Vocabria (Cabotegravir) for HIV

Vocabria (cabotegravir) is a prescription medication approved by the U.S. Food and Drug Administration (FDA) with rilpivirine (Edurant) for short-term treatment of human immunodeficiency virus type 1 (HIV-1) infection in certain adults and adolescents ages 12 years and older who weigh at least 35 kilograms and whose HIV-1 is already well controlled.

How Vocabria Works and How It’s Taken

Vocabria is a type of medicine called an integrase inhibitor. It blocks an HIV enzyme called integrase. HIV needs this enzyme to make more copies of itself.

For HIV-1 treatment, Vocabria is used with rilpivirine (Edurant) for certain adults and adolescents ages 12 years and older who weigh at least 35 kilograms and whose HIV-1 is already well controlled. It may be used for a short time before starting long-acting Cabenuva injections or when a person plans to miss a Cabenuva injection.

Vocabria is also used for short-term pre-exposure prophylaxis, or PrEP. PrEP helps reduce the risk of sexually acquired HIV-1. It may be used in adults and adolescents who weigh at least 35 kilograms and are at risk for getting HIV-1. A person must test negative for HIV-1 before starting Vocabria for PrEP.

HIV-1 is the virus that causes acquired immune deficiency syndrome (AIDS).

Vocabria comes as a tablet taken by mouth once daily.

Typical Dosing for HIV

When Vocabria is used as an oral lead-in before Cabenuva, the recommended dose is one 30-milligram Vocabria tablet with one 25-milligram Edurant tablet once daily for about one month, or at least 28 days.

Vocabria and Edurant should be taken at about the same time each day with a meal. The last oral doses are taken on the same day Cabenuva injections are started

Typical Dosing for PrEP

When Vocabria is used as an oral lead-in before Apretude, the recommended dose is one 30-milligram Vocabria tablet once daily for about one month, or at least 28 days.

The first Apretude injection is given on the day of the last Vocabria dose or within three days.

Vocabria may also be used for a short time when a person plans to miss an Apretude injection.

This information is based on prescribing information, but your healthcare provider may tailor your treatment plan. Always follow their guidance.

Vocabria Side Effects

In clinical studies of Vocabria, the most common side effects occurred based on the treatment group and treatment received.

Side effects in people with HIV-1 include:

Fatigue (feeling unusually tired)
Diarrhea
Headache
Anxiety
Abnormal dreams
Nausea
Dizziness
Abdominal (stomach) discomfort
Abdominal distension (bloating)
Insomnia (trouble sleeping)
Asthenia (weakness)

Side effects in people without HIV-1 include:

Diarrhea
Headache
Nausea
Dizziness
Drowsiness
Abnormal dreams
Fatigue (feeling unusually tired)
Abdominal (stomach) pain
Upper respiratory tract infection

Serious Side Effects and Warnings

Vocabria can cause serious side effects that may require immediate medical attention. These include:

Drug-resistant HIV-1 — If Vocabria is started or continued when someone has HIV-1, the virus can become harder to treat.
Severe allergic reactions — Serious reactions, such as Stevens-Johnson syndrome and toxic epidermal necrolysis (TEN), can cause severe rash, blisters, mouth sores, eye irritation, swelling, trouble breathing, or feeling very ill.
Liver problems — Liver injury may cause symptoms such as yellowing of the skin or eyes, dark urine, nausea, vomiting, stomach pain, or unusual tiredness.
Depression or mood changes — These mood changes can include suicidal thoughts or actions.

Get medical help right away if you think you are having a serious reaction. If you or someone you know needs help, you can contact the 988 Suicide & Crisis Lifeline by calling or texting 988 or by using the online chat.

How To Save on Vocabria

ViiV Healthcare, the manufacturer of Vocabria, offers the ViiVConnect Savings Card Program. Eligible people with commercial insurance may pay as little as $0 per prescription fill.

The program also offers reimbursement if your pharmacy can’t process the savings card.

To learn more, visit the ViiVConnect Savings Card Program website or call 866-279-4705.

What To Know Before Taking Vocabria

Before starting Vocabria for HIV-1 PrEP, your healthcare provider will test you for HIV-1 to make sure you are HIV-1 negative.

