What are cabotegravir and rilpivirine?
Cabotegravir and rilpivirine are medications used to treat HIV, delivered by injection. They have been engineered to stay in the body after injection for at least two months.
In Europe, long-acting cabotegravir is marketed under the name Vocabria. Long-acting rilpivirine is marketed under the name Rekambys. The two injectable treatments must be given together and not combined with other HIV medicines.
Rilpivirine is also available in a combination tablet with emtricitabine and tenofovir disoproxil fumarate (Eviplera) and in a combination tablet with emtricitabine and tenofovir alafenamide (Odefsey).
How do they work?
Rilpivirine is from a class of drugs known as non-nucleoside reverse transcriptase inhibitors (NNRTIs). Cabotegravir is from a class of drugs known as integrase inhibitors. Each drug class works against HIV in a different way.
The aim of HIV treatment is to reduce the level of HIV in your body (viral load). Ideally, your viral load should become so low that it is undetectable – usually less than 50 copies of virus per ml of blood. Taking HIV treatment and having an undetectable viral load protects your immune system and stops HIV being passed on to someone else during sex.
How do I take them?
You will start by taking cabotegravir and rilpivirine pills once a day for a month. This is to make sure that you have no serious side effects from either drug.
See the factsheet for rilpivirine tablets for information on taking it and possible side effects during the first month.
After one month of taking pills, you will receive your first injections. Both injections are given into the muscle of the buttocks, a few minutes apart. You will be asked to wait at the clinic for a few minutes after your injections, to check that you don’t have a bad reaction to the injections.
You will be scheduled to receive follow-up injections every one or two months. Your doctor will tell you whether you need to attend each month, or every two months, for your injections. In the United Kingdom, the usual frequency is every two months.
If you are unable to go to the clinic for your injections and you can’t attend within one week of your original appointment, you will be given a supply of cabotegravir and rilpivirine tablets to take each day until you can go back for more injections.
If you stop having the injections, it is important to switch to alternative, fully suppressive antiretroviral regimen to avoid the development of drug resistance. If you have been receiving the injections once a month, you should begin the new treatment no later than one month after the final injection. If you have been receiving them every two months, you should begin the new treatment no later than two months after the final injection.
What are the possible side effects?
All drugs have possible side effects. It’s a good idea to talk to your doctor about possible side effects before you start taking a drug. If you experience something that might be a side effect, talk to your doctor about what can be done.
We generally divide side effects into two types:
Common – a side effect that occurs in at least one in a hundred people (more than 1%) who take this drug.
Rare – a side effect that occurs in fewer than one in a hundred people (less than 1%) who take this drug.
The common side effects of long-acting cabotegravir and rilpivirine are (most common in bold):
- Injection site reactions (bumps, swellings, pain) that go away in most people within a week. Injection site reactions are most common with the first injection and decrease over time.
- Headache, dizziness
- Depression, anxiety, difficulty in sleeping (insomnia), abnormal dreams
- Raised temperature, feeling hot
- Aches and pains, muscle pain
- Tiredness, feeling weak
- Nausea (feeling sick), vomiting, abdominal pain, diarrhoea
Do they interact with other drugs?
You should always tell your doctor and pharmacist about any other drugs or medication you are taking. That includes anything prescribed by another doctor, medicines you have bought from a high-street chemist, herbal and alternative treatments, and recreational or party drugs (‘chems’).
Some medicines or drugs are not safe if taken together – the interaction could cause increased, dangerous levels, or it could stop one or both of the drugs from working. Other drug interactions are less dangerous but still need to be taken seriously. If levels of one drug are affected, you may need to change the dose you take. This must only be done on the advice of your HIV doctor.
You should not take the following medicines while you are taking long-acting injectable treatment with cabotegravir and rilpivirine:
- the anticonvulsants carbamazepine, oxcarbazepine, phenobarbital, phenytoin
- the antimycobacterials rifabutin, rifampicin, rifapentine
- the systemic glucocorticoid dexamethasone, except as a single-dose treatment
- St John’s wort (Hypericum perforatum).
Can I take them in pregnancy?
If you are considering having a baby, or think you might be pregnant, talk to your doctor as soon as possible about which combination of anti-HIV medications would be right for you. It is important to take antiretroviral treatment during pregnancy to prevent passing HIV from mother to baby.
Rilpivirine levels in the blood fall during pregnancy, so this anti-HIV medication is not recommended for use during pregnancy.
Can children take them?
Long-acting cabotegravir and rilpivirine is not approved for use in children.
Talking to your doctor
If you have any concerns about your treatment or other aspects of your health, it’s important to talk to your doctor about them.
For example, if you have a symptom or side-effect or if you are having problems taking your treatment every day, it’s important that your doctor knows about this. If you are taking any other medication or recreational drugs, or if you have another medical condition, this is also important for your doctor to know about.
Building a relationship with a doctor may take time. You may feel very comfortable talking to your doctor, but some people find it more difficult, particularly when talking about sex, mental health, or symptoms they find embarrassing. It’s also easy to forget things you wanted to talk about.
Preparing for an appointment can be very helpful. Take some time to think about what you are going to say. You might find it helpful to talk to someone else first, or to make some notes and bring them to your appointment.
For detailed information on this drug, visit the cabotegravir and rilpivirine injections page in the A-Z of antiretroviral medications.