Vocabria
Vocabria (cabotegravir) is a brand-name antiviral medication used to treat or help prevent human immunodeficiency virus (HIV) infection in certain adults and teens. It’s usually taken by mouth for a short time before switching to a long-acting injection — either Cabenuva (cabotegravir / rilpivirine) for treatment or Apretude (cabotegravir) for pre-exposure prophylaxis (PrEP) to lower your risk of HIV infection. For treatment, you take one tablet daily with Edurant (rilpivirine). Common side effects include headache, nausea, and diarrhea.
What is Vocabria (cabotegravir)?
What is Vocabria (cabotegravir) used for?
- Short-term HIV treatment taken together with Edurant (rilpivirine) before starting Cabenuva (cabotegravir / rilpivirine)
- Short-term HIV PrEP taken before starting Apretude (cabotegravir) to help prevent infection
- Oral option if you plan to miss a scheduled Cabenuva (cabotegravir / rilpivirine) or Apretude (cabotegravir) injection
How Vocabria (cabotegravir) works
Vocabria (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 medication helps prevent the virus from growing and spreading, lowering the amount of HIV in your body.
Drug facts
Side effects of Vocabria (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
HIV treatment:
- Tiredness
- Diarrhea
- Headache
- Nausea
- Dizziness
- Stomach discomfort
- Bloating
- Trouble sleeping
- Feeling weak
Note: Side effects listed above were reported in studies where people took Vocabria (cabotegravir) with Edurant (rilpivirine).
HIV PrEP:
- Headache (6%)
- Nausea (3%)
- Dizziness (3%)
- Diarrhea (2%)
- Upper respiratory tract infection (2%)
- Sleepiness (2%)
Less Common Side Effects
HIV treatment:
- Muscle pain
- Depression
- Sore on the skin
HIV PrEP:
- Reduced appetite
- Vomiting
- Itchiness
- Stomach pain
Vocabria (cabotegravir) 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 Vocabria (cabotegravir) 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 these to your care team if they continue or are bothersome):
Pros and cons of Vocabria (cabotegravir)
Pros
- Once-daily tablet taken by mouth
- Helps check for side effects before starting injections
- Can be used as a backup if you plan to miss an injection
Cons
- Common side effects include headache, diarrhea, and nausea
- Only for short-term use
- Must be taken with food when used for treatment with Edurant (rilpivirine)
Pharmacist tips for Vocabria (cabotegravir)
- If you're switching from Vocabria (cabotegravir) to Cabenuva (cabotegravir / rilpivirine) or Apretude (cabotegravir) injections, follow your prescriber's instructions closely. You’ll usually get your first injection on the same day as your last Vocabria (cabotegravir) tablet.
- Vocabria (cabotegravir) can interact with many medications. Tell your care team about everything you're taking — prescription, over-the-counter products, and supplements — before starting Vocabria (cabotegravir).
- If you get a rash while taking Vocabria (cabotegravir), call your care team. Stop taking the tablet and get medical help if the rash comes with fever, mouth sores, blisters, swelling in the face, trouble breathing, or yellowing of the skin or eyes. These could be signs of a serious allergic reaction.
- Vocabria (cabotegravir) can cause mood changes. Let your prescriber know right away if you feel very sad, hopeless, or notice big changes in your mood while taking this medication.
HIV treatment:
- Take Vocabria (cabotegravir) once daily with Edurant (rilpivirine) each day with a meal. Food helps your body absorb Edurant (rilpivirine) better, which helps control the infection properly.
- It's important to take Vocabria (cabotegravir) around the same time every day. Missing doses can make it easier for HIV to change and cause the medication to stop working.
HIV PrEP:
- Taking Vocabria (cabotegravir) for HIV PrEP should be part of a full prevention plan. This includes taking your medication daily and using safer sex practices, like condoms, to help lower the risk of sexually transmitted infections (STIs).
- Tell your care team right away if you think you were exposed to HIV or have symptoms of HIV, like fever, muscle pain, tiredness, or a rash. Your prescriber might run tests to check for HIV, since Vocabria (cabotegravir) by itself isn't a complete treatment for HIV infection.
Common questions about Vocabria (cabotegravir)
Yes, Vocabria (cabotegravir) is FDA approved for short-term HIV pre-exposure prophylaxis, also called PrEP. This means it can help lower your risk of getting HIV from sex before you're exposed to the virus. You take it by mouth for a short time — usually about one month — before switching to long-acting Apretude (cabotegravir) injections. Your care team will test you for HIV before starting this medication to make sure it’s safe for you.
You take Vocabria (cabotegravir) by mouth for about a month before starting Apretude (cabotegravir) or Cabenuva (cabotegravir / rilpivirine) to make sure your body can handle the injections. Starting with the tablet form helps your prescriber check for any side effects. After that, you can switch to the injections and stop the pills — unless you need to temporarily replace a missed injection. In that case, your prescriber might have you take Vocabria (cabotegravir) again until you can get back on schedule. If you have questions about switching from the tablets to the injections, talk with your prescriber.
