What is rilpivirine?
Rilpivirine is a medication used to treat HIV, marketed under the brand name Edurant. It is taken in combination with other antiretroviral drugs.
The usual adult dose of rilpivirine is one 25mg tablet per day.
Rilpivirine is also available in the combination tablets Eviplera (with emtricitabine and tenofovir disoproxil fumarate), Odefsey (with emtricitabine and tenofovir alafenamide) and Juluca (with dolutegravir).
Long-acting rilpivirine is available as an injectable treatment (Rekambys) in combination with cabotegravir (Vocabria).
How does rilpivirine work?
Rilpivirine is from a class of drugs known as non-nucleoside reverse transcriptase inhibitors (NNRTIs). Your doctor will prescribe rilpivirine as part of your HIV treatment, along with antiretrovirals from another class of drugs. It is important to take all the drugs as prescribed, every day. 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 rilpivirine?
It is important to take rilpivirine with a meal, as this helps your body absorb it.
HIV treatment works best if you take it every day. When would be a good time for you to plan to take your treatment? Think about your daily routine and when you will find it easiest to take your treatment.
If you forget to take a dose of rilpivirine, take it as soon as you remember, but make sure you take it with a meal. If your next dose is due within 12 hours, then don’t take a double dose, just skip the dose you’ve forgotten and carry on.
If you regularly forget to take your treatment, or you aren’t taking it for another reason, it’s important to talk to your doctor about this.
What are the possible side effects of rilpivirine?
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. A full list of side effects, including less common side effects, should be included in the leaflet that comes in the packaging with rilpivirine. If you have any questions, talk to your doctor or pharmacist.
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 rilpivirine are (most common in bold):
- insomnia (difficulty sleeping), abnormal dreams, sleep disorders, tiredness, drowsiness
- nausea, vomiting, stomach pain or discomfort, reduced appetite, dry mouth
- headache, dizziness, depression, low mood
- raised cholesterol, liver enzymes or pancreatic amylase, reduced white or red blood cell count, low platelet count, raised triglyceride or lipase levels.
People with HIV may gain weight after starting antiretroviral treatment. People taking rilpivirine may gain a small amount of weight; substantial weight gain is unusual.
Does rilpivirine 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.
A list of drugs, known to have interactions with rilpivirine,should be included in the leaflet that comes in the packaging with rilpivirine. Tell your doctor if you are taking any of these drugs, and other drugs that are not on the list.
You should not take rilpivirine with:
- St John's wort.
It’s not recommended that rilpivirine be used in combination with other NNRTIs.
Some drugs can interact with rilpivirine and change blood levels of one or both drugs, so dose adjustments may be needed. These drugs include:
- dabigatran etexilate
Medicines that affect stomach acidity can block the way rilpivirine is absorbed. Indigestion remedies called H2-blockers (such as ranitidine, Zantac) should be taken at least 12 hours before or at least four hours after taking rilpivirine. If taking other indigestion remedies (such as Rennies or Gaviscon) or calcium supplements, they should be taken at least two hours before or at least four hours after taking rilpivirine as they can prevent it being absorbed properly.
Can I take rilpivirine 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.
The British HIV Association (BHIVA) recommends that women who are already taking anti-HIV medications and become pregnant can usually continue to take the same medication throughout their pregnancy. In addition, BHIVA lists rilpivirine (in combination with other medications) as an option that may be considered for women who start HIV treatment in pregnancy, depending on their individual circumstances.
Can children take rilpivirine?
Edurant is approved for use in children aged 12 years and over.
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 rilpivirine page in the A-Z of antiretroviral medications.