General

Pronunciation:
broe-lue-siz-ue-mab

Trade Name(s)

• Beovu

Ther. Class.

ocular agents

Pharm. Class.

vascular endothelial growth factor antagonists

Indications

• Neovascular (wet) age-related macular degeneration (AMD).
• Diabetic macular edema.

Action

Binds to and inactivates vascular endothelial growth factor (VEGF) receptors which normally promote neovascularization and vascular permeability.

Therapeutic Effect(s):

• Slowed progression of AMD.
• Improve visual acuity in diabetic macular edema.

Pharmacokinetics

Absorption: Action is local following intravitreal injection, minimal systemic absorption occurs.

Distribution: Distribution occurs mainly in the vitreal space.

Metabolism and Excretion: Degraded by proteolytic enzymes. Undergoes passive renal excretion.

Half-life: 4.4 days.

TIME/ACTION PROFILE (improved visual acuity)

Contraindication/Precautions

Contraindicated in:

• Hypersensitivity

• Ocular/periocular infection

  Active intraocular inflammation
• Lactation: Lactation.

Use Cautiously in:

• OB:  Use during pregnancy only if potential maternal benefit justifies fetal risk;
• Rep:  Women of reproductive potential;
• Pedi:   Safety and effectiveness not established in children.

Adverse Reactions/Side Effects

CV: MI

EENT: blurred vision, ↑ intraocular pressure (from procedure), ↑ lacrimation, cataracts, conjunctival hemorrhage, conjunctivitis, corneal abrasion, endophthalmitis (from procedure), eye pain, intraocular inflammation, punctate keratitis, retinal detachment (from procedure), retinal hemorrhage, retinal tear, retinal vascular occlusion, retinal vasculitis, vitreous detachment, vitreous floaters

Neuro: STROKE

Misc: hypersensitivity reactions

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

None reported.

Route/Dosage

Neovascular Age-Related Macular Degeneration

Intravitreal (Adults): 6 mg every 4 wk for first three doses, then 6 mg every 8–12 wk.

Diabetic Macular Edema

Intravitreal (Adults): 6 mg every 6 wk for first five doses, then 6 mg every 8–12 wk.

Availability

Solution for injection (in vials and prefilled syringes): 6 mg/0.05 mL

Assessment

• Assess eye for signs of infection frequently during wk following injection.
• Check perfusion of optic nerve head immediately after injection, use tonometry to measure intraocular pressure prior to and 60 min following the injection.

Implementation

• Solution is clear to slightly opalescent and colorless to slightly brownish-yellow. Do not administer solutions that are cloudy, discolored, or contain particulate matter. Store in refrigerator; allow to warm to room temperature for up to 24 hr prior to injection. Do not freeze.

  • Adequate analgesia and a broad-spectrum antibiotic should be given prior to injection.
• Intravitreal For ophthalmic intravitreal injection only. Withdraw vial contents through a 5–micron gauge filter needle attached to a 1–mL tuberculin syringe. Discard filter needle after withdrawal. Replace filter needle with sterile 30–gauge x 1/2-inch needle for intravitreal injection. Expel contents until plunger tip is aligned with line marking 0.05 mL on syringe Each vial should be used for only one eye. If contralateral eye requires treatment, use new vial and equipment. Refrigerate solution and protect from light; do not freeze.

Patient/Family Teaching

• Advise patient to notify ophthalmologist immediately if eye becomes red, sensitive to light, painful, or develops a change in vision.
• May cause temporary visual disturbances. Caution patient to avoid driving or other activities requiring good eyesight until response to medication is known.
• Rep:  May cause fetal harm. Advise females of reproductive potential to use highly effective contraception and avoid breastfeeding during and 1 mo after last dose. May impair fertility.

Evaluation/Desired Outcomes

• Slowing of vision loss.
• Improve visual acuity in diabetic macular edema.