Cabenuva is a medicine that combines two different drugs, cabotegravir and rilpivirine, which are antiviral medications that target a virus known as human immunodeficiency virus type 1 (HIV-1). People infected with this virus are at risk of developing acquired immune deficiency (AIDS), a condition in which a person is unable to fight back against infections. The two HIV medicines, cabotegravir and rilpivirine, are slowly released into your body and keep the HIV level low enough that it won’t be detected using normal screening methods.
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What Should I Know About Being Treated With Cabenuva?
Cabenuva can be given to people aged 12 years or older with a weight of at least 35 kg. It is an intramuscular injectable drug that can only be administered by a healthcare provider. This injection is usually given in the muscles of the buttocks (gluteal region). There are two options for beginning Cabenuva. Your healthcare provider may start you on oral tablets for one month before switching to Cabenuva, or they may begin Cabenuva right away.
If started on the tablets, you will take two medications by mouth: Vocabria (cabotegravir) and Edurant (rilpivirine). These are the same two medications that make up Cabenuva. These two tablets will be swallowed daily, with a meal, for approximately 28 days. The last day of oral tablets will correspond with the first injection of Cabenuva.
If no oral tablets are used as a lead-in, Cabenuva will be given on the last day of your current antiviral therapy.
Cabenuva is injected in two parts, with one part containing cabotegravir and the other part containing rilpivirine. They will be administered in separate gluteal sites, at least two centimeters apart. It is common for injections to be given in opposite gluteal muscles (left and right). Cabenuva can be given once a month or once every 2 months. Your healthcare provider will help determine the best treatment schedule for you.
Where To Begin
It is important that you always consult your physician at any time before starting Cabenuva and especially during the course of the treatment. If you have been using any previous medication, have not taken the necessary tests first, or have any other active illness, then your physician will first determine if the treatment is suitable for you or not. Your physician will guide and instruct you on the precautions, expectations, and appointment schedule.
It is also important that you show up for every appointment and do not miss any injections; otherwise, this may lead to treatment failure. Cabenuva is unique in that it has a flexible treatment window. Your injection can occur within 7 days before or 7 days after your designated appointment date. However, if you do miss out on a scheduled injection or intentionally want to discontinue treatment temporarily, you must contact your healthcare provider immediately to discuss further treatment options.
Who Should Not Use Cabenuva?
Not everybody will be able to tolerate this drug. A certain percentage of people develop an allergy to different substances or medicines. If you previously have used cabotegravir or rilpivirine and have experienced an allergic reaction to either medication, Cabenuva should not be used.
If you are currently taking any of the medicines listed below, you should not use Cabenuva as it may interact with the other medicines and potentially cause a reaction. These medicines include anticonvulsants, barbiturates, antituberculous antibiotics, and corticosteroids, among others. Some important ones to note are as follows:
- Carbamazepine
- Oxcarbazepine
- Phenobarbital
- Rifabutin
- Rifampin
- Rifapentine
- Dexamethasone
Lactating mothers should also avoid breastfeeding their babies, as cabotegravir and rilpivirine can build up in the infant and may cause adverse effects. HIV-positive mothers are also advised not to breastfeed at all, even while not taking Cabenuva, as HIV-1-infected mothers can pass on the virus to their kids.
It is currently unknown how this drug can affect fetuses within the mother’s womb. Pregnant women are advised not to take Cabenuva until it has been properly tested in clinical trials.
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Side Effects
Typically, the most common side effects of Cabenuva are reactions at the injection site either due to improper administration or sensitivity to the drug.
Patients have reported the following on the injection site:
- Pain
- Tenderness
- Swelling
- Redness
- Itching
Aside from this, a patient may experience the following symptoms:
- Nausea
- Fever
- Rash
- Headache
- Lethargy (tiredness)
- Body aches
- Insomnia (difficulty sleeping)
- Dizziness
What To Do If You Experience Severe Side Effects
If you experience any form of a severe allergic reaction, contact your healthcare provider immediately. These symptoms include the following:
- Dyspnea (difficulty breathing)
- Wheezing
- Blisters or sores on the body
- Redness of the eyes
- Swelling of any part of the face, lips, or tongue
Your liver might also be vulnerable to damage when on Cabenuva, especially if you have a history of liver disease such as hepatitis B or hepatitis C virus infection. This is why it is important to get your liver health checked before taking the drug. This can be done by giving a blood test known as a liver function test (LFT). This test should also be done regularly once on Cabenuva so that the health of your liver can be monitored. If there is any abnormality in your test before or during treatment, your healthcare provider will step in and may stop the usage of Cabenuva.
