Cabenuva
Cabenuva (cabotegravir / rilpivirine) is a long-acting combination medication used to treat human immunodeficiency virus (HIV) infection in certain adults and teens. It includes two injections — cabotegravir and rilpivirine — which are from different classes of antiviral medications. A healthcare professional gives both shots in the buttock muscle either once a month or every other month. It’s meant for people whose HIV is already well controlled and who haven’t had treatment failure. The most common side effects are injection-site reactions, such as pain, redness, and hardening of the skin where the shot is given.
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. It works by blocking an enzyme (protein) called integrase that HIV uses to insert its genetic material into your cells. By stopping this step, the virus can’t spread and grow in your body.
- Rilpivirine is a non-nucleoside reverse transcriptase inhibitor (NNRTI). It works by blocking an enzyme called reverse transcriptase, which HIV needs to make copies of itself.
Drug facts
More on Cabenuva (cabotegravir / rilpivirine) essentials
Side effects of Cabenuva (cabotegravir / rilpivirine)
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 reactions (75-83%)
- Fever (8%)
- Feeling tired (5%)
- Headache (4%)
- Muscle or bone pain (3%)
- Nausea (3%)
- Trouble sleeping (2%)
- Dizziness (2%)
- Rash (2%)
Less Common Side Effects
- Stomach pain
- Vomiting
- Diarrhea
- Passing gas
- Weight gain
- Anxiety
- Abnormal dreams
Cabenuva (cabotegravir / rilpivirine) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious allergic reactions: rash, mouth sores, feeling ill, trouble breathing, tiredness, fever, muscle or joint pain, swelling in the face, redness or swelling in the eyes
- Liver problems: upper right stomach pain, yellowing of the skin or eyes, dark urine, light-colored stools nausea, vomiting, reduced appetite, itching
- Mood changes: feeling sad, restlessness, anxiety, suicidal thoughts and behavior
The following Cabenuva (cabotegravir / rilpivirine) 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 these to your care team if they continue or are bothersome):
Pros and cons of Cabenuva (cabotegravir / rilpivirine)
Pros
- Long-acting, complete HIV injectable medication
- Injected once every month or every other month
- Works well at keeping the viral load down
Cons
- Commonly causes injection site reactions
- Must be injected in the buttock muscle
- Requires regular visits to a healthcare professional for injections
Pharmacist tips for Cabenuva (cabotegravir / rilpivirine)
- It's important to keep taking Cabenuva (cabotegravir / rilpivirine) and show up to all scheduled appointments. Staying on track helps keep the virus under control and lowers the risk of it becoming resistant to the medication.
- Each time you get Cabenuva (cabotegravir / rilpivirine), you'll receive two injections — one in each buttock or both in the same buttock at least 2 cm apart. And you’ll usually get these shots at your prescriber’s office or clinic.
- If you're switching from Vocabria (cabotegravir) and Edurant (rilpivirine) tablets to Cabenuva (cabotegravir / rilpivirine) injections, follow your prescriber's instructions closely. You're likely to get your first injection on the same day you take your last doses of the tablets.
- Missing your Cabenuva (cabotegravir / rilpivirine) injection can make it easier for HIV to become harder to treat. If you miss or plan to miss a dose by more than 7 days, speak to your prescriber right away. You might need to take tablets for up to 2 months until you can restart injections.
- Plan to stay for a few minutes after your appointment, since your care team will watch you for side effects after your Cabenuva (cabotegravir / rilpivirine) injection. Let them know if you feel dizzy, have chest pain, trouble breathing, or swelling in your mouth or throat.
- Liver problems have been reported with Cabenuva (cabotegravir / rilpivirine). Your prescriber might want to check your liver with blood tests during treatment. Let your care team know if you notice signs like yellow skin or eyes, dark urine, or stomach pain.
- Cabenuva (cabotegravir / rilpivirine) can interact with other medications. Tell your care team about all prescriptions, over-the-counter medications, and supplements you take before starting.
- Call your care team right away if you get a rash while taking Cabenuva (cabotegravir / rilpivirine). Get medical help if the rash comes with fever, mouth sores, swelling, or trouble breathing. These could be signs of a serious allergic reaction.
- Depression and mood changes have been reported with Cabenuva (cabotegravir / rilpivirine). Let your care team know if you feel sad, hopeless, or have thoughts of self-harm. They can help decide if you should continue treatment.
- If you're pregnant or planning to get pregnant, talk to your prescriber about the risks and benefits. The medication stays in your body for a long time, and there isn't much data on its safety during pregnancy. It's also recommended that you enroll in a registry to track how this medication affects people in pregnancy.
- If you're breastfeeding, talk to your prescriber before starting Cabenuva (cabotegravir / rilpivirine). It's usually recommended to feed your baby with formula or donor breast milk since it's the safest way to avoid passing the virus to your baby.
Common questions about Cabenuva (cabotegravir / rilpivirine)
Cabenuva (cabotegravir / rilpivirine) is made by ViiV Healthcare.
It's possible for Cabenuva (cabotegravir / rilpivirine) to cause weight gain, but less than 2% of people reported this side effect in studies. After 48 weeks, people taking Cabenuva (cabotegravir / rilpivirine) gained about 3 lbs. If you have questions about weight changes, speak to your prescriber.
In clinical studies, Cabenuva (cabotegravir / rilpivirine) worked just as well as taking daily HIV pills at keeping the virus at undetectable levels, with over 90% of people staying undetectable. To stay protected, it’s important to get your injections on time every month or every other month, depending on your schedule.
Yes, Cabenuva (cabotegravir / rilpivirine) was FDA approved in 2021 as the first complete long-acting treatment for HIV.
