make the transition. Typically you can receive your first treatment of Cabenuva (cabotegravir / rilpivirine) along with the last Vocabria (cabotegravir) and Edurant (rilpivirine) tablets.
Be sure to plan for some extra time after your appointment. Your provider will need to monitor you for post-injection reactions after you've received Cabenuva (cabotegravir / rilpivirine). Signs and symptoms usually get better after a few minutes. But tell your provider if you experience tightness in your throat, stomach pain, sweating, trouble breathing, mouth feeling numb, back and chest pain, or dizziness.
Cabenuva (cabotegravir / rilpivirine) can interact with many medications. Let your provider or pharmacist know what medications you're taking, including over-the-counter products and supplements, before you start Cabenuva (cabotegravir / rilpivirine). Talk with your provider or pharmacist if you have any questions about interactions with this medication.
Tell your provider if you or your child experiences any changes in weight while taking Cabenuva (cabotegravir / rilpivirine). It's not clear whether this medication will be safe for or will work well for people who weigh less than 77 lbs. Let your provider know if you or your child has nausea, vomiting, or diarrhea that won’t go away since this can also be a cause of weight loss.
Make sure to get your routine blood tests done on time while you’re receiving Cabenuva (cabotegravir / rilpivirine) so your provider can make sure this medication is working for you and not causing side effects. Talk with your provider about your medical history, including any liver problems or history of hepatitis, before starting Cabenuva (cabotegravir / rilpivirine).
Let your provider know if you experience symptoms of depression or worsening mood while receiving Cabenuva (cabotegravir / rilpivirine). In cases of serious depression, your provider might ask you to stop taking this medication.
It's best to get your Cabenuva (cabotegravir / rilpivirine) injections around the same time every month or every other month. If you miss or are planning to miss a treatment, talk with your provider right away about rescheduling your appointment. Depending on when your next scheduled appointment is, your provider might ask you to take other HIV treatment in the meanwhile.
Frequently asked questions about Cabenuva (cabotegravir / rilpivirine)
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What are the risks and warnings for Cabenuva (cabotegravir / rilpivirine)?
Cabenuva (cabotegravir / rilpivirine) 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.
Serious allergic reactions
People who receive Cabenuva (cabotegravir / rilpivirine) can sometimes experience a serious post-injection reaction. Your risk might be higher if your IM injection was too fast. Most of the time, reactions are mild and usually go away within a couple of minutes after the injection. Your provider will monitor you for post-injection reactions each time you receive Cabenuva (cabotegravir / rilpivirine) to make sure this medication is safe for you. In addition, HIV treatments containing rilpivirine have caused allergic reactions that are sometimes life-threatening. 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. Watch out for signs and symptoms of allergic reactions, such as rash, trouble breathing, fever, general discomfort, tiredness, dizziness, mouth sores, pink eye, dark urine, or swelling in your face. Get medical attention right away if an allergic reaction occurs.
Liver problems
Risk factor: Past liver problems
Rarely, Cabenuva (cabotegravir / rilpivirine) can cause serious liver problems. Your risk might be higher if you have had past liver problems. Talk with your provider about your medical history before starting this medication so they can decide how you can safely take Cabenuva (cabotegravir / rilpivirine). You’ll need to get blood tests done while you take Cabenuva (cabotegravir / rilpivirine) so your provider can check your liver health. If you experience signs and symptoms of liver damage, such as feeling sleepy, upper right stomach pain, yellowing of the skin or whites of the eyes, or dark urine, talk with your provider right away.
Depression and suicidal thoughts
Some people have experienced depression, mood swings, and suicidal thoughts or attempt(s) while taking Cabenuva (cabotegravir / rilpivirine). If you notice any mood changes, call your provider so they can determine if your symptoms are related to this medication. They'll also decide whether Cabenuva (cabotegravir / rilpivirine) is still safe for you to continue taking.
Worsening of HIV infection (with missed doses)
It's very important to get your Cabenuva (cabotegravir / rilpivirine) injections regularly according to your provider's treatment plan. Missing doses frequently can make it easier for HIV virus to change form, causing Cabenuva (cabotegravir / rilpivirine) to stop working. It can also lead to a higher amount of HIV virus in your body and your infection getting worse. Tell your provider right away if you miss or plan to miss a scheduled appointment to receive your injections so that they can let you know about other options.
