Diabetic Retinopathy Drug Summary

• Cap: GI effects (nausea/vomiting, epigastralgia, diarrhea)
• Injection: Pain, burn and hematoma at injection site 

• Cap: Take on an empty stomach
• Contraindicated in patients with diathesis and hemorrhagic diseases
• Monitor hemocoagulative parameters regularly

1 tab PO 24 hourly

Adverse Reactions

• GI effects (abdominal pain, nausea/vomiting, diarrhea, flatulence); Other effects (increased homocysteine levels, increased transaminases)

• Contraindicated in patients with hepatic and kidney impairment, galactose and fructose intolerance, concomitant use with HMG CoA reductase inhibitors
• Monitor transaminase and creatinine levels regularly 

0.7 mg intravitreal injection 

Adverse Reactions

• Ocular effects (increased intraocular pressure [IOP], conjunctival hemorrhage, eye pain, conjunctival hyperemia, ocular hypertension, cataract, vitreous detachment); CV effect (hypertension)

• Contraindicated in patients with advanced glaucoma and active or suspected ocular or periocular infections including most viral disease of the cornea and conjunctiva including active ocular herpes simplex and fungal diseases
• Prior to administration, adequate anesthesia and a broad spectrum antibiotic should have been given to the patient
• Monitor signs of infection (eg endophthalmitis) for a week after administration

0.19 mg intravitreal injection in affected eye 

Adverse Reactions

• Ocular effects (cataract, increased IOP, eye pain, abnormal sensation in eyes, blepharoptosis, blurred vision, decreased visual acuity, eyelid edema, macular edema, conjunctival hemorrhage, vitreous opacity, glaucoma, vitreous hemorrhage, lacrimation); CNS effects (dizziness, headache); GI effects (nausea/vomiting) 

• Not recommended for concurrent administration to both eyes
• Contraindicated in patients with advanced glaucoma and active or suspected ocular or periocular infections including most viral disease of the cornea and conjunctiva including active ocular herpes simplex and fungal diseases
• Monitor signs of infection (eg endophthalmitis) for a week after administration

Initial dose: 500-2,000 mg PO 24 hourly
Maintenance dose:
1,000 mg 24 hourly 

Adverse Reactions

• GI effects (nausea, diarrhea); Other effects (skin rash, fever, joint and muscle pain, headache) 

• Take with food
• Use with caution in patients with severe renal insufficiency

2 mg intravitreal injection/month x 5 consecutive doses followed by 2 mg intravitreal injection every 2 months
Treatment interval may be extended after the first 12 months based on visual and/or anatomic outcomes

Adverse Reactions

• Ocular effects (conjunctival/vitreous hemorrhage, reduced visual acuity, eye pain, increased IOP, cataract, vitreous detachment, vitreous floaters, retinal pigment epithelial tear, detachment of retinal pigment epithelium, retinal degeneration, corneal erosion/abrasion, foreign body sensation in eyes, increased lacrimation, eyelid edema, punctate keratitis, conjunctival and ocular hyperemia) 

• Contraindicated in patients with active or suspected ocular or periocular infection and active severe intraocular inflammation
• Avoid injection if IOP ≥30 mmHg
• Avoid use in patients with clinical signs of irreversible ischemic visual function loss
• Use with caution in patients with history of stroke or transient ischemic attacks (TIA) or myocardial infarction (MI) within the last 6 months, endophthalmitis, risk factors for retinal pigment epithelial tears
• Withhold dose 28 days from performed ocular surgery or before planned ocular surgery
• Monitor IOP, optic nerve perfusion, visual acuity
• Monitor signs of infection (eg endophthalmitis) for a week after administration

0.5 mg intravitreal injection/month x 3 consecutive months or until visual acuity is stable 

Adverse Reactions

• Ocular effects (increased IOP, conjunctival hemorrhage, vitreous floaters, eye pain, ocular hyperemia, vitritis, vitreous detachment, retinal hemorrhage, visual disturbance, eye irritation, foreign body sensation in eyes, increased lacrimation, blepharitis, dry eye, eye pruritus); Renal effect (UTI); Other effects (headache, nasopharyngitis, arthralgia)

• Contraindicated in patients with active or suspected ocular or periocular infection and active severe intraocular inflammation 
• Use with caution in patients with history of stroke or TIA 
• Monitor visual acuity monthly
• Avoid giving concurrently with other VEGF-A inhibitors
• Prior to administration, adequate anesthesia and a broad spectrum antibiotics should have been given to the patient
• Monitor IOP 30 minutes after administration
• Monitor signs of infection (eg endophthalmitis) for a week after administration