Cabenuva (cabotegravir / rilpivirine) is given as two injections — one with cabotegravir and one with rilpivirine — into the buttock muscle. A healthcare professional will give you both shots either once a month or every other month. The injections are given on the same day, either on opposite sides of your buttocks or at least 2 cm apart in the same buttock.
Though anxiety isn’t a common side effect of Cabenuva (cabotegravir / rilpivirine), a small number of people in clinical trials reported feeling anxious, along with mood changes and depression. If you start feeling anxious or notice any changes in your mood after starting this medication, talk to your prescriber.
How long you take Cabenuva (cabotegravir / rilpivirine) depends on what you and your care team decide is best for you. Some people stay on it for a long time, as long as it keeps working and doesn’t cause side effects. Your prescriber will check how you're doing and let you know if you should keep taking it or make changes. Always follow their instructions and try not to miss any doses.
Both Cabenuva (cabotegravir / rilpivirine) and Biktarvy (bictegravir / emtricitabine / tenofovir alafenamide) are combination antiviral medications used to treat HIV, but they have some key differences. For one, they contain different antiviral medications and are taken in different ways. Cabenuva (cabotegravir / rilpivirine) is a long-acting injection given by a healthcare professional, while Biktarvy is a daily tablet taken by mouth. Biktarvy is approved for people who weigh at least 30 lbs, but Cabenuva (cabotegravir / rilpivirine) is only approved for people who weigh 77 lbs or more. Talk to your prescriber to learn more about how these medications compare.
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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 reaction
Some people have had serious allergic reactions while taking medications that contain cabotegravir and rilpivirine, like Cabenuva (cabotegravir / rilpivirine). These reactions can include rare but life-threatening conditions like Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN), which can cause rash, fever, and problems with organs like your liver.
If you notice signs of a serious reaction — such as a bad rash, fever, tiredness, muscle pain, mouth sores, red or swollen eyes, face swelling, or trouble breathing — get medical help right away. To help lower this risk, your prescriber might have you take Vocabria (cabotegravir) and Edurant (rilpivirine) tablets first before starting injections.
Side effects after the injection
People who receive Cabenuva (cabotegravir / rilpivirine) can sometimes experience a serious reaction right after the injection. This can include dizziness, trouble breathing, chest or back pain, stomach cramps, a rash, or numbness in the mouth. Most reactions are mild and usually go away within a few minutes. Your care team will watch you for about 10 minutes after each injection to make sure the medication is safe for you.
Liver problems
- Risk factor: History of liver problems
Cabenuva (cabotegravir / rilpivirine) can sometimes cause serious liver problems, but this is rare. Your risk might be higher if you've had liver problems before. Be sure to tell your prescriber about your medical history before starting this medication so they can help you take it safely. While you're taking Cabenuva (cabotegravir / rilpivirine), you might need regular blood tests to check your liver. Call your prescriber right away if you notice signs of liver damage, like feeling very tired, pain in the upper right side of your stomach, yellow skin or eyes, or dark urine.
Depression and mood changes
Mood changes, including depression and suicidal thoughts of behavior, have been reported in some people taking Cabenuva (cabotegravir / rilpivirine). If you or someone close to you notices any changes in your mood, call your prescriber right away. They will help decide if it’s safe for you to keep taking Cabenuva (cabotegravir / rilpivirine).
Interaction with other medications
Cabenuva (cabotegravir / rilpivirine) can interact with many other medications. These interactions can lead to side effects, making the medication not work as it should for preventing HIV. Before and while taking Cabenuva (cabotegravir / rilpivirine), tell your prescriber about everything you take — prescription, over-the-counter products, and supplements — so they can help manage any possible interactions.
Long-acting effects of the injection
After you stop taking Cabenuva (cabotegravir / rilpivirine), small amounts of the medication can stay in your body for up to 12 months or longer. That’s why it’s very important to stick to your injection schedule — either every month or every other month. Missing doses can raise your risk of getting HIV and make the virus harder to treat if you do get infected.
Cabenuva (cabotegravir / rilpivirine) dosage
Typical dosage for Cabenuva (cabotegravir / rilpivirine)
Cabenuva (cabotegravir / rilpivirine) is approved for adults and teens ages 12 and older, weighing at least 35 kg (77 lbs). The dose depends on how often you get the injections.
- Once-a-month: The typical starting dose is two separate injections — 600 mg of cabotegravir and 900 mg of rilpivirine — into the buttock muscle for the first month. Afterwards, the maintenance dose is 2 separate injections — 400 mg of cabotegravir and 600 mg of rilpivirine — given once a month.
- Every-other-month: The typical starting dose is two separate injections — 600 mg of cabotegravir and 900 mg of rilpivirine — into the buttocks muscle once a month for the first 2 months. Afterwards, the maintenance dose is the same — 600 mg of cabotegravir and 900 mg of rilpivirine — given once every other month starting at month 4.
*Note: Before starting Cabenuva (cabotegravir / rilpivirine), your prescriber might have you take Vocabria (cabotegravir) and Edurant (rilpivirine) tablets by mouth for about a month to make sure you can tolerate the injections.
Cabenuva (cabotegravir / rilpivirine) 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 Cabenuva (cabotegravir / rilpivirine) will not be safe for you to take.
- Taking certain seizure medications that cause Cabenuva (cabotegravir / rilpivirine) to not work as well (e.g., carbamazepine, oxcarbazepine, phenobarbital, phenytoin)
- Taking certain antibiotics that cause Cabenuva (cabotegravir / rilpivirine) to not work as well (e.g., rifampin, rifapentine)
- Taking more than one dose of dexamethasone
- Taking St. John's wort
What are alternatives to Cabenuva (cabotegravir / rilpivirine)?