If you chose to stop receiving Cabenuva (cabotegravir / rilpivirine) or if the amount of HIV virus in your blood has gone up, your provider can help you decide on a new HIV treatment plan. If you choose to start a different HIV treatment, make sure to start it within 1 to 2 months of your final Cabenuva (cabotegravir / rilpivirine) injection (depending on if you had been receiving monthly or bimonthly injections). If you wait too long to start a new treatment, you're at higher risk for for worsening HIV infection.
Interaction with other medications
Some medications can interfere with how your body removes Cabenuva (cabotegravir / rilpivirine). This can affect the amount of Cabenuva (cabotegravir / rilpivirine) in your body, how well it works, and the risk of side effects.
Taking medications like clarithromycin or erythromycin can raise the amount of rilpivirine in your body and raise your risk for serious heart problems. If you need to take a macrolide antibiotic, discuss with your provider whether azithromycin (Zithromax) is a better option since it has fewer interactions with Cabenuva (cabotegravir / rilpivirine).
Taking certain medications for seizures (e.g., carbamazepine (Tegretol), phenytoin (Dilantin), dexamethasone (more than one dose), St John’s wort, or antibiotics (e.g., rifampin (Rifadin), Priftin (rifapentine)) along with Cabenuva (cabotegravir / rilpivirine) should also be avoided. This is because these medications can lower the amount of Cabenuva (cabotegravir / rilpivirine) in your body and cause it to not work as well.
Cabenuva (cabotegravir / rilpivirine) also interferes with how your body removes other medications. For example, taking this medication with methadone (Methadose) can change the amount of pain medication that your body absorbs.
Let your provider or pharmacist know what other medications you’re taking before and while taking Cabenuva (cabotegravir / rilpivirine).
Cabenuva (cabotegravir / rilpivirine) dosage forms
Typical dosing for Cabenuva (cabotegravir / rilpivirine)
Cabenuva (cabotegravir / rilpivirine) is usually given in a hospital setting or at your provider's office by a healthcare professional. The dose of Cabenuva (cabotegravir / rilpivirine) depends on how often you receive the injections.
In general, for people 12 years and older who weigh 77 lbs or more:
Once-a-month dosing: The typical starting dose is 2 injections (600 mg of cabotegravir and 900 mg of rilpivirine) injected into the buttocks muscle (IM) for the first month. Afterwards, the typical dose is 2 IM injections (400 mg of cabotegravir and 600 mg of rilpivirine) once a month.
Every-other-month dosing: The typical starting dose is 2 injections (600 mg of cabotegravir and 900 mg of rilpivirine) injected into the buttocks muscle once a month for the first 2 months. Afterwards, the typical dose is 2 IM injections (600 mg of cabotegravir and 900 mg of rilpivirine) once every other month starting at month 4.
Please note: your provider might prescribe oral Vocabria (cabotegravir) and Edurant (rilpivirine) tablets for about a month before receiving Cabenuva (cabotegravir / rilpivirine) injections. Please read the FAQ section for details.
Cabenuva (cabotegravir / rilpivirine) contraindications
Taking any medication that greatly lowers the amount of cabotegravir or rilpivirine in your body, such as medications for seizures (e.g., carbamazepine (Tegretol), oxcarbazepine (Trileptal), phenobarbital, phenytoin (Dilantin)), antibiotics (e.g., rifampin (Rifadin), Priftin (rifapentine)), dexamethasone (multiple treatment), or St John’s wort
What are alternatives to Cabenuva (cabotegravir / rilpivirine)?
HIV treatment for people who are well controlled on an HIV ARV regimen already and want to switch regimens
What is the latest news about Cabenuva (cabotegravir / rilpivirine)?
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References
Best studies we foundCenters for Disease Control and Prevention. (2023). HIV treatment as prevention.
Clinical Info HIV.gov. (n.d.). Integrase strand transfer inhibitor (INSTI).
Clinical Info HIV.gov. (n.d.). Non-nucleoside reverse transcriptase inhibitor (NNRTI).
HIV.gov. (2023). Taking your HIV medicine as prescribed.
MedlinePlus. (n.d.). Creatine phosphokinase test.
U.S. Food and Drug Administration. (2021). FDA approves Cabenuva and Vocabria for the treatment of HIV-1 infection.
ViiV Healthcare Company. (2023). Cabenuva- cabotegravir and rilpivirine [package insert]. DailyMed.
ViiV Healthcare. (n.d.). About Cabenuva.
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