TABLE 3

Preexposure prophylaxis prescribing, safety, and other considerations

PrEP medications
Generic nameEmtricitabine/tenofovir disoproxil fumarateEmtricitabine/tenofovir alafenamideCabotegravir
Dosing200/300 mg daily or on-demand200/25 mg daily600-mg gluteal intramuscular injection
PopulationCisgender women/cisgender men,a transgender women, transgender men,a persons who inject drugsCisgender men,b transgender womenbCisgender women,a cisgender men,b transgender womenb
Prescribing30-day initial prescription
90-day maintenance		30-day initial prescription
90-day maintenance		Optional lead-in 30-mg oral daily for 4 weeks
Initial injection, then second injection in 4 weeks
Maintenance injection every 8 weeks
Safety
Side effectsHeadaches, abdominal pain, nausea, weight lossDiarrhea, weight gainTenderness and redness at injection site
Renal functionEstimated creatinine clearance
> 60 mL/minute		Estimated creatinine clearance
> 30 mL/minute		No renal restrictions
Drug interactionsDrugs compromising renal function (antivirals, aminoglycosides, and high-dose nonsteroidal anti- inflammatory drugs) may increase concentrationSt. John’s wort may decrease concentration
Antibiotics rifabutin and rifapentine should not be coadministered
May consider rifampin if benefit outweighs risk		Carbamazepine, oxcarbazepine, phenytoin, phenobarbital, rifampicin, and rifapentine may decrease concentration
May consider rifabutin if benefit outweighs risk
Other concernsAvoid use with osteopenia or osteoporosis or with renal impairmentAvoid use with osteopenia or osteoporosisCaution if gluteal fillers or if at increased bleeding risk
Caution with end-stage kidney disease not yet receiving dialysis
Other
Missed doseContinue daily dosingContinue daily dosing> 7 days late: oral preexposure prophylaxis bridging until next injection
> 8 weeks late: restart administration

  • ↵aIncludes insertive and receptive vaginal or anal sex.

  • ↵bInsertive vaginal or anal sex and receptive anal sex; not approved for risk from receptive vaginal sex.

  • Based on information from references 2,6,14,22–25,29.