Minimizing Apretude (Cabotegravir) Injection Reactions
To reduce Apretude injection reactions, premedication with oral antihistamines and antipyretics 30-60 minutes before the injection is recommended, along with proper injection technique and site rotation.
Understanding Apretude Injection Reactions
Apretude (cabotegravir) is a long-acting injectable HIV-1 pre-exposure prophylaxis (PrEP) medication administered intramuscularly. Injection site reactions are common:
- Injection site reactions occur in approximately 38% of patients receiving cabotegravir injections 1
- Common reactions include pain, redness, swelling, induration, and pruritus at the injection site
- Most reactions are mild to moderate and don't typically lead to discontinuation 2
Preventive Strategies
Premedication Protocol
- Administer 30-60 minutes before injection:
- Oral antihistamine (e.g., diphenhydramine 25-50mg or cetirizine 10mg)
- Antipyretic (e.g., acetaminophen/paracetamol 1g) 3
- Consider adding H2 antagonist (e.g., ranitidine) for enhanced prevention
Proper Injection Technique
- Ensure proper intramuscular injection in the gluteal muscle (ventrogluteal site preferred)
- Use Z-track injection method to minimize leakage into subcutaneous tissue
- Administer slowly to reduce tissue trauma
- Apply gentle pressure after injection without massaging the area
Site Management
- Rotate injection sites between left and right gluteal muscles
- Document injection sites to ensure proper rotation
- Apply cold compress to injection site for 10-15 minutes before injection to reduce pain
- Consider topical anesthetic (e.g., EMLA cream) 30-60 minutes before injection for patients with significant pain
Management of Reactions
Mild to Moderate Reactions (Grade 1/2)
- Apply cold compresses to reduce inflammation
- Administer oral antihistamines for pruritus (e.g., diphenhydramine 25-50mg)
- Provide oral analgesics for pain (e.g., acetaminophen or NSAIDs) 3
- Topical corticosteroids for persistent local reactions (e.g., triamcinolone 0.1%) 4
Severe Reactions (Grade 3/4)
- Stop any ongoing administration
- Provide aggressive symptomatic treatment
- Consider systemic corticosteroids for severe reactions (methylprednisolone 1-2 mg/kg) 3, 4
- Monitor vital signs and observe for progression of symptoms for at least 30-60 minutes 4
Patient Education
- Inform patients that injection site reactions are common but typically resolve within days
- Educate about expected sensations during and after injection
- Provide guidance on when to seek medical attention (severe pain, spreading redness, fever)
- Reassure that injection site reactions typically decrease in frequency and severity with subsequent injections
Special Considerations
- First injection carries the highest risk of reaction; consider enhanced premedication for the initial dose 4
- Higher BMI patients may experience fewer injection site reactions but require proper needle length selection
- Patients with history of allergic reactions may benefit from more aggressive premedication
Follow-up
- Document the nature, severity, and duration of any injection reactions
- Adjust premedication strategy based on individual response
- Consider dermatology consultation for persistent or unusual reaction patterns 4
Proper preparation, technique, and management of injection reactions can significantly improve the tolerability of Apretude, potentially enhancing adherence to this highly effective HIV prevention method.