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

ROUTE	ONSET	PEAK	DURATION
intravitreal	unknown	after injection	1 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.

Lucentis

a trademark for ranibizumab.