Visudyne

verteporfin

(ver-te-por-fin) ,

Visudyne

(trade name)

Classification

Therapeutic: none assigned
Pharmacologic: photodynamic agents
Pregnancy Category: C

Indications

Treatment of age-related macular degeneration in patients with predominantly classic subfoveal choroidal neovascularization.

Action

Vertoporfin is activated by nonthermal red light in the presence of oxygen to form reactive oxygen radicals. The resultant compound produces local damage to neovascular epithelium and subsequent vessel occlusion.

Therapeutic effects

Improved visual acuity.

Pharmacokinetics

Absorption: IV administration results in complete bioavailability.
Distribution: Transported by lipoproteins.
Metabolism and Excretion: Small amount of metabolism by the liver and plasma esterases; elimination is primarily fecal. Verteprofin in skin is inactivated by photobleaching from ambient indoor lighting.
Half-life: 5–6 hr.

Time/action profile ( improved visual acuity)

ROUTEONSETPEAKDURATION
IV1–7 daysunknownunknown

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Porphyria; Exposure to direct sunlight.
Use Cautiously in: Moderate/severe hepatic impairment; Pregnancy, lactation or children (safety not established).

Adverse Reactions/Side Effects

Central nervous system

  • headache (most frequent)
  • weakness

Ear, Eye, Nose, Throat

  • visual disturbances (most frequent)
  • cataracts, conjunctivitis/conjunctival injection
  • dry eyes
  • ocular itching
  • severe vision loss
  • subconjunctival/subretinal/vitreous hemorrhage

Dermatologic

  • photosensitivity

Local

  • injection site reactions including extravasation and rashes (most frequent)

Musculoskeletal

  • back pain (during infusion)

Miscellaneous

  • fever
  • flu-like syndrome

Interactions

Drug-Drug interaction

Calcium channel blockers, polymyxin B, or radiation therapy may increase the rate of uptake by the vascular epithelium.Concurrent use of other photosensitizing agents including thiazide diuretics, sulfonylureas, phenothiazines, sulfonamides or tetracyclines may increase the risk of skin photosensitivity reactions.Dimethyl sulfoxide, beta-carotene, alcohol, formate and mannitol may decrease the activity of verteporfin.

Route/Dosage

Intravenous (Adults) 6 mg/m² infused over 10 min, followed by appropriate laser light delivery initiated 15 min after the start of the infusion.

Availability

lyophylized powder for reconstitution: 15 mg

Nursing implications

Nursing assessment

  • Assess IV site frequently for extravasation. Prior to injection, ensure line is free-flowing and monitor carefully. The largest arm vein, preferrably the antecubital, should be used for injection. Avoid small veins in the back of the hand. If extravasation occurs, stop infusion immediately and apply cold compresses. Area of extravasation must be protected from light until swelling and discoloration have faded to prevent a potentially severe local burn. If emergency surgery is necessary within 48 hr after treatment, protect as much internal tissue from intense light as possible.
  • Lab Test Considerations: May cause anemia, decreased or increased WBC, elevated liver function tests, increased creatinine, and albuminuria.

Potential Nursing Diagnoses

Disturbed sensory perception (Indications)

Implementation

  • Therapy is a 2-step process requiring administration of verteporfin followed by light administration. Laser light is administered 15 min after start of 10-min infusion.
  • Intravenous Administration
  • pH: No Data.
  • Intermittent Infusion: Diluent: Reconstitute each vial of verteporfin with 7 mL of sterile water for injection providing 7.5 mL. Withdraw volume for desired dose and dilute with D5W for a total infusion volume of 30 mL Concentration: Concentration will be 2 mg/mL. Reconstituted solution must be protected from light and used within 4 hr. Solution is a opaque dark green; inspect solution for particulate matter or discoloration.
  • Rate: Infuse over 10 min at a rate of 3 mL/min, using appropriate syringe pump and in-line filter.

Patient/Family Teaching

  • Instruct patient to avoid exposure of skin or eyes to direct sunlight or bright indoor light for 5 days due to photosensitivity. Patients should wear a wrist band to remind them to avoid direct sunlight or bright indoor light (tanning salons, bright halogen lighting and high power lighting used in surgical operating rooms and dental offices) for 5 days. If patients must go outdoors during first 5 days after treatment, they should protect all parts of their skin and eyes by wearing protective clothing and dark sunglasses. UV sunscreens are not effective protection. However, patients should not stay in the dark and should be encouraged to expose their skin to ambient indoor light which will help inactivate the drug in the skin.
  • Emphasize the importance of follow-up evaluations every 3 mo determine need for repeated therapy.

Evaluation/Desired Outcomes

  • Improved visual acuity.

Visudyne®

Verteporfin Ophthalmology A photodynamic–light-activated agent used for age-related macular degeneration. See Macular degeneration.
References in periodicals archive ?
Building on Auxilium's strong foundation and commercial expertise, the merger with QLT represents a unique opportunity to accelerate our desired strategic transformation into a leading, diversified North American specialty biopharmaceutical company," said Auxilium CEO Adrian Adams said, "QLT may also receive royalties from Valeant Pharmaceuticals International on future sales of Visudyne in new indications beyond wet age-related macular degeneration and possesses technology platforms in drug delivery (Atrigel) and photodynamic therapy.
Visudyne is used in photodynamic therapy, in which the light-activated drug is administered intravenously in the patient's arm.
M2 PHARMA-September 25, 2012-Valeant Pharmaceuticals acquires Visudyne from QLT Inc for USD162.
M2 EQUITYBITES-September 25, 2012-Valeant Pharmaceuticals acquires Visudyne from QLT Inc for USD162.
That investigation forecasts sales of 20 leading drugs, including Lucentis, Visudyne, Xalatan/Xalacom and Restasis.
Sony's Walkman is an example of architectural innovation to access a market of previous nonconsumers, and Ciba Vision's Visudyne represents a radical innovation paired with a new value network.
Fast forward to the present, and Visudyne, the drug that Levy, Dolphin and their colleagues developed and brought to market has revolutionized the treatment of macular degeneration.
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Visudyne is used to treat an eye condition known as age-related macular degeneration.
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She mentioned that Visudyne, a new drug, could treat the disease, but neither she nor Matt Lauer indicated that she had been paid by the drug's manufacturer, Novartis, to mention the drug.