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Ranibizumab intravitreal injection


Injections of ranibizumab.

These products have been produced by recombinant technology using E.coli.

Drugs List

  • LUCENTIS 1.65mg/0.165ml injection solution
  • LUCENTIS 2.3mg/0.23ml solution for injection vial
  • ONGAVIA 2.3mg/0.23ml solution for injection vial
  • ranibizumab 1.65mg/0.165ml injection solution
  • ranibizumab 2.3mg/0.23ml solution for injection vial
  • Therapeutic Indications


    Macular oedema following branch or central retinal vein occlusion
    Retinopathy of prematurity with zone 1, zone 2 or AP-ROP disease
    Treatment of neovascular age-related macular degeneration
    Treatment of proliferative diabetic retinopathy
    Treatment of visual impairment due to diabetic macular oedema
    Visual impairment due to choroidal neovascularisation (CNV)


    Treatment should be administered by ophthalmologists experienced in intravitreal injections.


    500micrograms (0.05ml) given as a single intravitreal injection. The interval between two doses injected into the same eye should be at least four weeks.

    Treatment is initiated with one injection per month until maximum visual acuity is achieved and/or there are no signs of disease activity (there is no change in visual acuity and no change in other signs and symptoms of the disease under continued treatment). In patients with neovascular (wet) age-related macular degeneration (AMD), visual impairment due to diabetic macular oedema (DME), proliferative diabetic retinopathy (PDR) and visual impairment due to macular oedema secondary to retinal vein occlusion (RVO), initially three or more consecutive monthly injections may be needed.

    Thereafter, monitoring and treatment intervals should be determined by the physician and should be based on disease activity, as assessed by visual acuity and/or anatomical parameters. If visual and anatomic parameters indicate that the patient is not benefiting from continued treatment, this medication should be discontinued.

    Monitoring for disease activity may include clinical examination, functional testing or imaging techniques such as optical coherence tomography or fluorescein angiography.

    If patients are being treated according to a treat-and-extend regimen, once maximum visual acuity is achieved and/or there are no signs of disease activity, the treatment intervals can be extended stepwise until signs of disease activity or visual impairment recur. Extend the treatment interval by no more than two weeks at a time for wet AMD and by up to one month at a time for DME. For PDR and RVO, treatment intervals may also be gradually extended, however there is insufficient data to conclude on the length of these intervals. If disease activity recurs, shorten the treatment interval accordingly.

    Treatment of CNV visual impairment is determined for each patient based on disease activity. Some patients may need only one injection during the first 12 months, whereas others may need more frequent treatment, including a monthly injection. For CNV secondary to pathologic myopia (PM), many patients may only need one or two injections during the first year.

    Ranibizumab and laser photocoagulation in DME and in macular oedema secondary to BRVO:
    There is some experience of this medication administered concomitantly with laser photocoagulation. When given on the same day, administer ranibizumab at least 30 minutes after laser photocoagulation. The medication can be administered in patients who have received previous laser photocoagulation.


    Treatment of retinopathy of prematurity (ROP)

    Preterm infants
    0.2mg (0.02ml) given as an intravitreal injection initiated with a single injection per eye. This can be given bilaterally on the same day. If signs of disease activity, up to 3 injections per eye may be administered within six months of treatment initiation. The interval between two doses injected into the same eye should be at least four weeks.


    For intravitreal use only.

    In preterm infants, insert injection needle into the eye 1.0 to 2.0mm posterior to the limbus with the needle pointing towards the optic nerve.


