Starting patients on every-2-month CABENUVA

  • CABENUVA is administered as 2 intramuscular (IM) injections by a healthcare professional once monthly or every 2 months. Adherence to the dosing schedule is strongly recommended. Talk to your patients about the two dosing options and decide which dosing frequency would be the most appropriate option
  • Setting a target treatment date (TTD) every 2 months, where medicines are administered around the same date of the month, can help keep your patients on track. CABENUVA can be administered up to 7 days before or after the TTD
  • Before initiation of CABENUVA, ensure patients agree to the required every-2-month dosing schedule and counsel patients about the importance of adherence to scheduled dosing visits
  • An optional oral lead-in can be used to assess tolerability with CABENUVA. If using the oral lead-in, prescribe 2 tablets (1 x 30-mg cabotegravir tablet and 1 x 25-mg rilpivirine tablet) to be taken once daily with a meal for approximately 1 month (at least 28 days). Initiation injections (cabotegravir 600 mg/3 mL and rilpivirine 900 mg/3 mL) should be administered on the last day of oral lead-in, if used
Every-2-month dosing schedule
  • 2 IM injections at separate gluteal sites (opposite sides or at least 2 cm apart) during same visit

Initiate injections on the last day of current antiretroviral therapy or oral lead-in, if used.

Injection Education—How to Administer Injectable Medicine

Continuing every-2-month CABENUVA after missed injections

  • Patients who miss a scheduled injection visit should be clinically reassessed to ensure resumption of therapy remains appropriate
  • If a patient plans to miss a scheduled injection visit by more than 7 days:
    • Any fully suppressive, oral ARV regimen may be used until injections are resumed; or
    • Oral cabotegravir (30-mg tablet) in combination with rilpivirine (25-mg tablet) once daily may be used for up to 2 consecutive months to cover a planned missed injection visit
  • The first dose of oral therapy should be taken approximately 2 months after the last injection dose of CABENUVA and continued until the day injection dosing is restarted

Restarting after missed injections for patients on every-2-month dosing schedule

Planned Missed CABENUVA Injections
Unplanned Missed CABENUVA Injections

Dosing and administration guide

  • Drug-drug interactions

    The information regarding potentially significant drug interactions is from the CABENUVA Prescribing Information. These recommendations are not inclusive of all potential drug interactions that may exist.

    • Cabotegravir is primarily metabolized by UGT1A1, with some contribution from UGT1A9, and rilpivirine is primarily metabolized by CYP3A
    • Drugs that are inducers and inhibitors of UGT1A1, UGT1A9, or CYP3A may affect plasma concentrations of CABENUVA

    No drug interaction studies were conducted with CABENUVA. The drug interactions described are based on studies conducted with cabotegravir or rilpivirine when administered alone.

    Concomitant drug class:

    Drug name

    		 Effect on concentration Clinical comment
    Anticonvulsants:
    Carbamazepine
    Oxcarbazepine
    Phenobarbital
    Phenytoin    		 Cabotegravir
    Rilpivirine    		 Coadministration is contraindicated with CABENUVA due to potential for loss of virologic response and development of resistance
    Antimycobacterials:
    Rifabutin
    Rifampin
    Rifapentine    		 Cabotegravir
    Rilpivirine
    Glucocorticoid (systemic):
    Dexamethasone
    (more than a single-dose treatment)    		 Rilpivirine
    Herbal product:
    St John’s wort (Hypericum perforatum)    		 Rilpivirine
    Macrolide or ketolide antibiotics:
    Azithromycin
    Clarithromycin
    Erythromycin    		 Cabotegravir
    Rilpivirine    		 Macrolides are expected to increase concentrations of rilpivirine and are associated with a risk of Torsade de Pointes. Where possible, consider alternatives, such as azithromycin, which increases rilpivirine concentrations less than other macrolides.
    Narcotic analgesic:
    Methadone    		 Cabotegravir
    Rilpivirine    		 No dose adjustment of methadone is required when starting coadministration of methadone with CABENUVA. However, clinical monitoring is recommended as methadone maintenance therapy may need to be adjusted in some patients.
    Concomitant drug class:

    Drug name

    		 Effect on concentration
    Anticonvulsants:
    Carbamazepine
    Oxcarbazepine
    Phenobarbital
    Phenytoin    		 Cabotegravir
    Rilpivirine
    Clinical comment: Coadministration is contraindicated with CABENUVA due to potential for loss of virologic response and development of resistance
    Antimycobacterials:
    Rifabutin
    Rifampin
    Rifapentine    		 Cabotegravir
    Rilpivirine
    Clinical comment: Coadministration is contraindicated with CABENUVA due to potential for loss of virologic response and development of resistance
    Glucocorticoid (systemic):
    Dexamethasone
    (more than a single-dose treatment)    		 Rilpivirine
    Clinical comment: Coadministration is contraindicated with CABENUVA due to potential for loss of virologic response and development of resistance
    Herbal product:
    St John’s wort (Hypericum perforatum)    		 Rilpivirine
    Clinical comment: Coadministration is contraindicated with CABENUVA due to potential for loss of virologic response and development of resistance
    Macrolide or ketolide antibiotics:
    Azithromycin
    Clarithromycin
    Erythromycin    		 Cabotegravir
    Rilpivirine
    Clinical Comment: Macrolides are expected to increase concentrations of rilpivirine and are associated with a risk of Torsade de Pointes. Where possible, consider alternatives, such as azithromycin, which increases rilpivirine concentrations less than other macrolides.
    Narcotic analgesic:
    Methadone    		 Cabotegravir
    Rilpivirine
    Clinical Comment: No dose adjustment of methadone is required when starting coadministration of methadone with CABENUVA. However, clinical monitoring is recommended as methadone maintenance therapy may need to be adjusted in some patients.

    = Increase, = Decrease, = No change.

    Please see full Prescribing Information for more information.

ARV=antiretroviral; UGT=uridine diphosphate (UDP)-glucuronosyl transferase; CYP3A=cytochrome P450.

PMUS-CBRWCNT250027