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

ROUTEONSETPEAKDURATION
intravitrealunknownafter injection1 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

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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