    Ocular infection
    Periocular infection
    Recent ocular surgery
    Severe intra-ocular inflammation

    Precautions and Warnings

    Children under 18 years
    Females of childbearing potential
    Risk factors for retinal pigment epithelial tears
    Cerebrovascular accident
    History of transient ischaemic attack

    Suspend treatment if planned surgery within next 28 days
    Advise patient blurred vision may affect ability to drive/operate machinery
    Not all formulations are licensed for all uses
    Discard any unused portion
    Do not use if solution is discoloured or particulates are apparent
    Record name and batch number of administered product
    Treatment to be administered under the supervision of a specialist
    Monitor during the week following injection for signs of infection
    Monitor intra-ocular pressure post injection and manage appropriately
    Monitor visual acuity during and after treatment
    Advise patient to report any symptoms of endophthalmitis immediately
    Advise patient to report any unexpected changes in eye symptoms immediately
    Discontinue if rhegmatogenous retinal detachment or stage 3/4 macular holes
    Suspend if best-corrected visual activity declines by 30 letters or more
    Suspend treatment if central foveal haemorrhage
    Suspend treatment if foveal haemorrhage >50% of the total lesion area
    Suspend treatment if intraocular pressure of >29 mmHg
    Suspend treatment if retinal break or tear develops
    Female: Contraception required during and for 3 months after treatment

    There is a potential for immunogenicity with ranibizumab. As there is a potential for an increased systemic exposure in patients with DME, an increased risk for developing hypersensitivity in this patient population cannot be excluded. Patients should also be instructed to report if an intraocular inflammation increases in severity, which may be a clinical sign attributable to intraocular antibody formation.

    Ranibizumab should not be administered concurrently with other anti-VEGF (vascular endothelial growth factor) medicinal products (systemic or ocular).

    Pregnancy and Lactation


    Use ranibizumab with caution during pregnancy.

    The manufacturer recommends ranibizumab is not used during pregnancy unless the potential benefit to the mother outweighs the potential risk to the foetus. Studies in cynomolgus monkeys have not indicated direct or indirect harmful effects regarding pregnancy or embryonal/foetal development. After ocular use, systemic exposure to ranibizumab is low but due to its mechanism of action, it is regarded as potentially teratogenic and embryotoxic and foetotoxic.


    Ranibizumab is contraindicated during breastfeeding.

    The manufacturer advises that ranibizumab is not recommended when breastfeeding. The presence of ranibizumab in human breast milk and the effects on exposed infants are unknown.

    Side Effects

    Abnormal sensation in eye
    Allergic conjunctivitis
    Anterior chamber inflammation
    Arterial thrombosis
    Atrial fibrillation
    Blurred vision
    Conjunctival haemorrhage
    Conjunctival hyperaemia
    Corneal abrasion
    Corneal deposits
    Corneal oedema
    Corneal striae
    Dry eyes
    Eye pruritus
    Eyelid oedema
    Eyelid pain
    Eyelid reaction
    Haemorrhage (injection site)
    Hypersensitivity reactions
    Increased intra-ocular pressure
    Increased lacrimation
    Iris adhesion
    Irritation (injection site)
    Local pain (injection site)
    Ocular discharge
    Ocular discomfort
    Ocular haemorrhage
    Ocular hyperaemia
    Ocular inflammation
    Ocular irritation
    Ocular pain
    Posterior capsule opacification
    Punctate keratitis
    Reduced visual acuity
    Retinal degeneration
    Retinal detachment
    Retinal disturbances
    Retinal haemorrhage
    Retinal pigment epithelial tear
    Retinal tear
    Sensation of foreign body in eye
    Subcapsular cataract
    Traumatic cataract
    Urinary tract infections
    Visual disturbances
    Vitreous detachment
    Vitreous disorder
    Vitreous haemorrhage


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: November 2019

    Reference Sources

    Summary of Product Characteristics: Lucentis 10mg/ml solution for injection. Novartis Pharmaceuticals UK Ltd. Revised October 2019.
    Summary of Product Characteristics: Lucentis 10mg/ml solution for injection in pre-filled syringe. Novartis Pharmaceuticals UK Ltd. Revised October 2018.
    Summary of Product Characteristics: Ongavia 10mg/ml solution for injection. Teva UK Ltd. Revised May 2022.

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    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

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    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.