Lucentis
ranibizumab
(ran-i-bi-zoo-mab) ,Lucentis
(trade name)Classification
Therapeutic: ocular agentsPharmacologic: monoclonal antibodies
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.