VOCABRIA PROLONGED-RELEASE SUSPENSION FOR INJECTION 400 MG/ 2 ML
Indications
Film-coated Tablets:
VOCABRIA tablets are indicated in combination with rilpivirine tablets for short term ( see Dosage and Administration) treatment of human immunodeficiency virus (HIV)-1 infection in adults who are virologically suppressed (HIV-1 RNA <50 copies/mL) on a stable antiretroviral regimen without present or past evidence of viral resistance to, and no prior virological failure with agents of the NNRTI and INI class:
oral lead-in to assess tolerability of cabotegravir prior to administration of long acting (LA) VOCABRIA injection.
oral therapy for adults who will miss planned dosing with VOCABRIA injection.
Suspension for Injection:
VOCABRIA injection is indicated in combination with rilpivirine injection for treatment of HIV-1 infection in adults who are virologically suppressed (HIV-1 RNA <50 copies/mL) on a stable antiretroviral regimen without present or past evidence of viral resistance to, and no prior virological failure with agents of the NNRTI and INI class ( see Clinical studies – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).
Contraindications
VOCABRIA is contraindicated in patients:
with known hypersensitivity to cabotegravir or to any of the excipients in the tablets or the injection formulation.
receiving rifampicin, rifapentine, phenytoin, phenobarbital, carbamazepine and oxcarbazepine.
VOCABRIA is only indicated for treatment of HIV in combination with rilpivirine, therefore, the prescribing information for rilpivirine should also be consulted.
Dosage and Administration
Pharmaceutical Form
Film-coated tablet and suspension for injection
Posology
Therapy should be initiated by a physician experienced in the management of HIV infection.
VOCABRIA is indicated for the treatment of HIV in combination with rilpivirine, therefore, the prescribing information for rilpivirine should be consulted for recommended dosing.
Prior to starting VOCABRIA, healthcare professionals should have carefully selected patients who agree to the required injection schedule and counsel patients about the importance of adherence to scheduled dosing visits to help maintain viral suppression and reduce the risk of viral rebound and potential development of resistance with missed doses.
Method of Administration
Film-coated Tablet
VOCABRIA may be taken with or without food. When taken at the same time as rilpivirine, VOCABRIA should be taken with a meal.
Suspension for Injection
Refer to the Instructions for Use for detailed step by step injection procedure ( see Instructions for Use & Handling – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).
VOCABRIA injection should be administered by a healthcare professional.
When administering the VOCABRIA injection, healthcare professionals should take into consideration the BMI of the patient to ensure that the needle length is sufficient to reach the gluteus muscle.
Cabotegravir and rilpivirine injections should be administered at separate gluteal injection sites during the same visit.
Adults
Oral lead-in (Film-coated Tablets)
When used for oral lead-in VOCABRIA oral tablets are recommended for approximately one month (at least 28 days) in virologically suppressed patients prior to the initiation of VOCABRIA injection to assess tolerability to cabotegravir. VOCABRIA tablets should be taken together with rilpivirine tablets.
Monthly Dosing (Suspension for Injection)
Initiation Injection
On the final day of oral lead-in, the recommended initial VOCABRIA injection dose in adults is a single 3 mL (600 mg) intramuscular injection.
Continuation Injection
After the initiation injection, the recommended VOCABRIA continuation injection dose in adults is a single 2 mL (400 mg) intramuscular injection, administered monthly. Patients may be given injections up to 7 days before or after the date of the monthly 2 mL dosing schedule.
Every 2 Month Dosing (Suspension for Injection)
Initiation Injections
On the final day of oral lead-in, the recommended initial VOCABRIA injection dose in adults is a single 3 mL (600 mg) intramuscular injection. One month later, a second 3 mL (600 mg) intramuscular injection should be administered. Patients may be given the second 3 mL (600 mg) initiation injection up to 7 days before or after the scheduled dosing date.
Continuation Injections
After the second initiation injection, the recommended VOCABRIA continuation injection dose in adults is a single 3 mL (600 mg) intramuscular injection administered every 2 months. Patients may be given injections up to 7 days before or after the date of the every 2 month, 3 mL dosing schedule.
Change in Dosing Frequency
Dosing Recommendations when Switching from Monthly to Every 2 Month Injections
Patients switching from a monthly continuation injection schedule to an every 2 month continuation injection dosing schedule should receive a single 3 mL (600 mg) intramuscular injection of VOCABRIA one month after the last 2 mL (400 mg) continuation injection dose and then 3 mL (600 mg) every 2 months thereafter.
Dosing Recommendations when Switching from Every 2 Month to Monthly Injections
Patients switching from an every 2 month continuation injection schedule to a monthly continuation dosing schedule should receive a single 400 mg intramuscular injection of VOCABRIA 2 months after the last 600 mg continuation injection dose and then 400 mg monthly thereafter.
Missed dose
Film-coated Tablet
If the patient misses a dose of oral VOCABRIA, the patient should take the missed dose as soon as possible.
Suspension for Injection
Adherence to the injection dosing schedule is strongly recommended. Patients who miss a scheduled injection visit should be clinically reassessed to ensure resumption of therapy remains appropriate (see Tables 3 and 4).
Missed monthly injection
If a delay of more than 7 days from a scheduled injection visit cannot be avoided, VOCABRIA tablets (30 mg) may be used in combination with rilpivirine tablets (25 mg) once daily to replace up to 2 consecutive monthly injection visits. For oral therapy durations greater than two months, an alternative oral regimen is recommended.
The first dose of oral therapy should be taken one month (+/–7 days) after the last injection dose of VOCABRIA or rilpivirine. Injection dosing should be resumed on the day oral dosing completes, as recommended in Table 3.
Missed 2 month injection
If a delay of more than 7 days from a scheduled injection visit cannot be avoided, VOCABRIA tablets (30 mg) may be used in combination with rilpivirine tablets (25 mg) once daily to replace one 2-monthly injection visit. For oral therapy durations greater than two months, an alternative oral regimen is recommended.
The first dose of oral therapy should be taken two months (+/–7 days) after the last injection dose of VOCABRIA or rilpivirine. Injection dosing should be resumed on the day oral dosing completes, as recommended in Table 4.
Adolescents and Children
The safety and efficacy of VOCABRIA in children and adolescents aged under 18 years has not been established.
Elderly
No dose adjustment is required in elderly patients. There are limited data available on the use of VOCABRIA in patients aged 65 years and over ( see Pharmacokinetics – Special Patient Populations – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).
Renal impairment
No dosage adjustment is required in patients with mild to severe renal impairment and not on dialysis ( see Pharmacokinetics - Special Patient Populations – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information). Cabotegravir has not been studied in patients with end-stage renal disease on renal replacement therapy.
Hepatic impairment
No dosage adjustment is required in patients with mild or moderate hepatic impairment (Child-Pugh score A or B). VOCABRIA has not been studied in patients with severe hepatic impairment (Child-Pugh score C) ( see Pharmacokinetics – Special Patient Populations – please refer to the Product Insert/Patient Information Leaflet published on HSA for the full drug information).
