Ranibizumab

INTRODUCTION

Indications

Treatment of neovascular (wet) macular degeneration.

Action

Binds to vascular endothelial growth factor A (VEGF-A) receptor sites, preventing the binding of endogenous VEGF-A, resulting in ↓ endothelial proliferation, vascular leakage, and new vessel formation. Therapeutic Effects: ↓ progression of visual loss.

Adverse Reactions/Side Effects

EENT: conjunctival hemorrhage, eye pain, ↑ intraocular pressure, intraocular inflammation, vitreal floaters, endophthalmitis, retinal detachment. CV: arterial thromboembolic events.

PHYSICAL THERAPY IMPLICATIONS

Examination and Evaluation

• Monitor any eye pain, conjunctival hemorrhage, or other eye problems. Be alert for balance or mobility deficits that may indicate worsening vision. Report these findings to the physician.

Interventions

• Guard against falls and trauma. Implement fall-prevention strategies, especially if patient exhibits blurred vision or other visual impairments (See Appendix E).

Patient/Client-Related Instruction

• Instruct patient to report any loss of vision that might indicate increased intraocular pressure or other vision problems.

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).

Contraindications/Precautions

Contraindicated in: Hypersensitivity; Ocular/periocular infections.

Use Cautiously in: OB: Use only in pregnancy if clearly needed, use cautiously during lactation; Pedi: Safe use in children not established.

Interactions

Drug-Drug: ↑ risk of serious intraocular inflammation with verteporfin.

Route/Dosage

Intravitreal (Adults): 0.5 mg (0.05 mL) once monthly; after 4 mo, injections may be given q 1–3 mo.

Availability

Solution for intravitreal injection: each vial delivers 0.5 mg (0.05 mL).