Ranibizumab (Lucentis®)

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

 

Last review date: December 2, 2013