Guides

cabotegravir LA + rilpivirine LA (Vocabria+Rekambys or Cabenuva)

1 August 2024. Related: ARVs, Integrase inhibitors, NNRTIs.

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Cabotegravir-LA and rilpivirine-LA are long acting injections given by intramuscular injections every two months.

cab-oh-TEG-ra-veer + ril-PIV-a-reen

Cabotegravir LA is an integrase inhibitor. Rilpivirine LA is an NNRTI. Both drugs are given together as long-acting (LA) injections.

This dual injectable combination was approved in the EU and US in December 2021.

It was approved by NHS Scotland on 11 October 2021 and by NICE for access in England and Wales on 18 November 2021.

  • Currently, injections are only approved as a switch combination. This means that you have to have been undetectable on an oral combination for at least six months.
  • Oral tablets are sometimes used for both drugs for the first month of treatment. This is to make sure you can tolerate the active drugs. Sometimes people start with injection though, without the oral pills first,
  • The first injections are given either every month or every two months. Different doses are used for each schedule. A higher dose is sometimes used for the first injection.
  • In the UK, injections are only given every two months.
  • The injections can be given with or without food.
  • Both injections need to be given by a health professsional at the same clinic visit. The injections should be to different areas of the gluteus muscle (your ass/arse/bottom).
  • Missing a course of injections might need restarting with oral dosing. This depends on the time missed. Oral versions should be provided in case there is a short unplanned delay.
  • These long-acting drugs can take more than a year to leave your body. If for any reason you need to stop CAB/RPV LA, it is essential to switch to an alternative combination. Otherwise drug resistance will develop when drug levels drop to lower levels.
  • Most people reported skin reactions from where the drug was injected. These very usually mild or moderate. Most people in research studies did not stop treatment because of these reactions but about 1 in 100 (1%) did.
  • Other very common or common side effects include headache, tiredness, dizziness and fever. These occurred in more than 1 in 10 people.
  • Drug interactions include with: carbamazepine, oxcarbazepine, phenobarbital, phenytoin (medicines for epilepsy); rifabutin, rifampicin, rifapentine (antibiotics); systemic dexamethasone (a steroid anti-inflammatory and immunosuppressant medicine), except when used as a single dose treatment; St John’s wort (a herbal antidepressant medicine).
  • Drug interactions. Please tell your doctor or pharmacist about any other drugs or supplements before taking them with CAB/RPV-LA. Drug interactions can also be checked using the online checker at Liverpool University HIV Interaction website:
    https://www.hiv-druginteractions.org/checker
  • In general, CAB/RPV-LA is not recommended during pregnancy. This is because there is limited data, but the long dosing intervals means that some women will already have become pregnancy on CAB/RPV-LA. These pregnancies will be carefully following in a safety registry. Although no safety signals have been reported, this usually takes several years to collect data. Your doctor is likely to suggest a different combination to use during pregnancy if there are oral meds that you are able to use.
  • Early results from using CAB-LA as PrEP (to prevent HIV infection) did not report any complications in about 350 women during pregnancy. However, drug levels in HIV positive women still need to be studied in more detail,
  • CAB LA/RPV LA is being marketed by ViiV Healthcare. In the EU the drugs are packaged separately. Cabotegravir has the tradename Vocabria and rilpivirine is called Rekambys.
  • In the US, both drugs are packaged together, with the single trade name Cabenuva.

Further information

The European patient information and detailed Product Information for maraviroc are available from these links on the European Medicines Agency (EMA) website.

The Patient Information is a simplified summary: what the drug is, why it is used, results from studies and cautions including side effects.

The Product Information is a detailed technical summary that you can access as a PDF file by clicking the ‘Product Information’ tab. It describes more precisely how the drug works and how it is processed by your body. This includes, for example, reported food interaction studies in terms of calories or fat content. It includes more details of the study results and a full list of side effects and drug interactions.