References UK clinical guidance from the NHS, the British HIV Association (BHIVA), and the British Association for Sexual Health and HIV (BASHH). Last updated: April 2026.
Rilpivirine (brand name Edurant) is a next-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) used in HIV treatment. It’s better tolerated than efavirenz with fewer neuropsychiatric side effects, and is a component of several combination tablets including Eviplera, Odefsey, Juluca and the long-acting injectable regimen with cabotegravir.
Here’s how rilpivirine works and what to consider.
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How Rilpivirine Works
Like other NNRTIs, rilpivirine binds directly to HIV’s reverse transcriptase enzyme and blocks it from converting viral RNA into DNA. It’s more potent than first-generation NNRTIs and has fewer central nervous system side effects.
Where You’ll Find Rilpivirine
| Product | Other Ingredients | Form |
|---|---|---|
| Edurant | None (standalone) | Oral tablet |
| Eviplera | Emtricitabine + tenofovir DF | Oral single tablet |
| Odefsey | Emtricitabine + TAF | Oral single tablet |
| Juluca | Dolutegravir | Oral single tablet |
| Rekambys | Used with cabotegravir (Vocabria) | Long-acting injection |
Who Can Take Rilpivirine?
- Adults starting treatment with a viral load below 100,000 copies/ml
- People switching from another regimen with an undetectable viral load
- Those without NNRTI resistance mutations
How to Take Rilpivirine (Oral)
Take with a meal — always. Rilpivirine absorption requires food. An empty stomach reduces levels significantly, risking virological failure and resistance.
Side Effects
Rilpivirine is generally well tolerated:
- Insomnia or vivid dreams (less than efavirenz)
- Headache
- Depressive symptoms (uncommon)
- Rash (uncommon)
- Nausea (mild)
The Acid-Reducing Drug Problem
Rilpivirine’s most important limitation is its interaction with acid-reducing medicines:
- PPIs (omeprazole, lansoprazole) — absolutely contraindicated
- H2 blockers — only with strict timing (12 hours before or 4 hours after)
- Antacids — 2 hours before or 4 hours after
If you need regular acid-reducing medication, a different HIV drug may be more suitable.
Rilpivirine in Long-Acting Injections
Rilpivirine is one half of the long-acting injectable HIV treatment (with cabotegravir). As Rekambys, it’s given as a gluteal injection every 1-2 months for people who are already virally suppressed. This eliminates the need for daily pills.
Read more: Eviplera | Odefsey | Long-acting injections
Frequently Asked Questions
Is rilpivirine better than efavirenz?
Rilpivirine has fewer neuropsychiatric side effects than efavirenz. However, it’s only suitable for people with lower viral loads and cannot be used with PPIs.
Can I skip the meal sometimes?
No. Taking rilpivirine without food significantly reduces absorption and can lead to treatment failure. A proper meal is essential every time.
Does rilpivirine work against drug-resistant HIV?
Rilpivirine shares some cross-resistance with other NNRTIs. If you have NNRTI resistance, your HIV team will check whether rilpivirine is likely to work.
Related reading
- Choosing the Right PrEP Drug: Truvada vs Descovy
- Dovato for HIV: A Two-Drug Regimen
- Triumeq for HIV: A Straightforward Guide
- Efavirenz for HIV: An Older NNRTI Still in Use
- Eviplera: How This Anti-HIV Drug Works
Sources
- NHS — Sexual health conditions
- BASHH — UK clinical guidelines for STI management
- British HIV Association (BHIVA) — HIV treatment guidelines
- Terrence Higgins Trust — sexual health information
- UK Health Security Agency — STI surveillance data
Steve Page is a recognised expert on Sexually Transmitted Diseases (STDs) and STD treatments, having published numerous articles in peer-reviewed journals and presented his research at conferences around the world. He has an in-depth understanding of the latest medical research on STDs, and is an advocate for the development of new treatments and protocols to improve the health of those affected. In addition to his research, he has dedicated his career to understanding the causes and symptoms of STDs, as well as how to best treat those impacted.
