Cabotegravir

Age <12 years
Weight <35 kg
Pregnancy
1. Neural Tube Defects with Dolutegravir (Tivicay), unknown if class effect

Lead in Dosing prior to IM dosing (Cabenuva) for HIV Treatment
1. Cabotegravir (Vocabria) 30 mg orally daily AND
2. Rilpivirine (Edurant) 25 mg orally daily
Lead in Dosing prior to IM dosing (Apretude) for HIV Pre-exposure Prophylaxis (PREP)
1. Cabotegravir (Vocabria) 30 mg orally daily

Cabenuva combines Integrase Inhibitor and Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI)
1. Integrase Inhibitor: Cabotegravir
2. Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI): Rilpivirine)
Dosing
1. Two Intramuscular Injections in gluteal Muscle (one for each drug) once monthly
2. Administered in clinic, at $4000 per month
3. Requires one month of oral "lead-in" daily therapy to evaluate tolerability before IM Injection
Efficacy
1. Appears as effective as triple therapy combinations
Drug Interactions
1. Less effective when combined with CYP 3A4 inducers (e.g. Phenytoin)
References
1. Orkin (2020) N Engl J Med 382(12):1124-35 [PubMed]
2. Swindells (2020) N Engl J Med 382(12):1112-23 [PubMed]
3. (2021) presc lett 28(3): 18

Cabotegravir Monthly to Bimonthly IM injection Integrase Inhibitor
Indications: HIV Pre-exposure Prophylaxis (PREP)
1. See HIV Preexposure Prophylaxis (HIV PrEP)
2. Teens over age 12 years and Adults >35 kg who are HIV negative, but high risk for HIV Infection
Contraindications
1. Do NOT use as single therapy for HIV Infection
Dosing
1. Give 600 mg IM on days 1 and 30 of initial month, then every 2 months
2. Consider a one month lead in period of Cabotegravir 30 mg orally daily to assess tolerability
3. Cost $4000 per dose
Renal Disease
1. Adverse effects may increase at Creatinine Clearance <30 ml/min
2. However, may be used in Stage 4 and 5 Chronic Kidney Disease
Efficacy
1. Higher efficacy than Emtricitabine/Tenofovir
References