Some HIV-1 tests may miss a very recent infection. Tell your healthcare provider if you may have been exposed to HIV-1 within the past month or have had flu-like symptoms. These symptoms may include fever, tiredness, muscle or joint aches, headache, sore throat, vomiting or diarrhea, rash, night sweats, or swollen lymph nodes.

Before receiving Vocabria, tell your doctor if you:

Have any allergies to cabotegravir or any ingredients in Vocabria
Have or have had liver problems, including hepatitis B or C
Have or have had mental health problems
Are pregnant or plan to become pregnant
Are breastfeeding or plan to breastfeed

While receiving Vocabria for PrEP:

Know your HIV-1 status and your partners’ HIV-1 status.
Ask partners with HIV-1 if they are taking HIV medicines and have an undetectable viral load.
Get tested for HIV-1 when your healthcare provider tells you.
Get tested for other sexually transmitted infections, such as syphilis, chlamydia, and gonorrhea.
Tell your healthcare provider right away if you think you were exposed to HIV-1.

Tell your doctor about all medicines you take, including prescription drugs, over-the-counter medicines, vitamins, and herbal supplements.

Do not take Vocabria for PrEP if you:

Have HIV-1 or do not know your HIV-1 status
Have had a previous allergic reaction to cabotegravir
Take carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, or rifapentine

Do not miss doses or let your supply of Vocabria run out. The amount of virus in your blood may increase, and the virus may become harder to treat.

If you plan to miss an Apretude injection by more than seven days, your healthcare provider may have you take one Vocabria tablet each day to replace one every-two-month injection visit. Vocabria is usually started about two months after the last Apretude injection. Apretude is restarted on the day Vocabria is finished or within three days.

If you are pregnant, planning to become pregnant, or breastfeeding while taking Vocabria, talk with your doctor about the risks and benefits.

If you are pregnant or plan to become pregnant, talk with your healthcare provider. It is not known whether Vocabria can harm the baby.

A pregnancy exposure registry monitors pregnancy outcomes in people exposed to Vocabria. Healthcare providers can register pregnancies by visiting the Antiretroviral Pregnancy Registry or calling 800-258-4263.

If you are breastfeeding or plan to breastfeed, talk with your healthcare provider. If you have HIV-1, breastfeeding may:

Pass HIV-1 to a baby who does not have HIV-1
Make HIV-1 harder to treat in a baby who has HIV-1
Expose your baby to side effects from Vocabria

Do not breastfeed if a new HIV-1 infection is suspected because HIV-1 could be passed to your baby.

Community FAQs

These answers are fact-checked by our editorial staff.

How effective is Vocabria for HIV?

In one study of people whose HIV-1 was already well controlled, 93 percent of people who used an oral lead-in before Cabenuva had HIV-1 levels below 50 copies per milliliter at Week 124. This compared with 99 percent of people who started Cabenuva injections without an oral lead-in.

At the same time, 0.8 percent of people in the oral lead-in group had HIV-1 levels of 50 copies per milliliter or higher, compared with 0.9 percent of people who started injections without an oral lead-in.

These results were similar between the two groups. The study was designed to look at Cabenuva treatment with or without an oral lead-in, so these numbers should not be used to describe Vocabria as a long-term HIV treatment by itself.

How long does Vocabria take to work for HIV?

The study does not say exactly how long Vocabria takes to start working.

For HIV-1 treatment, Vocabria is used with rilpivirine (Edurant). It may be taken once daily for about one month, or at least 28 days, before starting Cabenuva injections. The last oral dose is taken on the same day the Cabenuva injections are started.

Vocabria may also be used with Edurant for a short time if a planned Cabenuva injection will be missed.

Can Vocabria interact with other medicines?

Yes. Some medicines can lower the amount of Vocabria in your body and may make it work less well. Do not take Vocabria with carbamazepine, oxcarbazepine, phenobarbital, phenytoin, rifampin, or rifapentine.

If you take an antacid that contains aluminum, magnesium, or calcium, take it at least two hours before or four hours after Vocabria.

Tell your healthcare provider about all medicines, vitamins, and supplements you take.