A few signs and symptoms of liver toxicity are as follows:
- Jaundice (yellowing of the skin or eyes)
- Dark-colored urine
- Light-colored stool
- Loss of appetite
- Abdominal pain
- Generalized nausea
Your mood is also liable to change while on the drug. If you start feeling sad, anxious, restless, or have suicidal ideation, then you might have entered a state of depression. Do not hesitate to contact your healthcare providers and inform them of these changes.
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Drug Administration
Cabenuva can be given as an injectable either once monthly or every 2 months. Cabenuva comes in two injectable single dose kits: 600 mg cabotegravir/900 mg rilpivirine and 400 mg cabotegravir/600 mg rilpivirine.
The schedule for once monthly Cabenuva is given below:
- Optional oral tablet lead-in: Tablets for cabotegravir (30 mg) and rilpivirine (25 mg), both taken daily with meals for at least 28 days.
- 1st month: On the last day of taking the tablets, Cabenuva (600 mg cabotegravir/900 mg rilpivirine) is administered in the gluteal region, once.
- 2nd month onwards: From the second month onwards, patients will receive Cabenuva (400 mg cabotegravir/600 mg rilpivirine) once monthly, in the glutes.
The schedule for bi-monthly Cabenuva is given below:
- Optional oral tablet lead-in: Tablets for cabotegravir (30 mg) and rilpivirine (25 mg), both taken daily with meals for at least 28 days.
- 1st month: On the last day of taking the tablets, Cabenuva (600 mg cabotegravir/900 mg rilpivirine) is administered in the gluteal region.
- 2nd month: Cabenuva (600 mg cabotegravir/900 mg rilpivirine) is administered in the glutes.
- 4th month onwards: Cabenuva (600 mg cabotegravir/900 mg rilpivirine) is administered in the gluteal region every 2 months.
Cabenuva Treatment Cost
The extended-release injectables (4 ml) can range from $3,000 to $5,000 depending upon the pharmacy or your health insurance provider. This means that on average, 1 ml would cost approximately $1,000. If you are interested in receiving copay assistance for Cabenuva, please contact us.
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REFERENCES:
- Healthcare V. Cabotegravir extended-release injectable suspension; rilpivirine extended-release injectable suspension (Cabenuva) Prescribing Information. US, January. 2021 Jan.
- Idusuyi AM, Shah R, Brotherton A. Ready, Set, Cabenuva: Implementing Cabotegravir/Rilpivirine.
- Leonard A, Broussard J, Wilson N, Dawson-Rose C. Cabotegravir and Rilpivirine: A Long-Acting Injectable Antiretroviral Treatment for Human Immunodeficiency Virus. The Journal for Nurse Practitioners. 2022 Jan 1;18(1):17-21.
- Moc C, Badowski M. Long-Acting HIV Regimen May Prove Revolutionary. Pharmacy Times Health Systems Edition. 2021 May 24;10(3):24-.
- PHAR W, Combinations AH. Antivirals: HIV–Cabotegravir/rilpivirine (Cabenuva).
- Post RC. Cabenuva: A Monthly Injectable for the Treatment of HIV-1.
- Taki E, Soleimani F, Asadi A, Ghahramanpour H, Namvar A, Heidary M. Cabenuva: the last FDA-approved drug to treat HIV. Expert Review of Anti-infective Therapy. 2022 Aug 3(just-accepted).
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Dr. Samantha Kaeberlein, PharmD was born and raised in Canton, OH. She received her pharmacy degree from Northeast Ohio Medical University (NEOMED) in 2020. The most rewarding part of her job is providing medical guidance so patients can make informed, well-rounded decisions regarding their healthcare. Her areas of expertise are geriatrics and long-term care. In her free time, she enjoys spending time outdoors, reading, and hunting for the best cup of coffee in America.