ranibizumab


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Related to ranibizumab: Bevacizumab, aflibercept, Pegaptanib, Lucentis

ranibizumab

(ran-i-bi-zoo-mab) ,

Lucentis

(trade name)

Classification

Therapeutic: ocular agents
Pharmacologic: monoclonal antibodies
Pregnancy Category: C

Indications

Neovascular (wet) age-related macular degeneration.Macular edema following retinal vein occlusion.Diabetic macular edema

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 effects

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

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Ocular/periocular infections.
Use Cautiously in: Obstetric: Use only in pregnancy if clearly needed, use cautiously during lactation; Pediatric: Safety not established.

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

  • conjunctival hemorrhage (most frequent)
  • eye pain (most frequent)
  • ↑ intraocular pressure (most frequent)
  • intraocular inflammation (most frequent)
  • vitreal floaters (most frequent)
  • endophthalmitis
  • retinal detachment

Cardiovascular

  • arterial thromboembolic events (life-threatening)

Interactions

Drug-Drug interaction

↑ risk of serious intraocular inflammation with verteporfin.

Route/Dosage

Macular Degeneration

Intravitreal (Adults) 0.5 mg (0.05 mL) once monthly; after 4 mo, injections may be given every 1–3 mo.

Macular Edema Following Retinal Vein Occlusion

Intravitreal (Adults) 0.5 mg (0.05 mL) once monthly.

Diabetic Macular Edema

Intravitreal (Adults) 0.3 mg (0.05 mL) once monthly.

Availability

Solution for intravitreal injection: 0.3 mg (0.05 mL)/vial, 0.5 mg (0.05 mL)/vial

Nursing implications

Nursing assessment

  • Assess eye for signs of infection frequently during week 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 Nursing 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–cc 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.

ranibizumab

an ophthalmic drug that binds to the receptor binding site of active forms of vascular endothelial growth factor A.
indications This drug is used in the treatment of neovascular macular degeneration.
contraindications Ocular infections and known hypersensitivity to this drug prohibit its use.
adverse effects Adverse effects of this drug include dizziness; headache; blepharitis; cataract; conjunctival hemorrhage and hyperemia; detachment of the retinal pigment epithelium; dryness, irritation, and pain in the eye; visual impairment; vitreous floaters; ocular infection; constipation; nausea; hypertension; urinary tract infection; thromboembolism; bronchitis; cough; sinusitis; and upper respiratory infection.

ranibizumab

A recombinant monoclonal antibody drug that inhibits the action of vascular endothelial growth factor (VEGF) protein and is believed to be useful in the treatment of age-related neovascular macular degeneration.

anti-VEGF drugs 

Drugs which bind to VEGF receptors without causing activation, thus blocking the production of new blood vessels and enhanced vessel permeability by the vascular endothelial growth factor (VEGF). They are used in the treatment of some forms of cancer (administered intravenously), and injected intravitreally in the treatment of choroidal neovascularization, retinal venous occlusion, and macular oedema. Examples: bevacizumab, pegaptanib sodium, ranibizumab. Syn. angiogenesis inhibitors. See age-related macular degeneration; diabetic retinopathy; VEGF.

macular degeneration, age-related (ARMD, AMD)

A common, chronic degenerative condition found in a large percentage of elderly patients (and sometimes middle-aged ones) characterized by loss of central vision. There are two main forms of the condition: non-neovascular (dry, atrophic) AMD, which is the most common, and exudative (wet, neovascular) AMD in which the loss of vision is the most severe. The main features of dry AMD are the presence in the macular region of small, yellowish-white spots (hard drusen) and large, poorly defined, coalescing soft drusen, focal hyperpigmentation of the retinal pigment epithelium (RPE) and at a later stage geographic atrophy of the RPE and depigmentation exposing choroidal vessels. Visual acuity becomes markedly reduced, there is metamorphopsia and the condition usually becomes bilateral over several years. The condition is managed essentially by the use of low vision aids.Exudative AMD has a similar clinical picture initially but is followed by choroidal neovascularization (CNV), which gives rise to subretinal fluid, haemorrhages, exudation, RPE detachment and subretinal fibrosis in the macular region resulting in severe loss of central vision. If detected early (usually with an Amsler chart), treatment with laser photocoagulation will reduce the risk of further visual loss. Photodynamic therapy (PDT) is another method of reducing the risk of visual loss. It allows selective destruction of the choroidal neovascularization with minimal damage to the overlying retinal tissue. It consists of injecting a photosensitizing agent (e.g. verteporfin) that is taken up by the abnormal vessels and when activated by a laser light of a given wavelength (e.g. 689 nm) it damages and shrivels up the vessels. Recent drug therapies, such as the anti-VEGF ranibizumab and bevacizumab, which are injected intravitreally at regular intervals and designed to stop the leakage and the growth of blood vessels, not only reduce loss of vision but improve visual acuity in a significant percentage of cases of wet AMD. Syn. senile macular degeneration. See fluorescein angiography; disciform scar; drusen; macular dystrophy; lipofuscin; age-related maculopathy; oxidative stress; macular pigment; Kollner's rule; photostress test; VEGF.
References in periodicals archive ?
FDA onayi almis FDT, intravitreal pegaptanib ve ranibizumab uygulanmakta olan tedavilerdir.
En este estudio se presenta el efecto de terapia antiangiogenica con ranibizumab como segunda linea de tratamiento, despues de la falta de resolucion completa con el tratamiento previo con termoterapia transpupilar en prematuros con ROP umbral y agresiva posterior a una mediana seguimiento de 23,5 meses.
Three-year outcomes of individualized ranibizumab treatment in patients with diabetic macular edema: the RESTORE extension study Ophthalmology 2014;121:1045-1053.
Ranibizumab (Lucentis[R]; Genentech, South San Francisco, CA, USA) is a humanized antibody fragment directed at all isoforms of VEGF-A and is fabricated specifically for intravitreal use.
sup][15] Ranibizumab and conbercept are typical drugs used in anti-VEGF treatments of ophthalmological conditions.
Ranibizumab for edema of the macula in diabetes study: 3-year outcomes and the need for prolonged frequent treatment.
A similar molecule and with same effect which costs approximately 1/60 the cost of Ranibizumab is Bevacizumab (Avastin) and is used in the world over especially in the 3rd World in the treatment of Diabetic Retinopathy.
In the landmark Comparison of AMD Treatments Trials (CATT), researchers from Cleveland Clinic and elsewhere compared treatment with bevacizumab and ranibizumab in nearly 650 people with wet AMD.
Long-term outcomes of ranibizumab therapy for diabetic macular edema: the 36-month results from two phase III trials: RISE and RIDE.
Researchers from the AMD EMR Users Group looked at the effect of ranibizumab on more than 11,100 treatment-naive patients with AMD, in this paper published in the British Journal of Ophthalmology.