ranibizumab intravitreal injection 

Action and Spectrum

Actions and spectrum: 

Ranibizumab is a protein produced by combining humanized immunoglobulin class G1 with antibody that is directed to against vascular endothelial growth factor A. In fact, it binds VEGF-A specifically, even though it is characterized by a high level of affinity for VEGF-A. The predominant human eye isoform VEGF165 increases blood vessel permeability thus preventing cell death while at the same time inducing movement of bone marrow derived endothelial progenitor cells which are prone to angiogenesis.

This drug works by binding to receptor-binding site of VEG-F and prevents it from interacting with endothelial cell surface receptors known as VEGFR1 and VEGFR2. This reduces endothelial cell proliferation, vascular leakage, new blood vessel formation. 

Drug Interaction

Adverse Reaction

Frequency defined 

>10%  

Eye pain (17-37%)  

Increase in intraocular pressure (8-24%)  

Eye irritation (4-19%)  

Headache (2-15%)  

Retinal disorder (13%)  

Retinal degeneration (1-11%)  

Conjunctival bleeding (43-77%)  

Vitreous floaters (3-32%)  

Vitreous detachment (7-22%)  

Intraocular inflammation (5-18%)  

URTI (2-15%)  

Blepharitis (3-13%)  

1-10%  

opacification of Posterior capsule (8%)  

Vitreous hemorrhage (4%)  

Conjunctival hyperemia (9%)  

Injection site bleeding (5%)  

Post marketing Reports  

Ocular: retinal pigment epithelium tear in patients having neovascular AMD  

Black Box Warning

Black box warning 

No specific black box warning is available 

Contraindication / Caution

Contraindications/Caution 

Hypersensitivity 

Active ocular infection 

Caution 

Endophthalmitis 

Increased ocular pressure 

Thromboembolic events 

Retinal detachment 

Pregnancy / Lactation

Pregnancy & breastfeeding: 

Pregnancy consideration: 

Safety and efficacy studies about the use of the drug in pregnancy is not available  

Breastfeeding warnings: 

Data about the excretion of the drug into human milk is not known 

Pregnancy category: 

• Category A: well-controlled and satisfactory studies show no risk to the fetus in the first or later trimester. 
• Category B: There was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 
• Category C: There was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women. 
• Category D: Adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. Hence, these categories of drugs need to be avoided by pregnant women. 
• Category N: No data for the drug under this category is available. 

Pharmacology

Pharmacology: 

Ranibizumab is an antagonist of VEGF-A and humanized recombinant monoclonal antibody of kappa isotype IgG1 approved for ophthalmic use in macular degeneration related to age. 

Pharmacodynamics: 

Ranibizumab, is used to inhibit vascular endothelial growth factor-A in order to manage eye diseases which are characterized by abnormal angiogenesis. The inhibition of new blood vessels by ranibizumab is a process which takes up longer thereby leading to the slow progression of loss of vision and a significant improvement in patients with the degenerative eye disorder, especially AMD. Besides this, it can also reduce retinal thickness. As this does not contain an Fc fragment of the antibody, it might help the patient avoid intraocular inflammation after intravitreal injection. 

Pharmacokinetics: 

Absorption:  

It penetrates rapidly into the retina immediately after an intravitreal injection. 

Distribution: 

The Vd/F (volume of central component) is 2.77L. It is not known tobe accumulated in the serum. 

Metabolism: 

Being a fragment of monoclonal antibody, it might undergo catabolism. 

Half-life: 

25 weeks 

Adminstartion

Administration: 

It should be used with an asceptic technique. 

Intraocular pressure must be monitored using tonometry half an hour before administration of the intravitreal injection. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: ranibizumab intravitreal injection  

Why do we use ranibizumab intravitreal injection? 

Ranibizumab is the medicine administered for NAMD, diabetic macular edema, macular edema caused by retinal vein occlusion, and myopic choroidal neovascularization. It suppresses blood vessels growing abnormally, reduces loss of sight, makes sharp eyesight clear, and curtails the development of the disease. The drug also can help treat diabetic retinopathy, macular edema caused by retinal vein occlusion, and myopic choroidal neovascularization, which in the process reduces the development of disease and at the same time bettering the eyesight.