Apretude (cabotegravir) is an antiviral medication administered to at-risk adults and adolescents. It is indicated for pre-exposure prophylaxis (PrEP) to reduce the risk of acquiring an HIV-1 infection. Apretude is classified as a human immunodeficiency virus type-1 (HIV-1) integrase strand transfer inhibitor. HIV-1 accounts for 95% of all HIV infections and can lead to Acquired Immune Deficiency Syndrome (AIDS) if left untreated. A negative HIV-1 test is required prior to initiating Apretude. If you are HIV-1 positive and take Apretude as a single therapy, your HIV can actually become more difficult to treat. Apretude (cabotegravir) is an antiviral medication administered to at-risk adults and adolescents. It is indicated for pre-exposure prophylaxis (PrEP) to reduce the risk of acquiring an HIV-1 infection. Apretude is classified as a human immunodeficiency virus type-1 (HIV-1) integrase strand transfer inhibitor. HIV-1 accounts for 95% of all HIV infections and can lead to Acquired Immune Deficiency Syndrome (AIDS) if left untreated. A negative HIV-1 test is required prior to initiating Apretude. If you are HIV-1 positive and take Apretude as a single therapy, your HIV can actually become more difficult to treat.
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Apretude overview
BRAND NAMES:
Apretude
Generic Names:
Cabotegravir
Uses:
Pre-exposure prophylaxis (PrEP) for HIV-1
Therapeutic Classes:
Human immunodeficiency virus type-1 (HIV-1) integrase strand transfer inhibitor
Forms:
Apretude 600 mg/3 ml extended-release suspension for injection
How it’s taken:
Gluteal intramuscular injection
What is Apretude used for?
Apretude is used for pre-exposure prophylaxis (PrEP) to reduce the risk of acquiring an HIV-1 infection.
Key takeaways
Apretude is only appropriate as a PrEP therapy, and you must be confirmed HIV-1 negative prior to administering.
The active ingredient in Apretude is not appropriate as a stand-alone treatment in someone who is HIV positive.
Apretude is a gluteal intramuscular injection given monthly for the first two months, then every two months after that starting in month four from initiation.
Your prescriber may initiate a 28-day course of oral cabotegravir (Vocabria) to assess your tolerance of the active ingredient prior to beginning injections with the long-acting suspension (Apretude).
Apretude may not be appropriate in patients with a history of liver disease, and your prescriber may test your liver function before starting Apretude.
What form(s) does Apretude come in?
Injection
600 mg/3 ml extended-release suspension for injection (includes vial and syringe)
What are common Apretude dosages?
Month 1: 600 mg (3 ml)
Month 2: 600 mg (3ml)
Month 4: 600 mg (3ml) and continue every 2 months thereafter
Apretude images - What does Apretude look like?
Apretude
3ml of 600mg/3ml vial
How to take Apretude
A ventrogluteal or dorsogluteal injection site is recommended (the most prominent part of the hip or the upper right quadrant). No other sites should be used.
Bring the vial to room temperature prior to administration.
Shake the vial vigorously before drawing the entire contents into the syringe. Tap any air bottles out of the syringe, and then proceed to inject immediately.
What to do if you miss a dose of Apretude
There is a 7 day grace period before or after the scheduled date of the injection. If you are past the 7 day window, the manufacturer has a specific schedule to follow.
If the time since the initial injection was less than 2 months prior, then give as soon as possible, and then proceed on schedule every 2 months.
If it has been more than 2 months since initiation, the schedule should be restarted from the beginning. Your doctor may at any time assess if continuation of Apretude is appropriate.
Apretude contraindications - Who shouldn't take Apretude?
Unknown or positive HIV-1 status
Previous sensitivity to Apretude or its active ingredient
Concurrent therapy with carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, or rifapentine
Apretude warnings
Apretude should be a part of a comprehensive plan to prevent HIV transmission. This can include other safe sex practices such as condoms.
Apretude will not always prevent HIV-1 infection, and this is why other safety measures are important
HIV-1 testing should be conducted PRIOR to each injection to confirm the patient is still HIV-1 negative. There is an increased risk of resistance in HIV if an HIV-1 positive patient were to take Apretude as monotherapy.
If you have a history of liver disease or decreased hepatic function, you may not be a candidate for Apretude. Apretude can cause hepatotoxicity.
Monitor for signs of new or worsening depression in patients taking Apretude. If you are having suicidal thoughts or suspect your loved one who is taking Apretude is, contact the prescriber immediately.
Apretude interactions & what to avoid when taking Apretude
Carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, and rifapentine can decrease blood levels of Apretude and render it less effective at protecting against HIV. These should not be used with Apretude.
Apretude side effects - How does Apretude make you feel?
Injection site reactions are the most common adverse event. It may help to switch body sides with each administration. If you experience discoloration of the skin or eyes, seek help immediately, as this can be symptomatic of hepatotoxicity. Seek help immediately if your depression worsens or you have suicidal thoughts.
Diarrhea
Headache
Pyrexia
Fatigue
Sleep disorders
Nausea
Dizziness
Flatulence
Abdominal pain
Sources:
DailyMed - APRETUDE- cabotegravir kit, DailyMed NIH (2023)
Apretude (HIV PrEP) Uses, Dosage, Side Effects, Drugs.com (2022)
Cabotegravir/Rilpivirine: the last FDA-approved drug to treat HIV, Expert Rev Anti Infect Ther (2022)
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