pegaptanib


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pegaptanib

(peg-apt-i-nib) ,

Macugen

(trade name)

Classification

Therapeutic: ocular agents
Pharmacologic: vascular endothelial growth factor antagonists
Pregnancy Category: B

Indications

Neovascular (wet) age-related macular degeneration.

Action

Acts as an antagonist of vascular endothelial growth factor (VEGF). VEGF may be responsible for the formation of incompetent, leaky blood vessels associated with macular degeneration.

Therapeutic effects

Decreased rate of loss of visual acuity.

Pharmacokinetics

Absorption: Slowly absorbed into systemic circulation after intravitreous administration.
Distribution: Unknown.
Metabolism and Excretion: Metabolized by exo- and endonucleases.
Half-life: 10 days (plasma).

Time/action profile

ROUTEONSETPEAKDURATION
Intravitrealunknownunknown6 wk

Contraindications/Precautions

Contraindicated in: Ocular/periocular infections.
Use Cautiously in: Obstetric: Use only if maternal benefit outweighs fetal risk; Lactation / Pediatric: Safety not established.

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

  • cataract
  • blurred vision
  • conjunctival bleeding
  • irritation/pain
  • ↑ intraocular pressure
  • ocular inflammation
  • infection (rare)
  • retinal detachment (rare)
  • traumatic cataract formation (rare)

Miscellaneous

  • Anaphylaxis
  • angioedema

Interactions

Drug-Drug interaction

None known.

Route/Dosage

Intravitreal (Adults) 0.3 mg every 6 wk.

Availability

Solution for intraviteous injection: 0.3 mg/mL in 1-mL single use glass syringes

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 within 30 min following the injection, and biomicroscopy between 2 and 7 days following injection. Increases in intraocular pressure have been seen within 30 min of 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.

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.

pegaptanib

An anti-vascular endothelial growth factor agent that has been found helpful in the treatment of neovascular age-related macular degeneration. A brand name is Macugen.
References in periodicals archive ?
Later in 1940s, IVT was used to deliver antibiotics for the treatment of endophthalmitis.1 At present, many anti VEGF (vascular endothelial growth factor) drugs are used such as pegaptanib, ranibizumab, bevacizumab and aflibercept.
(1,2,3,4,5,6,7) The first labeled intravitreal drug for the treatment of nAMD was pegaptanib, then off-label drug bevacizumab and approved drugs aflibercept and ranibizumab have led us to prevention of vision loss in most of the nAMD patients and vision gain in one third of them.
Immediate intraocular pressure changes following intravitreal injections of triamcinolone, pegaptanib, and bevacizumab.
Pegaptanib is an FDA approved aptamer bound with VEGF that blocks the interaction with VEGF receptor [130].
Here, "nAMD," "wet AMD," and "exudative AMD" were searched for "nAMD"; "Type 1," "PCV," "occult," "poorly-defined," "sub-RPE," "Type 2," "classic," "well-defined," "subretinal," "Type 3," "RAP," and "intraretinal" were for different subtypes of nAMD, while "pegaptanib," "bevacizumab," "ranibizumab," "aflibercept" and "conbercept" were searched for "anti-VEGF."
From 2005 to 2009, intravitreal injection volume then increased dramatically due to the approval and use of pegaptanib, ranibizumab, and bevacizumab (Ramulu et al.
Four VEGF-binding agents are currently used for ocular diseases: pegaptanib, bevacizumab (off-label), ranibizumab and aflibercept.
Ice, "A phase 2/3, multicenter, randomized, double-masked, 2-year trial of pegaptanib sodium for the treatment of diabetic macular edema," Ophthalmology, vol.
Pegaptanib sodium/Macugen (Eyetech Pharmaceuticals/Pfizer) is an RNA aptamer directed against vascular endothelial growth factor (VEGF)-165, which is primarily responsible for pathological ocular neovascularization and vascular permeability.
Researchers found that participants treated with any of the three anti-VEGF agents--ranibizumab (Lucentis), bevacizumab (Avastin), and pegaptanib (Macugen)--more often had improved vision, less often lost vision, and were less likely to be legally blind after one year than those treated with control treatments.
One aptamer drug, Pegaptanib, has already gotten FDA approval, and Shumbera believes diagnostic applications arent far behind.
There are three agents in this class: aflibercept (Eylea), pegaptanib (Macugen), and ranibizumab (Lucentis).