Drug Guide
Ranibizumab-eqrn
Classification
Therapeutic: Vascular Endothelial Growth Factor (VEGF) inhibitor
Pharmacological: Monoclonal antibody
FDA Approved Indications
- Neovascular (Wet) Age-related Macular Degeneration (AMD)
- Diabetic Macular Edema (DME)
- Central Retinal Vein Occlusion (CRVO)
- Branch Retinal Vein Occlusion (BRVO)
Mechanism of Action
Ranibizumab binds to vascular endothelial growth factor A (VEGF-A), inhibiting its interaction with VEGF receptors, thereby reducing abnormal blood vessel growth and leakage in the retina.
Dosage and Administration
Adult: Administer intravitreally (directly into the eye) at a dose of 0.5 mg once monthly for the first 3 months, then as needed based on clinical response.
Pediatric: Not approved for pediatric use.
Geriatric: No specific dosage adjustment; monitor closely for adverse effects.
Renal Impairment: No specific adjustments required.
Hepatic Impairment: No data available; use with caution.
Pharmacokinetics
Absorption: Local injection; systemic absorption minimal.
Distribution: Primarily localized in ocular tissues.
Metabolism: Degraded locally via proteolytic enzymes.
Excretion: Minimal systemic clearance; largely remains in ocular tissues.
Half Life: Approximately 9 days in ocular tissues.
Contraindications
- Hypersensitivity to ranibizumab or any component of the formulation.
Precautions
- Potential for intraocular inflammation, endophthalmitis, increased intraocular pressure, and retinal detachment. Use with caution in patients with active ocular or periocular infections. Consider risks in patients with recent intraocular surgery or trauma.
Adverse Reactions - Common
- Conjunctival hemorrhage (Common)
- Eye pain (Common)
- Hyphema (blood in the anterior chamber) (Less common)
- Increased intraocular pressure (Less common)
Adverse Reactions - Serious
- Endophthalmitis (eye infection) (Rare)
- Retinal detachment (Rare)
- Vitreous hemorrhage (Rare)
- Cataract formation or progression (Less common)
Drug-Drug Interactions
- Other intraocular medications or procedures that may increase risk of adverse reactions.
Drug-Food Interactions
- No significant interactions identified.
Drug-Herb Interactions
- Limited data; generally no known interactions.
Nursing Implications
Assessment: Monitor for signs of ocular infection or inflammation, intraocular pressure, visual acuity, and patient-reported symptoms.
Diagnoses:
- Risk of infection, potential for impaired vision, anxiety related to injections.
Implementation: Administer intravitreal injections under sterile conditions; educate patient on post-injection care and warning signs.
Evaluation: Assess visual acuity and ocular health regularly to determine treatment efficacy and detect adverse effects.
Patient/Family Teaching
- Maintain ocular hygiene, report any pain, redness, or sudden vision changes immediately.
- Attend all follow-up visits.
- Understand the purpose of injections and expected outcomes.
Special Considerations
Black Box Warnings:
- Increased risk of endophthalmitis after intravitreal injections.
Genetic Factors: No specific genetic considerations.
Lab Test Interference: Minimal; monitor intraocular pressure and ocular health.
Overdose Management
Signs/Symptoms: Increased intraocular pressure, ocular pain, or infection signs.
Treatment: Immediate ocular examination; manage intraocular pressure as needed; hospitalize if severe infection or complications occur.
Storage and Handling
Storage: Store at 2°C to 8°C (36°F to 46°F); do not freeze.
Stability: Stable until the expiration date when stored properly; use within a specified period after opening as per manufacturer guidance.