rilpivirine hydrochloride: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
rilpivirine hydrochloride: clinical details
Prescribing considerations
- Initiation should be overseen by a clinician experienced in HIV management.
- Confirm the licensed viral-load threshold and use genotypic resistance testing to assess NNRTI susceptibility.
- Review hepatic and renal status; evidence is limited in severe renal impairment and moderate hepatic impairment, and use is not recommended in severe hepatic impairment.
- The product contains lactose.
Contraindications and cautions
- Hypersensitivity to rilpivirine or an excipient.
- Concomitant carbamazepine, oxcarbazepine, phenobarbital or phenytoin.
- Concomitant rifampicin or rifapentine.
- Concomitant proton-pump inhibitors.
- Systemic dexamethasone other than one-off use.
- Concomitant St John's wort.
Monitoring
- HIV-1 RNA response, adherence and resistance where virological response is inadequate.
- Closer viral-load monitoring during pregnancy.
- Liver function where clinically indicated.
- Review food-dependent absorption and important interactions at medication changes.
- Assess mood, rash and symptoms of immune reactivation.
Clinical pharmacology
Rilpivirine is a diarylpyrimidine NNRTI that non-competitively inhibits HIV-1 reverse transcriptase. It is predominantly metabolised through CYP3A; CYP3A inducers or medicines that raise gastric pH can reduce exposure.
Formulation and product differences
- The selected product is a film-coated tablet intended to be swallowed whole with a meal.
- A paediatric dispersible formulation also exists, but has different bioavailability and is not directly interchangeable with the film-coated tablet.
rilpivirine hydrochloride preparations and strengths
Tablet
Route: Oral
Strengths: 25 mg
rilpivirine hydrochloride interactions
Rilpivirine absorption depends on stomach acidity and it is mainly metabolised by CYP3A. Check all prescribed, non-prescription and herbal products with the HIV team.
Proton-pump inhibitors, including omeprazole, esomeprazole, lansoprazole, pantoprazole and rabeprazole
These substantially reduce rilpivirine absorption and must not be used together.
Antacids containing aluminium, magnesium or calcium
These can reduce absorption and need to be separated from rilpivirine.
H2-receptor antagonists, such as famotidine
These can reduce absorption and require strict separation from rilpivirine.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.