Look inside the book: Nursing 2025-2026 Drug Handbook

cabotegravir 205

INTERACTIONS Drug-drug. Antacids containing aluminum, calcium carbonate, or magnesium: Mayde crease oral cabotegravir level. Administer antacids at least 2 hours before or 4 hours after cabotegravir. Methadone: May decrease methadone level. Monitor patient and adjust methadone dosage asneeded. Other antiretrovirals: Avoid use of other an tiretrovirals with cabotegravir when used as monotherapy for PrEP or in combination with rilpivirine for treatment of HIV-1. Rifabutin: May decrease cabotegravir level when given with extended-release injection. If used together, give second injection of extended-release cabotegravir 2 weeks af ter initial dose, and give maintenance doses monthly while patient is receiving rifabutin. Strong inducers of UGT1A1 or UGT1A9 (carbamazepine, oxcarbazepine, phenobar bital, phenytoin, rifampin, rifapentine): May significantly decrease cabotegravir level and cause loss of virologic response. Avoid use together. EFFECTS ON LAB TEST RESULTS • May increase AST, ALT, lipase, creatinine, CONTRAINDICATIONS & CAUTIONS • Contraindicated in patients hypersensitive to drug or its components. • Contraindicated for PrEP in patients with unknown or positive HIV-1 status. Monother apy with drug isn’t a complete regimen for HIV-1 treatment. • Time from initiation of HIV-1 PrEP to max imal protection is unknown. Boxed Warning Risk of drug resistance may occur with use for HIV PrEP in patients with undiagnosed HIV-1 infection. Drug-resistant variants have been identified in patients with undiagnosed HIV-1 infections with use of cabotegravir injections. • Serious or severe hypersensitivity reactions may occur with cabotegravir. Discontinue drug if hypersensitivity reactions occur. • Drug may cause liver toxicity in patients with or without known preexisting liver dis ease or other risk factors. Use cautiously in patients with underlying liver disease or marked transaminase elevations before drug initiation. fasting lipid, and CK levels. • May decrease HDL level.

• Residual extended-release formulation of drug may remain in circulation for 12 months or longer. • Use cautiously in older adults and patients with severe or end-stage kidney disease. Use in patients with Child-Pugh class C liver impairment hasn’t been studied. • Safety and efficacy in children younger than age 12 or weighing less than 35 kg haven’t been established. • Dialyzable drug: Unlikely. PREGNANCY-LACTATION-REPRODUCTION • There are no studies during pregnancy. Cabotegravir injections aren’t recommended for use in patients planning to become preg nant. Consider risks and benefits of therapy in patients of childbearing potential or who are pregnant. • Enroll patients exposed to drug during pregnancy in the Antiretroviral Pregnancy Registry (1-800-258-4263). • It isn’t known if drug appears in human milk or how drug affects milk production or infants who are breastfed. • Breastfeeding isn’t recommended in pa tients who are HIV positive. For uninfected patients taking drug for PrEP, assess risks and benefits of therapy during breastfeeding. Extended-release formulation may appear in human milk 12 months or more after discon tinuing drug. NURSING CONSIDERATIONS Boxed Warning Before starting drug (oral or IM) for PrEP and before each subse quent injection, test for HIV-1 infection us ing an FDA-approved or FDA-cleared test for diagnosis of acute primary HIV-1 in fection. Patients who become infected with HIV-1 while receiving injections for PrEP must transition to a complete HIV-1 therapy regimen. • Evaluate patient for potential exposure events and signs and symptoms of acute HIV-1 infection. Test patient for HIV-1 infec tion if diagnosed with other STIs. • Monitor for signs and symptoms of hyper sensitivity reactions (severe rash; rash with fever; general malaise; fatigue; muscle or joint aches; blisters, including oral blisters or lesions; conjunctivitis; facial edema; hep atitis; eosinophilia; angioedema; difficulty breathing); immediately discontinue drug if any occur and treat patient as appropriate.

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