Cabotegravir side effects: what 1,557 FDA adverse event reports show
Drug class
Hiv-1 integrase strand transfer inhibitor (insti)
Brand names
Apretude
Who reports
1,557 reports · 71% serious · 87 with death outcome · 29% female
Used for
APRETUDE is indicated for pre‑exposure prophylaxis (PrEP) to reduce the risk of sexually acquired HIV-1 infection in adults and adolescents weighing at least 35 kg who are at risk for HIV-1 acquisition. Individuals must have a negative HIV-1 test prior.
What it is
APRETUDE contains cabotegravir extended-release injectable suspension, an HIV INSTI.
Boxed warning
RISK OF DRUG RESISTANCE WITH USE OF APRETUDE FOR HIV-1 PRE‑EXPOSURE PROPHYLAXIS (PrEP) IN UNDIAGNOSED HIV-1 INFECTION Individuals must be tested for HIV-1 infection prior to initiating APRETUDE or oral cabotegravir, .
Causality screen of the 22 strongest signals
What the badges mean
- Labeled adverse reaction The exact term appears in the label's warnings or adverse-reactions sections: a known, expected effect. The FAERS signal confirms the label rather than discovering anything.
- Labeled (related wording) The label describes this effect under different wording (e.g. 'neutropenia' for 'neutrophil count decreased'). Treated as known.
- Reporting / coding artifact An administrative, monitoring or exposure term (product issue, off-label use, 'test normal', overdose...). Not a biological reaction; a high PRR here reflects how reports are coded.
- Not in label — unassessed Not found in the label text, not an artifact pattern. This is a genuine candidate for a formal causality assessment (Bradford Hill / WHO-UMC); it has NOT had one here.
Strongest disproportionality signals
Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only and flags pairs whose reports are unusually skewed by sex or come mostly from consumers rather than clinicians. 29 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.
| Reaction | Reports | PRR 95% CI · ROR · χ²/p | EBGM EB05 · IC025 | Label screen | Serious-only & strata | Trial cross-check |
|---|---|---|---|---|---|---|
| Drug level decreased | 17 | 22.4 14.0–36.0ROR 22.6 · χ² 326 / p 3e-73 | 21.8 EB05 14.3 · IC025 +3.0 3/3 methods agree | Reporting / coding artifact | serious PRR 22.5 | no trial data cached |
| Injection site discomfort | 17 | 22.2 13.8–35.6ROR 22.4 · χ² 323 / p 2e-72 | 21.6 EB05 14.2 · IC025 +3.0 3/3 methods agree | Labeled (related wording) related wording | serious n=16 | no trial data cached |
| Injection site nodule | 17 | 20.9 13.0–33.5ROR 21.1 · χ² 302 / p 8e-68 | 20.3 EB05 13.2 · IC025 +2.9 3/3 methods agree | Labeled (related wording) related wording | serious n=12 | no trial data cached |
| Erectile dysfunction | 28 | 14.6 10.1–21.1ROR 14.9 · χ² 343 / p 9e-77 | 14.3 EB05 10.1 · IC025 +2.9 3/3 methods agree | Not in label — unassessed | serious PRR 17.1 · 96% clinician | no trial data cached |
| Psychotic disorder | 31 | 14.1 10.0–20.0ROR 14.4 · χ² 366 / p 9e-82 | 13.8 EB05 9.9 · IC025 +2.9 3/3 methods agree | Not in label — unassessed | serious PRR 12.1 · ♀ 0% (drug 29%) | no trial data cached |
| Injection site induration | 13 | 13.5 7.9–23.2ROR 13.6 · χ² 138 / p 3e-32 | 12.2 EB05 6.8 · IC025 +2.3 3/3 methods agree | Labeled (related wording) related wording | serious n=9 | no trial data cached |
| Product administration error | 15 | 10.1 6.1–16.8ROR 10.2 · χ² 114 / p 5e-27 | 8.7 EB05 5.3 · IC025 +2.1 3/3 methods agree | Reporting / coding artifact | serious PRR 5.4 | no trial data cached |
| Hepatitis (liver inflammation) | 17 | 8.9 5.6–14.4ROR 9.0 · χ² 112 / p 2e-26 | 7.7 EB05 4.9 · IC025 +2.0 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 7.4 | no trial data cached |
| Aggression | 33 | 8.9 6.3–12.4ROR 9.0 · χ² 223 / p 1e-50 | 8.2 EB05 6.0 · IC025 +2.4 3/3 methods agree | Not in label — unassessed | serious PRR 9.0 · ♀ 3% (drug 29%) | no trial data cached |
| Treatment noncompliance | 26 | 6.4 4.4–9.4ROR 6.5 · χ² 114 / p 5e-27 | 5.8 EB05 4.2 · IC025 +1.9 3/3 methods agree | Reporting / coding artifact | serious PRR 4.4 | no trial data cached |
