Cabotegravir和rilpivirine注射劑

資料來源：Aidsmap /Keith Alcorn/ 2021年1月；財團法人台灣紅絲帶基金會編譯

 

什麼是Cabotegravir和rilpivirine？

Cabotegravir（一種整合酶抑製劑）和rilpivirine（一種類非核苷反轉錄酶抑制劑）是用於治療HIV的藥物，透過注射給藥。他們被設計成可以在注射後留在體內至少兩個月。

在歐洲，長效型cabotegravir以Vocabria的名稱銷售。長效型rilpivirine以Rekambys的名稱出售。兩種注射劑必須同時使用，不得與其他HIV藥物聯合使用。

Rilpivirine還可以與emtricitabine和 tenofovir disoproxil (Eviplera)組合成錠劑使用，也可以與emtricitabine和tenofovir alafenamide (Odefsey) 組合成錠劑使用。

 

它們如何作用？

Rilpivirine來自一類稱為非核苷逆轉錄酶抑製劑（NNRTIs）的藥物。 Cabotegravir來自一類稱為整合酶抑製劑的藥物。每種藥物類別都以不同的方式對抗HIV。

HIV治療的目的是減少您體內的HIV水平（病毒載量）。理想情況下，您的病毒載量應低至無法被檢測到–通常每毫升血液少於50個病毒拷貝。接受HIV治療並檢測不到病毒載量，可以保護您的免疫系統並阻止HIV在性行為中傳染給他人。

 

我該如何服用？

您將首先每月服用一次cabotegravir和rilpivirine藥丸，持續一個月。這是為了確保您在服用這兩種藥物中都沒有嚴重的副作用。

在第一個月服用rilpivirine錠劑時其可能產生副作用的有關信息，請參閱情況說明書。

服藥一個月後，您將獲得第一次注射。兩次的注射分咧間隔幾分鐘打入臀部肌肉。注射後，系統會要求您在診所等待幾分鐘，以檢查注射後情況是否良好。

您將被安排每隔一或兩個月接受後續注射。您的醫生會告訴您是否需要每月或每兩個月參加一次注射。

如果您無法去診所進行注射，並且無法在原定預約的一周內參加，則將獲得每天服用的cabotegravir 和rilpivirine錠劑，直到您可以再次注射。

 

有哪些可能的副作用？

所有藥物都有可能的副作用。在開始服藥之前，最好先與您的醫生討論可能的副作用。如果您遇到可能有副作用的情形，請與您的醫生討論可以採取的措施。

我們通常將副作用分為兩種類型：

常見–至少有百分之一（超過1％）服用這種藥物的人會發生副作用。

罕見–不到百分之一（少於1％）服用這種藥物的人會發生副作用。

長效型cabotegravir和rilpivirine的常見副作用是（最常見的是以粗體呈現）：

•大多數人會在一周內消失的注射部位反應（腫塊，腫脹，疼痛）。注射部位的反應最常見於第一次注射後，並會隨時間而減少。

•頭痛，暈眩

•抑鬱，焦慮，入睡困難（失眠），異夢

•溫度升高，感覺很熱

•酸痛，肌肉疼痛

•疲倦，虛弱

•噁心（感覺不適），嘔吐，腹痛，腹瀉

•皮疹

 

它們是否會與其他藥物相互作用？

您始終應該將您正在服用的任何其他藥品或藥物告知您的醫生和藥劑師。其中包括其他醫生開出的處方藥，您從購物街藥房那裡購買的藥物，草藥和非傳統的另類替代療法以及娛樂性或俱樂部藥物（藥愛藥物）。

如果將某些藥物混合在一起使用有時會不安全–藥物交互作用可能會增加風險程席，或者使某一種或兩種藥物均停止作用。其他藥物相互作用的危險性可能較小，但仍需要認真對待。如果一種藥物的藥效受到影響，您可能需要更改服用劑量。而這只能在您的HIV醫生的建議下進行。

在使用cabotegravir和rilpivirine進行長效注射治療時，您不應服用以下藥物：

•抗驚厥的藥物carbamazepine, oxcarbazepine, phenobarbital, phenytoin

•抗分枝桿菌（如結核病的用藥）rifabutin, rifampicin, rifapentine

•全身性糖皮質糖皮質類固醇dexamethasone，單劑量治療除外

•聖約翰草（Hypericum perforatum，貫葉連翹，又名貫葉金絲桃，金絲桃科金絲桃屬植物，是歐美的常用草藥，主要用於婦女調經，亦有寧神、平衡情緒的作用）。

 

我可以在懷孕時服用嗎？

如果您正在考慮生孩子，或者您認為可能懷孕，請盡快與您的醫生討論哪種抗HIV藥物適合您。懷孕期間必須接受抗反轉錄病毒治療，以防止愛滋病毒從母體傳給嬰兒。

懷孕期間血液中的Rilpivirine水平會下降，因此不建議在懷孕期間使用這種抗HIV藥物。

 

兒童可以使用嗎？

長效的cabotegravir和rilpivirine未獲准用於兒童。

 

與您的醫生談論

如果您對治療或健康的其他方面有任何疑問，請務必與您的醫生討論。例如，如果您有症狀或副作用，或者在每天的治療中遇到問題，那麼醫生一定要知道這一點，這一點很重要。如果您正在服用任何其他藥物或娛樂性藥物，或者您患有其他疾病，這部份對醫生來說也很重要。

與醫生建立關係可能需要一些時間。您可能會覺得很自在地與您的醫生交談，但也有些人會發現這更加困難，尤其是在談論性，心理健康或他們感到尷尬的症狀時；而也會很容易忘記要談論的事情。

因此約診前的準備可能會很有幫助。花一些時間考慮一下您要說的話。您可能會發現若先與他人談論或做一些記錄並將其帶到您的約診中會很有幫助。

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Cabotegravir and rilpivirine injections

Aidsmap/Keith Alcorn  January 2021

What are cabotegravir and rilpivirine?

