ranibizumab
General
Pronunciation:
ran-i-bi-zoo-mab
Trade Name(s)
- Lucentis
Ther. Class.
ocular agents
Pharm. Class.
monoclonal antibodies
Indications
- Neovascular (wet) age-related macular degeneration.
- Macular edema following retinal vein occlusion.
- Diabetic macular edema.
- Diabetic retinopathy.
- Myopic choroidal neovascularization.
Action
Binds to vascular endothelial growth factor A (VEGF-A) receptor sites, preventing the binding of endogenous VEGF-A, resulting in decreased endothelial proliferation, vascular leakage and new vessel formation.
Therapeutic Effect(s):
Decreased progression of visual loss.
Pharmacokinetics
Absorption: Intravitreal injection results in complete local bioavailability. Very low serum levels are achieved.
Distribution: Unknown.
Metabolism and Excretion: Unknown.
Half-life: 9 days (intravitreal).
TIME/ACTION PROFILE
ROUTE | ONSET | PEAK | DURATION |
---|---|---|---|
intravitreal | unknown | after injection | 1 mo |
Contraindication/Precautions
Contraindicated in:
- Hypersensitivity
- Ocular/periocular infections.
Use Cautiously in:
- OB: Use only in pregnancy if clearly needed, use cautiously during lactation
- Pedi: Safety not established.
Adverse Reactions/Side Effects
EENT: conjunctival hemorrhage, eye pain, ↑ intraocular pressure, intraocular inflammation, vitreal floaters, endophthalmitis, retinal detachment
CV: MI, STROKE
* CAPITALS indicate life-threatening.
Underline indicate most frequent.
Interactions
Drug-Drug
↑ risk of serious intraocular inflammation with verteporfin.
Route/Dosage
Macular Degeneration
Intravitreal (Adults): 0.5 mg once monthly; after 4 mo, injections may be given every 1–3 mo.
Macular Edema Following Retinal Vein Occlusion
Intravitreal (Adults): 0.5 mg once monthly.
Diabetic Macular Edema and Diabetic Retinopathy
Intravitreal (Adults): 0.3 mg once monthly.
Myopic Choroidal Neovascularization
Intravitreal (Adults): 0.5 mg once monthly for up to 3 mo. May be retreated if needed.
Availability
Solution for intravitreal injection: 0.3 mg/0.05 mL (vial or prefilled syringe), 0.5 mg/0.05 mL (vial or prefilled syringe)
Assessment
- Assess eye for signs of infection frequently during wk following injection.
- Check perfusion of optic nerve head immediately after injection, use tonometry to measure intraocular pressure prior to and 60 min following the injection.
Potential Diagnoses
- Disturbed sensory perception (Indications)
Implementation
Do not administer solutions that are discolored or contain particulate matter. Attach threaded plastic threader rod to the rubber stopper inside barrel of syringe. Do not pull back on plunger.
- Adequate analgesia and a broad-spectrum antibiotic should be given prior to injection.
- Intravitreal For ophthalmic intravitreal injection only. Withdraw vial contents through a 5–micron gauge filter needle attached to a 1–mL tuberculin syringe. Discard filter needle after withdrawal. Replace filter needle with sterile 30-gauge x 1/2-inch needle for intravitreal injection. Expel contents until plunger tip is aligned with line marking 0.05 mL on syringe Each vial should be used for only one eye. If contralateral eye requires treatment, use new vial and equipment. Refrigerate solution and protect from light; do not freeze.
Patient/Family Teaching
Advise patient to notify ophthalmologist immediately if eye becomes red, sensitive to light, painful, or develops a change in vision.
Evaluation/Desired Outcomes
Slowing of vision loss.
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