rilpivirine at a glance
Medicine class
Non-nucleoside reverse transcriptase inhibitor (NNRTI).
Usual role
Maintains control of already-suppressed HIV-1 when used with cabotegravir.
How it is given
A healthcare professional injects it into a buttock muscle, separately from cabotegravir.
Important practical point
Keep every planned clinic appointment and contact the HIV team promptly if one may be missed.
What is rilpivirine used for?
The selected product is licensed with cabotegravir injection to treat HIV-1 in adults and eligible adolescents whose viral load is already suppressed, provided there is no relevant resistance or previous virological failure involving the medicine classes used.
Maintenance of virological suppression in HIV-1 infection as part of the long-acting rilpivirine–cabotegravir combination.
How does rilpivirine work?
Rilpivirine binds to HIV-1 reverse transcriptase and inhibits it, reducing production of new virus. It controls HIV but does not cure it.
rilpivirine preparations and strengths
Injection
Route: Parenteral
Strengths: 900 mg
How to take rilpivirine
Rilpivirine injection is prepared and given by a healthcare professional into a buttock muscle. It is given with cabotegravir at the same visit, at a separate injection site. An oral lead-in may be used to assess tolerability; oral rilpivirine must be taken with a meal.
Attend every arranged injection visit.
Tell the HIV team in advance if travel or another issue may prevent attendance.
Do not stop injectable treatment without an alternative HIV-treatment plan.
rilpivirine side effects
Common or expected effects
- Pain, discomfort, a lump or hardening at the injection site
- Headache or feeling feverish
- Nausea, vomiting, diarrhoea, abdominal discomfort or wind
- Dizziness, tiredness, weakness or muscle pain
- Sleep disturbance, abnormal dreams, anxiety or depressed mood
- Rash, injection-site redness, swelling, itching, warmth or bruising
- Weight gain or changes in cholesterol and other blood-test results
Get urgent medical advice
- Rare immediate post-injection reaction, including breathing difficulty, faintness, chest or back pain, rash or blood-pressure changes
- Possible liver injury: yellow skin or eyes, dark urine, pale stools, itching or abdominal tenderness
- Severe abdominal pain that may indicate pancreatitis
- New fever, chills or sweats that may indicate immune reactivation of an underlying infection
rilpivirine in pregnancy
Tell the HIV team before trying to conceive or immediately after learning of a pregnancy. The injectable product is not recommended during pregnancy unless the expected benefit justifies the potential risk, and rilpivirine may remain in the body for years after an injection. Do not stop HIV treatment without specialist advice.
rilpivirine while breastfeeding
The product information recommends not breastfeeding because HIV can be transmitted through breast milk and rilpivirine is expected to enter milk. Formula feeding is regarded as the safest option, although supported breastfeeding may sometimes be discussed for someone with sustained viral suppression and intensive specialist monitoring.
rilpivirine interactions
Rilpivirine is mainly metabolised through CYP3A. Check prescribed, over-the-counter and herbal products with the HIV team because enzyme inducers can leave rilpivirine ineffective for a prolonged period.
Carbamazepine, oxcarbazepine, phenobarbital or phenytoin
Contraindicated because they can substantially reduce rilpivirine exposure and cause loss of HIV control.
Rifabutin, rifampicin or rifapentine
Contraindicated because they can reduce rilpivirine exposure and effectiveness.
Systemic dexamethasone
Contraindicated except for single-dose treatment because repeated exposure can lower rilpivirine concentrations.
Common questions about rilpivirine
Answers are fully visible for fast scanning and source review.
Can rilpivirine cure HIV?
No. It suppresses HIV replication but does not eliminate the virus.
Why is rilpivirine injection given with cabotegravir?
Together they form the complete long-acting regimen and act at different stages of HIV replication.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.