Drug Guide
Aflibercept
Classification
Therapeutic: Antivascular Endothelial Growth Factor (anti-VEGF) Agent
Pharmacological: Recombinant Fusion Protein
FDA Approved Indications
- Treatment of wet age-related macular degeneration (AMD)
- Diabetic retinopathy (including diabetic macular edema)
- Macular edema following retinal vein occlusion
Mechanism of Action
Aflibercept acts as a decoy receptor for vascular endothelial growth factor (VEGF), binding VEGF-A, VEGF-B, and placental growth factor (PlGF), thereby inhibiting angiogenesis and decreasing vascular permeability in the retina.
Dosage and Administration
Adult: 2 mg (0.05 mL) intravitreal injection every 4 weeks for the initial 12 weeks, then as needed based on clinical response.
Pediatric: Not approved for pediatric use.
Geriatric: Dosing adjustments are not typically required, but monitor for adverse effects in elderly patients.
Renal Impairment: No specific dosage adjustment required.
Hepatic Impairment: No specific dosage adjustment required.
Pharmacokinetics
Absorption: Local ocular delivery; systemic absorption is minimal.
Distribution: Distributed primarily within ocular tissues.
Metabolism: Metabolized locally in the eye; systemic metabolism unstudied.
Excretion: Excreted mainly via ocular tissues; systemic clearance is minimal.
Half Life: Approximately 9 to 11 days intravitreally.
Contraindications
- Hypersensitivity to aflibercept or any component of the formulation.
Precautions
- Use with caution in patients with active or suspected ocular or periocular infections, or ocular trauma. Monitor for intraocular inflammation, retinal detachment, and increased intraocular pressure.
Adverse Reactions - Common
- Eye pain, conjunctival hemorrhage, blurred vision, intraocular inflammation (Common)
- Endophthalmitis, increased intraocular pressure (Less common)
Adverse Reactions - Serious
- Retinal detachment, retinal tear, vitreous hemorrhage, ocular ischemia or vascular disorders (Rare)
- Systemic thromboembolic events (Rare)
Drug-Drug Interactions
- Potential increased risk of ocular or systemic hemorrhage when used with anticoagulants or antiplatelet agents.
Drug-Food Interactions
- No significant interactions reported.
Drug-Herb Interactions
- No significant interactions reported.
Nursing Implications
Assessment: Monitor visual acuity, ocular examination before and after injections. Watch for signs of ocular infection or inflammation.
Diagnoses:
- Risk for infection, injury, or bleeding related to injection procedures.
- Impaired visual sensory perception related to ocular disease.
Implementation: Ensure sterile technique during administration, monitor for adverse reactions, educate patient on symptoms of complications.
Evaluation: Assess visual acuity improvements, monitor for adverse effects, ensure timely follow-up.
Patient/Family Teaching
- Instruct patient to report any eye pain, redness, sudden vision changes, or signs of infection.
- Explain the procedure and possible side effects.
- Advise on post-injection care and when to seek medical attention.
Special Considerations
Black Box Warnings:
- Potential for serious ocular infections, including endophthalmitis, and retinal detachment.
Genetic Factors: None established.
Lab Test Interference: No known interference with laboratory tests.
Overdose Management
Signs/Symptoms: Overdose is unlikely as the drug is administered intravitreally; however, excessive doses could cause increased intraocular pressure or local toxicity.
Treatment: Supportive care; no specific antidote. May require ocular pressure monitoring and management.
Storage and Handling
Storage: Store unopened vials in a refrigerator at 2°C to 8°C (36°F to 46°F). Protect from light.
Stability: Use the product within the expiration date. Once opened, use promptly or discard per institutional protocol.