| Abortion spontaneous | 19 | 6.4 4.1–9.9ROR 6.4 · χ² 81 / p 1e-19 | 5.6 EB05 3.8 · IC025 +1.7 3/3 methods agree | Not in label — unassessed | serious PRR 5.2 | no trial data cached |
| Exposure during pregnancy | 26 | 5.6 3.8–8.2ROR 5.7 · χ² 95 / p 1e-22 | 5.1 EB05 3.7 · IC025 +1.7 3/3 methods agree | Reporting / coding artifact | serious PRR 6.1 · 100% clinician | no trial data cached |
| Injection site mass | 13 | 4.7 2.8–8.2ROR 4.8 · χ² 35 / p 2e-9 | 4.1 EB05 2.6 · IC025 +1.1 3/3 methods agree | Labeled (related wording) related wording | serious PRR 19.0 | no trial data cached |
| Injection site pain (pain where injected) | 105 | 4.7 3.9–5.6ROR 4.9 · χ² 302 / p 6e-68 | 4.6 EB05 3.9 · IC025 +1.9 3/3 methods agree | Labeled (related wording) related wording | serious PRR 18.1 · 92% clinician | no trial data cached |
| Nightmare | 12 | 4.6 2.6–8.2ROR 4.7 · χ² 31 / p 1e-8 | 4.0 EB05 2.5 · IC025 +1.0 3/3 methods agree | Not in label — unassessed | serious PRR 4.3 | no trial data cached |
| Inappropriate schedule of product administration | 56 | 4.3 3.3–5.5ROR 4.4 · χ² 138 / p 4e-32 | 4.1 EB05 3.3 · IC025 +1.6 3/3 methods agree | Reporting / coding artifact | serious PRR 5.8 | no trial data cached |
| Suicidal ideation (thoughts of suicide) | 29 | 4.3 3.0–6.1ROR 4.3 · χ² 69 / p 4e-17 | 4.0 EB05 2.9 · IC025 +1.4 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 3.6 | no trial data cached |
| Product dose omission issue | 89 | 4.2 3.4–5.1ROR 4.4 · χ² 217 / p 2e-49 | 4.1 EB05 3.5 · IC025 +1.7 3/3 methods agree | Reporting / coding artifact | serious PRR 5.7 | no trial data cached |
| Foetal exposure during pregnancy | 20 | 3.3 2.1–5.1ROR 3.3 · χ² 30 / p 2e-8 | 3.1 EB05 2.1 · IC025 +0.9 3/3 methods agree | Reporting / coding artifact | serious PRR 2.8 | no trial data cached |
| Suicide attempt | 10 | 2.2 1.2–4.1ROR 2.2 · χ² 6 / p 0.009 | 2.1 EB05 1.2 · IC025 -0.0 PRR-only: not supported by EBGM or IC | Labeled adverse reaction exact term | serious PRR 1.8 | no trial data cached |
| Injection site reaction | 11 | 2.2 1.2–3.9ROR 2.2 · χ² 6 / p 0.008 | 2.1 EB05 1.3 · IC025 +0.0 | Labeled adverse reaction exact term | serious PRR 7.4 | no trial data cached |
| Injection site swelling | 12 | 2.1 1.2–3.7ROR 2.1 · χ² 6 / p 0.007 | 2.0 EB05 1.3 · IC025 +0.0 | Labeled (related wording) related wording | serious PRR 5.6 | no trial data cached |
Trial evidence (ClinicalTrials.gov)
Most frequently reported reactions
By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.
| Reaction | Reports | PRR 95% CI · ROR · χ²/p | EBGM EB05 · IC025 | Label screen | Serious-only & strata | Trial cross-check |
|---|---|---|---|---|---|---|
| Injection site pain (pain where injected) | 105 | 4.7 3.9–5.6ROR 4.9 · χ² 302 / p 6e-68 | 4.6 EB05 3.9 · IC025 +1.9 3/3 methods agree | Labeled (related wording) related wording | serious PRR 18.1 · 92% clinician | no trial data cached |
| Product dose omission issue | 89 | 4.2 3.4–5.1ROR 4.4 · χ² 217 / p 2e-49 | 4.1 EB05 3.5 · IC025 +1.7 3/3 methods agree | Reporting / coding artifact | serious PRR 5.7 | no trial data cached |
| Inappropriate schedule of product administration | 56 | 4.3 3.3–5.5ROR 4.4 · χ² 138 / p 4e-32 | 4.1 EB05 3.3 · IC025 +1.6 3/3 methods agree | Reporting / coding artifact | serious PRR 5.8 | no trial data cached |
| Aggression | 33 | 8.9 6.3–12.4ROR 9.0 · χ² 223 / p 1e-50 | 8.2 EB05 6.0 · IC025 +2.4 3/3 methods agree | Not in label — unassessed | serious PRR 9.0 · ♀ 3% (drug 29%) | no trial data cached |
| Psychotic disorder | 31 | 14.1 10.0–20.0ROR 14.4 · χ² 366 / p 9e-82 | 13.8 EB05 9.9 · IC025 +2.9 3/3 methods agree | Not in label — unassessed | serious PRR 12.1 · ♀ 0% (drug 29%) | no trial data cached |
| Suicidal ideation (thoughts of suicide) | 29 | 4.3 3.0–6.1ROR 4.3 · χ² 69 / p 4e-17 | 4.0 EB05 2.9 · IC025 +1.4 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 3.6 | no trial data cached |
