Ranibizumab

Indications

Ranibizumab is used for: Wet ARMD, Central retinal vein occlusion, Diabetic macular edema

Adult Dose

Intravitreal Neovascular (wet) age-related macular degeneration Adult: 0.5 mg (0.05 mL of 10 mg/mL) mthly into the affected eye as a single dose. Continue treatment until visual acuity is stable for 3 consecutive mth. Doses are given at intervals of at least 1 mth. Macular oedema secondary to retinal vein occlusion Adult: 0.5 mg mthly into the affected eye as a single dose for 6 months. Doses are given at intervals of at least 1 mth. Diabetic Macular Edema, Diabetic Retinopathy with DME 0.3 mg (0.05 mL of 6 mg/mL) administer by intravitreal injection once a month (approximately every 28 days).

Child Dose

Renal Dose

Administration

Contra Indications

Active or suspected ocular or periocular infection, active severe intraocular inflammation, signs of irreversible ischaemic visual function loss in patients w/ retinal vein occlusion.

Precautions

Patient w/ risk factors for retinal pigment epithelial tears, history of stroke or transient ischaemic attack, uncontrolled HTN, previous intravitreal inj, active systemic infections, proliferative diabetic retinopathy, diabetic macular oedema due to type 1 DM. Discontinue treatment if rhegmatogenous retinal detachment or stage 3 or 4 macular hole develops. Diabetic patients w/ glycosylated Hb over 12%. Lactation: Unknown if distributed in milk; use caution

Pregnancy-Lactation

Pregnancy There are no adequate and well-controlled studies in pregnant women Administration of ranibizumab to pregnant monkeys throughout the period of organogenesis resulted in a low incidence of skeletal abnormalities at intravitreal doses 13-times the predicted human exposure (based on maximal serum trough levels [Cmax]) after a single eye treatment at the recommended clinical dose Ranibizumab should be given to a pregnant woman only if clearly needed Lactation There are no data available on presence of ranibizumab in human milk; effects of ranibizumab on breastfed infant or effects of ranibizumab on milk production/excretion; developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed child from ranibizumab

Interactions

May enhance the adverse/toxic effect of belimumab. Serious intraocular inflammation may occur when used adjunctively w/ verteporfin photodynamic therapy (PDT).

Adverse Effects

Side effects of Ranibizumab : >10% Conjunctival hemorrhage (43-77%), Eye pain (17-37%), Vitreous floaters (3-32%), Incr IOP (8-24%), Vitreous detachment (7-22%), Eye irritation (4-19%), Intraocular inflammation (5-18%), Headache (2-15%), Upper resp tract infection (2-15%), Retinal disorder (13%), Blepharitis (3-13%), Retinal degeneration (1-11%) 1-10% Conjunctival hyperemia (9%), Posterior capsule opacification (8%), Injection site hemorrhage (5%), Vitreous hemorrhage (4%)

Mechanism of Action

Humanized monoclonal antibody to VEGF-A, inhibits VEGF-A-induced ocular neovascularization.