Managing the injection schedule
Once initiated, your patient will receive treatment injections every 2-months.1 Here you will find guidance on helping your patient manage their treatment schedule successfully.
Target Treatment Date
It is recommended that healthcare teams aim to deliver the injections on the same date each month. This date is called the Target Treatment Date – the date patients received their first or 'initiation' injections.
However, there will be times when patients can’t make their appointment, the clinic is not open or they have to delay their visit for reasons out of their control.
Follow the guidance below when assessing the best option for your patient to manage their injection schedule.
Flexible Dosing Window
For patients who need to delay or bring forward their injection visit by +/- 7 days, there is a Flexible Dosing Window.1
Once the patient has received their injections within the 7-day window, they will return in two months for their next injections on their original Target Treatment Date.1
Restarting after planned or unplanned missed injections (outside of the Flexible Dosing Window)
There are 2 scenarios for managing planned or unplanned missed injections that fall outside the +/- 7 day Flexible Dosing Window:
- Restarting after planned missed injections and Oral Bridging
- Restarting after unplanned missed injections without Oral Bridging
In each of these scenarios, healthcare teams need to follow the guidance for restarting injections, which can be found below.
1. Restarting after planned missed injections and Oral Bridging
To identify how to restart patients after planned missed injections and Oral Bridging, determine how much time has passed since their Target Treatment Date.
- If <1 month since missed Target Treatment Date, resume injections on final day of Oral Bridging. Continue with every 2-month dosing schedule thereafter.
- If >1 month since missed Target Treatment Date, repeat initiation injections on final day of Oral Bridging 1 month apart for 2 consecutive months. Continue with every 2-month dosing schedule thereafter.
2. Restarting after unplanned missed injections without Oral Bridging
Adherence to scheduled injection visits is important. If you haven’t been able to aim for the Target Treatment Date +/- 7 days, nor plan for longer delays with Oral Bridging, refer to the guidance below.
Clinically reassess the patient to determine whether long-acting treatment remains appropriate.
To identify how to restart patients after unplanned missed injections without Oral Bridging, determine how much time has passed since their Target Treatment Date.
Oral Bridging Overview
If a patient cannot receive their scheduled injections or needs to delay their treatment appointment by more than 7 days after their Target Treatment Date, prescribe daily oral therapy with cabotegravir and rilpivirine for up to 2 months.
Cabotegravir tablets (30 mg) may be used in combination with rilpivirine tablets (25 mg) to replace one injection visit. The tablets should be taken together with a meal at the same time each day. This is known as oral bridging.
The first dose of Oral Bridging should be taken on the day of the planned missed injections visit (+/- 7 days).
Restart injections on the final day of oral bridging, keeping the previous Target Treatment Date or setting a new one if required.
If a patient requires oral therapy for more than 2 months, an alternative oral ARV regimen is recommended.
Please consult Vocabria + Rekembys SmPCs for further information:
Stopping VOCABRIA + REKAMBYS injections1
If treatment is discontinued, it is essential to start alternative ARV therapy no later than two months after the final injections (or one month if after first initiation injections) in order to minimise the risk of resistance.1
ARV = antiretroviral.
- VOCABRIA Summary of Product Characteristics. ViiV Healthcare.
- REKAMBYS Summary of Product Characteristics. Janssen Healthcare.
Adverse events should be reported. Reporting forms and information can be found at https://yellowcard.mhra.gov.uk/ or search for MHRA Yellowcard in the Google Play or Apple App store. Adverse events should also be reported to GlaxoSmithKline on 0800 221 441.
REKAMBYS (rilpivirine long acting injection), including the trademark is owned by the Janssen Pharmaceutical Companies and used under license by the ViiV Healthcare group of companies. All other trademarks are owned by the ViiV Healthcare group.
PM-GB-CBR-WCNT-210001v3 I April 2022
Adverse events should be reported. Reporting forms and information can be found at www.mhra.gov.uk/yellowcard or search for MHRA Yellowcard in the Google Play or Apple App store. Adverse events should also be reported to GlaxoSmithKline on 0800 221441.
If you are from outside the UK, you can report adverse events to GSK/ViiV by selecting your region and market, here.