cabotegravir: clinical use

Prescribing considerations

• Prescribe through a clinician experienced in HIV PrEP.
• Confirm suitability for injection attendance and counsel about adherence, virological failure and integrase-resistance risk.
• Exclude acute or established HIV before initiation.
• Plan continuing HIV prevention when injections stop because residual cabotegravir persists.
• Discuss pregnancy intentions and prolonged-release exposure.
• Consider hepatic disease, previous hypersensitivity and psychiatric history.

Contraindications and cautions

• Hypersensitivity to cabotegravir or an excipient.
• Unknown or positive HIV-1 status.
• Concurrent rifampicin, rifapentine, carbamazepine, oxcarbazepine, phenytoin or phenobarbital.

Monitoring

• HIV antigen/antibody and HIV-RNA testing before initiation and at injectable visits where available; otherwise follow local testing arrangements.
• Clinical and laboratory assessment for hepatotoxicity.
• Hypersensitivity or severe cutaneous reactions.
• Mental health symptoms, particularly suicidal ideation.
• Injection-site reactions and correct intramuscular technique.
• Ongoing HIV-risk assessment, other sexually transmitted infection testing and wider prevention measures.

Clinical pharmacology

Cabotegravir inhibits integrase-mediated HIV DNA strand transfer. It is highly protein bound and metabolised mainly through UGT1A1, with a lesser UGT1A9 contribution. The injection forms a gluteal depot and is slowly absorbed.

Formulation and product differences

• The prolonged-release suspension is administered intramuscularly by a healthcare professional and may remain measurable in circulation for a year or longer.
• The tablet is taken orally with or without food and is licensed for oral lead-in or temporary replacement of a planned injection.
• The tablet contains lactose; check suitability in relevant rare hereditary carbohydrate-intolerance disorders.

Tablet

Route: Oral

Strengths: 30 mg

Injection

Route: Parenteral

Strengths: 600 mg