Administration of Apretude (Cabotegravir) in the Deltoid Muscle
Apretude (cabotegravir) should not be administered in the deltoid muscle, as it is specifically formulated for gluteal intramuscular injection only.
Approved Administration Site for Apretude
Apretude (cabotegravir) is an extended-release injectable HIV-1 antiretroviral medication used for pre-exposure prophylaxis (PrEP) that has specific administration requirements:
- Apretude is formulated as a long-acting injectable suspension that requires proper administration technique to ensure optimal drug delivery and efficacy
- The medication is specifically designed for gluteal intramuscular injection only
- The large volume (3 mL) of the injection makes the gluteal muscle the only appropriate site for administration 1
Pharmacokinetic Considerations
The pharmacokinetic profile of Apretude depends on proper administration:
- Cabotegravir's extended-release formulation relies on slow absorption from the injection site to maintain therapeutic levels for 2 months between doses 2
- The gluteal muscle provides adequate tissue mass to accommodate the 3 mL injection volume
- The deltoid muscle has insufficient mass to properly accommodate the large injection volume, which could lead to:
- Increased risk of injection site reactions
- Altered drug absorption and potentially compromised efficacy
- Increased pain and discomfort
Research on Alternative Administration Sites
Recent research has begun exploring alternative administration sites:
- A 2024 study evaluated cabotegravir administration in the vastus lateralis (lateral thigh) muscle as a potential alternative site 1
- This study found that thigh administration produced acceptable pharmacokinetic profiles that warrant further evaluation
- However, deltoid administration has not been similarly studied or approved
Proper Administration Technique
When administering Apretude in the approved gluteal site:
- The medication should be brought to room temperature before injection 3
- The injection should be administered slowly to minimize discomfort 3
- The gluteal muscle should be relaxed during administration 3
- Most healthcare providers report that a prone position provides optimal patient comfort during administration 3
Clinical Implications
Using the correct administration site is critical for:
- Maintaining proper drug levels between doses
- Ensuring the full 2-month protection period
- Minimizing injection site reactions
- Preventing treatment failure and potential HIV acquisition
Conclusion
While healthcare providers may be familiar with deltoid administration for many vaccines and medications 4, 5, Apretude represents a different class of medication with specific administration requirements. The large volume and extended-release properties of cabotegravir necessitate gluteal administration to ensure proper drug delivery and maintenance of protective drug levels.