Talk to a healthcare professional about how you can get Vocabria (cabotegravir). It's only available with a prescription, and pharmacists in some states might be able to prescribe it. There are also programs that can also help you pay for and find PrEP medications like Vocabria (cabotegravir).
Weight gain wasn't a commonly reported side effect in people taking Vocabria (cabotegravir) during clinical studies. If you have any questions or concerns about weight gain with this medication, talk to your prescriber.
Vocabria (cabotegravir) hasn’t been well-studied in people during pregnancy, but it's generally recommended in pregnancy when needed. In addition, research on the injectable form of this medication showed that it's safe to take before and during pregnancy. If you're pregnant while taking Vocabria (cabotegravir), you’re encouraged to enroll in the Antiretroviral Pregnancy Registry (APR). This registry tracks the health of you and your baby. You can learn more by calling 1-800-258-4263.
It's not clear if Vocabria (cabotegravir) is safe while breastfeeding, but animal studies show that the medication can pass into breast milk. If you have HIV, feeding your baby with formula or donor breast milk is the safest way to avoid passing the virus to your baby. But if you choose to breastfeed, discuss with your prescriber about the risks of taking this medication while nursing. Even if you’re taking Vocabria (cabotegravir) for HIV prevention (PrEP), your breastfed baby could still have side effects from the medication.
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Risks and warnings for Vocabria (cabotegravir)
Vocabria (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.
Take extra steps to prevent HIV when used for PrEP
Vocabria (cabotegravir) might not always fully prevent HIV infection, so it’s important to use other ways to protect yourself too. This includes practicing safer sex (like using condoms), knowing your partner’s HIV status, and getting tested regularly for HIV and other STIs. Taking Vocabria (cabotegravir) on time every day helps lower your chance of getting HIV.
Before starting Vocabria (cabotegravir), your prescriber might ask you about any recent situations where you could have been exposed to HIV — like unprotected sex or a recent STI. You'll also need to take an HIV test. Let your prescriber know if you have symptoms of HIV, such as fever, feeling tired, muscle pain, and skin rash, either before or during treatment.
Serious allergic reaction
Some people have had serious allergic reactions while taking cabotegravir, the active ingredient in Vocabria (cabotegravir). In rare cases, these reactions have included serious skin problems like Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN). That's why you start with Vocabria (cabotegravir) tablets — to help catch any reaction before switching to long-acting injections. Stop taking the medication right away and call your care team if you get a severe rash or a rash with other symptoms like fever, feeling very tired, muscle or joint pain, blisters, mouth sores, red or irritated eyes, facial swelling, or trouble breathing.
Liver problems
- Risk factor: History of liver problems
Rarely, Vocabria (cabotegravir) can cause serious liver problems. Your risk might be higher if you’ve had liver problems before. Talk to your care team about your medical history before starting this medication so they can decide if it's safe for you to take.
You might need regular blood tests while taking Vocabria (cabotegravir) to check your liver health. Call your prescriber right away if you notice signs of liver problems like pain in the upper right side of your stomach, yellowing of your skin or eyes, dark urine, pale stools, nausea, vomiting, loss of appetite, or itching.
Depression and mood changes
Some people have experienced mood changes, including depression, mood swings, and suicidal thoughts of behavior while taking Vocabria (cabotegravir). 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 Vocabria (cabotegravir).
Interaction with other medications
Vocabria (cabotegravir) can interact with many other medications. These interactions can lead to side effects, making the medication not work as it should for treating or preventing HIV, or cause the virus to become harder to treat. Before and while taking Vocabria (cabotegravir), tell your prescriber about everything you take — prescription, over-the-counter products, and supplements — so they can help manage any possible interactions.
Vocabria (cabotegravir) dosage
Typical dosage for Vocabria (cabotegravir)
Vocabria (cabotegravir) is approved for adults and teens ages 12 and older, weighing at least 35 kg (77 lbs).
- Short-term HIV treatment: The typical dose is 30 mg by mouth together with one 25 mg tablet of Edurant (rilpivirine) once a day with food for about 1 month (28 days).
- Short-term HIV PrEP: The typical dose is 30 mg by mouth once a day for about 1 month (28 days).
- Oral backup if you plan to miss an injection
- For Cabenuva (cabotegravir / rilpivirine): The typical dose is 30 mg by mouth together with one 25 mg tablet of Edurant (rilpivirine) once a day with food for up to 2 months.
- For Apretude (cabotegravir): The typical dose is 30 mg by mouth once a day for up to 2 months.
Vocabria (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 Vocabria (cabotegravir) will not be safe for you to take.
- Take certain seizure medications that cause Vocabria (cabotegravir) to not work as well (e.g., carbamazepine, oxcarbazepine, phenobarbital, phenytoin)
- Take certain antibiotics that cause Vocabria (cabotegravir) to not work as well (e.g., rifampin, rifapentine)
- Have a positive or unknown HIV status (for PrEP only)