| Erectile dysfunction | 28 | 14.6 10.1–21.1ROR 14.9 · χ² 343 / p 9e-77 | 14.3 EB05 10.1 · IC025 +2.9 3/3 methods agree | Not in label — unassessed | serious PRR 17.1 · 96% clinician | no trial data cached |
| Exposure during pregnancy | 26 | 5.6 3.8–8.2ROR 5.7 · χ² 95 / p 1e-22 | 5.1 EB05 3.7 · IC025 +1.7 3/3 methods agree | Reporting / coding artifact | serious PRR 6.1 · 100% clinician | no trial data cached |
| Treatment noncompliance | 26 | 6.4 4.4–9.4ROR 6.5 · χ² 114 / p 5e-27 | 5.8 EB05 4.2 · IC025 +1.9 3/3 methods agree | Reporting / coding artifact | serious PRR 4.4 | no trial data cached |
| Foetal exposure during pregnancy | 20 | 3.3 2.1–5.1ROR 3.3 · χ² 30 / p 2e-8 | 3.1 EB05 2.1 · IC025 +0.9 3/3 methods agree | Reporting / coding artifact | serious PRR 2.8 | no trial data cached |
| Abortion spontaneous | 19 | 6.4 4.1–9.9ROR 6.4 · χ² 81 / p 1e-19 | 5.6 EB05 3.8 · IC025 +1.7 3/3 methods agree | Not in label — unassessed | serious PRR 5.2 | no trial data cached |
| Hepatitis (liver inflammation) | 17 | 8.9 5.6–14.4ROR 9.0 · χ² 112 / p 2e-26 | 7.7 EB05 4.9 · IC025 +2.0 3/3 methods agree | Labeled adverse reaction exact term | serious PRR 7.4 | no trial data cached |
| Injection site nodule | 17 | 20.9 13.0–33.5ROR 21.1 · χ² 302 / p 8e-68 | 20.3 EB05 13.2 · IC025 +2.9 3/3 methods agree | Labeled (related wording) related wording | serious n=12 | no trial data cached |
| Injection site discomfort | 17 | 22.2 13.8–35.6ROR 22.4 · χ² 323 / p 2e-72 | 21.6 EB05 14.2 · IC025 +3.0 3/3 methods agree | Labeled (related wording) related wording | serious n=16 | no trial data cached |
| Drug level decreased | 17 | 22.4 14.0–36.0ROR 22.6 · χ² 326 / p 3e-73 | 21.8 EB05 14.3 · IC025 +3.0 3/3 methods agree | Reporting / coding artifact | serious PRR 22.5 | no trial data cached |
Unlabeled candidate signals
These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.
- Erectile dysfunction — n=28, PRR 14.6
- Psychotic disorder — n=31, PRR 14.1
- Aggression — n=33, PRR 8.9
Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.
Common questions
What are the most reported side effects of Cabotegravir?
In FDA FAERS, the most frequently co-reported reaction terms for Cabotegravir are injection site pain, aggression, psychotic disorder, suicidal ideation, erectile dysfunction, abortion spontaneous. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.
Does Cabotegravir have an FDA boxed warning?
Yes. The current FDA label carries a boxed warning: RISK OF DRUG RESISTANCE WITH USE OF APRETUDE FOR HIV-1 PRE‑EXPOSURE PROPHYLAXIS (PrEP) IN UNDIAGNOSED HIV-1 INFECTION Individuals must be tested for HIV-1 infection prior to initiating APRETUDE or oral cabotegravir, .
Do FAERS signals prove that Cabotegravir causes these side effects?
No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.
Sources & methods
- FDA label via openFDA (set ID 4338428e-43d4-4e02-ac9d-bd98e738a7da, effective 20250411; matched on
openfda.generic_name.exact:"CABOTEGRAVIR") - Bayesian shrinkage measures computed offline over all 1,317,300 cached pairs: BCPNN information component (IC, with Norén closed-form IC025) and MGPS empirical-Bayes geometric mean (EBGM, EB05) with a two-component gamma prior fitted by maximum marginal likelihood (α₁=0.57, β₁=0.02, α₂=1.42, β₂=0.70, w=0.17); unstratified
- FAERS pair statistics from the OpenPV build of 2026-09-14 (openFDA
count=aggregation, fieldpatient.drug.openfda.generic_name.exact, 51 reaction terms, min 3 co-reports); PRR/ROR with 95% CI, chi-square with Yates correction - Serious-only and stratified counts (serious:1, patient.patientsex, primarysource.qualification) from openFDA count queries; serious-only PRR uses the drug serious report total and the term global serious total (N_serious=11,882,979); strata shown only when n ≥ 20
- Seriousness and sex counts from openFDA
count=serious,patient.patientsex,seriousnessdeath
Page generated 2026-10-08. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.