Ranibizumab (Lucentis®)

Approved for: office administration (sterile environment/aseptic technique)

Indications for Prior Authorization

  • neovascular (WET) age related Macular Degeneration (AMD)
  • macular edema secondary to retinal vein occlusion (RVO)
  • diabetic macular edema (DME)

The following indications do not meet the criteria for use established by the Western Health Advantage Pharmacy and Therapeutics Committee.

  • combination therapy with verteporfin (Visudyne®)
  • any other diagnosis not listed in the approved indications

Dosing

The dose of ranibizumab for AMD and RVO is not to exceed 0.5 mg (five units) once a month (28 days) by intravitreous injection. The dose for DME is 0.3 mg once a month (28 days).

Monitoring

elevation in intraocular pressure

ocular inflammation (endophthalmitis)

  • immediately after injection check for perfusion of the optic nerve head
  • measure intraocular pressure (tonometry) within 30 minutes following injection
  • slit lamp biomicroscopy between 2 and 7 days following injection

     


Western Health Advantage Pharmacy and Therapeutics Committee

Approved/Revised: Jan. 2013 Reviewed: December 2013