Cabotegravir and rilpivirine are medications used to treat HIV, delivered by injection. They have been engineered to stay in the body after injection for at least two months.

In Eurpe, long-acting cabotegravir is marketed under the name Vocabria. Long-acting rilpivirine is marketed under the name Rekambys. The two injectable treatments must be given together and not combined with other HIV medicines.

Rilpivirine is also available in a combination tablet with emtricitabine and tenofovir disoproxil (Eviplera) and in a combination tablet with emtricitabine and tenofovir alafenamide (Odefsey).

How do they work?

Rilpivirine is from a class of drugs known as non-nucleoside reverse transcriptase inhibitors (NNRTIs). Cabotegravir is from a class of drugs known as integrase inhibitors. Each drug class works against HIV in a different way.

The aim of HIV treatment is to reduce the level of HIV in your body (viral load). Ideally, your viral load should become so low that it is undetectable – usually less than 50 copies of virus per ml of blood. Taking HIV treatment and having an undetectable viral load protects your immune system and stops HIV being passed on to someone else during sex.

How do I take them?

You will start by taking cabotegravir and rilpivirine pills once a day for a month. This is to make sure that you have no serious side effects from either drug.

See the factsheet for rilpivirine tablets for information on taking it and possible side effects during the first month.

After one month of taking pills, you will receive your first injections. Both injections are given into the muscle of the buttocks, a few minutes apart. You will be asked to wait at the clinic for a few minutes after your injections, to check that you don’t have a bad reaction to the injections.

You will be scheduled to receive follow-up injections every one or two months. Your doctor will tell you whether you need to attend each month, or every two months, for your injections.

If you are unable to go to the clinic for your injections and you can’t attend within one week of your original appointment, you will be given a supply of cabotegravir and rilpivirine tablets to take each day until you can go back for more injections.

What are the possible side effects?

All drugs have possible side effects. It’s a good idea to talk to your doctor about possible side effects before you start taking a drug. If you experience something that might be a side effect, talk to your doctor about what can be done.

We generally divide side effects into two types:

Common – a side effect that occurs in at least one in a hundred people (more than 1%) who take this drug.

Rare – a side effect that occurs in fewer than one in a hundred people (less than 1%) who take this drug.

The common side effects of long-acting cabotegravir and rilpivirine are (most common in bold):

•        Injection site reactions (bumps, swellings, pain) that go away in most people within a week. Injection site reactions are most common with the first injection and decrease over time.

•        Headache, dizziness

•        Depression, anxiety, difficulty in sleeping (insomnia), abnormal dreams

•        Raised temperature, feeling hot

•        Aches and pains, muscle pain

•        Tiredness, feeling weak

•        Nausea (feeling sick), vomiting, abdominal pain, diarrhoea

•        Rash

Do they interact with other drugs?

You should always tell your doctor and pharmacist about any other drugs or medication you are taking. That includes anything prescribed by another doctor, medicines you have bought from a high-street chemist, herbal and alternative treatments, and recreational or party drugs (‘chems’).

Some medicines or drugs are not safe if taken together – the interaction could cause increased, dangerous levels, or it could stop one or both of the drugs from working. Other drug interactions are less dangerous but still need to be taken seriously. If levels of one drug are affected, you may need to change the dose you take. This must only be done on the advice of your HIV doctor.

You should not take the following medicines while you are taking long-acting injectable treatment with cabotegravir and rilpivirine:

•        the anticonvulsants carbamazepine, oxcarbazepine, phenobarbital, phenytoin

•        the antimycobacterials rifabutin, rifampicin, rifapentine

•        the systemic glucocorticoid dexamethasone, except as a single-dose treatment

•        St John’s wort (Hypericum perforatum).

Can I take them in pregnancy?

If you are considering having a baby, or think you might be pregnant, talk to your doctor as soon as possible about which combination of anti-HIV medications would be right for you. It is important to take antiretroviral treatment during pregnancy to prevent passing HIV from mother to baby.

Rilpivirine levels in the blood fall during pregnancy, so this anti-HIV medication is not recommended for use during pregnancy.

Can children take them?

Long-acting cabotegravir and rilpivirine is not approved for use in children.

Talking to your doctor

If you have any concerns about your treatment or other aspects of your health, it’s important to talk to your doctor about them.

For example, if you have a symptom or side-effect or if you are having problems taking your treatment every day, it’s important that your doctor knows about this. If you are taking any other medication or recreational drugs, or if you have another medical condition, this is also important for your doctor to know about.

Building a relationship with a doctor may take time. You may feel very comfortable talking to your doctor, but some people find it more difficult, particularly when talking about sex, mental health, or symptoms they find embarrassing. It’s also easy to forget things you wanted to talk about.

Preparing for an appointment can be very helpful. Take some time to think about what you are going to say. You might find it helpful to talk to someone else first, or to make some notes and bring them to your appointment.

https://www.aidsmap.com/about-hiv/arv-factsheet/cabotegravir-and-rilpivirine-injections