Age-Related Macular Degeneration Drug Summary

2 mg intravitreal injection every 21-35 days for up to 12 months 

Adverse Reactions

• Ocular effects (conjunctival hemorrhage, blepharitis, blurred vision, eye pain, increased intraocular pressure [IOP], subretinal neovascularization) 

• Contraindicated in patients with active or suspected ocular or periocular infection, active severe intraocular inflammation, clinical signs of irreversible ischemic visual function loss 
• Prior to administration, adequate anesthesia and a broad spectrum antibiotic should have been given to the patient
• Monitor IOP and optic nerve perfusion immediately after administration 
• Monitor signs of infection (endophthalmitis) for a week after administration

2 mg (0.05 mL) intravitreal injection once every month for 3 consecutive doses then every 2 months thereafter 
May increase injection intervals in 2- or 4-weekly increments to maintain stable visual and/or anatomic outcome

Adverse Reactions

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

• Contraindicated in patients with active or suspected ocular or periocular infection, active severe intraocular inflammation, clinical signs of irreversible ischemic visual function loss
• Avoid injection if IOP is ≥30 mmHg
• Use with caution in patients with history of stroke or transient ischemic attacks or myocardial infarction (MI) within the last 6 months, risk factors for retinal pigment epithelial tears, poorly controlled glaucoma
• Prior to administration, adequate anesthesia and a broad spectrum antibiotic should have been given to the patient
• Monitor IOP and optic nerve perfusion immediately after administration
• Monitor signs of infection (endophthalmitis) for a week after administration

6 mg intravitreal injection once every 4 weeks for 3 consecutive doses then individualize treatment intervals based on disease activity as follows:
Treatment interval in patients with disease activity: 
Every 8 weeks
Treatment interval in patients without disease activity: 
Every 12 weeks 

Adverse Reactions

• Ocular effects (reduced visual acuity, retinal hemorrhage and tear, uveitis, iritis, vitreous detachment and floaters, cataract, conjunctival hemorrhage, eye pain, increased IOP, conjunctivitis, retinal pigment epithelial tear, blurred vision, corneal abrasion, punctate keratitis); Other effect (hypersensitivity) 

• Contraindicated in patients with active or suspected ocular or periocular infection and active severe intraocular inflammation
• Avoid injection if IOP is ≥30 mmHg
• Avoid giving concurrently with other anti-VEGF agents
• Use with caution in patients with history of stroke or transient ischemic attacks or myocardial infarction (MI) within the last 6 months, risk factors for retinal pigment epithelial tears, hepatic impairment 
• Prior to administration, adequate anesthesia and a broad spectrum antibiotic should have been given to the patient 
• Monitor IOP and optic nerve perfusion immediately after administration
• Monitor for symptoms of endophthalmitis and retinal detachment (eg eye pain, redness of the eye, photophobia, blurred vision) after administration

0.3 mg intravitreous injection once every 6 weeks 
Max dose: 9 injections/year 

Adverse Reactions

• Ocular effects (inflammation of the anterior chamber, blurred vision, cataract, conjunctival hemorrhage, corneal edema, endophthalmitis, eye discharge, eye irritation, eye pain, increased IOP, ocular discomfort, punctate keratitis, decreased visual acuity, visual disturbance, vitreous floaters, vitreous opacities); CV effect (hypertension) 

• Contraindicated in patients with active or suspected ocular or periocular infection
• Prior to administration, adequate anesthesia and a broad spectrum antibiotic should have been given to the patient
• Monitor IOP 30 minutes after administration 
• Monitor signs of infection (endophthalmitis) for a week after the administration of the drug
• Therapy should be stopped when there has been no benefit observed after 2 consecutive injections

• Ocular effects (eye discomfort, macular degeneration, optic neuropathy, conjunctival hemorrhage, intraocular inflammation, punctate keratitis, cataract, vitreous detachment) 

• Contraindicated in patients with active or suspected ocular or periocular infection
• Prior to administration, adequate anesthesia and a broad spectrum antibiotic should have been given to the patient
• Monitor IOP 30 minutes after administration
• Monitor signs of infection (endophthalmitis) for a week after administration

• Ocular effects (conjunctival hemorrhage, endophthalmitis, eye pain, vitreous floaters, increased IOP, blurred vision, visual disturbance, intraocular inflammation, blepharitis, maculopathy, ocular hyperemia); Musculoskeletal effect (arthralgia); Respiratory effects (nasopharyngitis, bronchitis)

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

• Ocular effects (blurred vision, flashes of light, decreased visual acuity, visual field defects eg scotoma); Injection site reactions (discoloration, edema, extravasation, hemorrhage, inflammation, pain, rash); Other effects (idiosyncratic back pain) 

• Contraindicated in patients with porphyria and severe hepatic impairment
• For >1 eye treatment: Second eye can be treated 1 week later, treat first the eye with the most aggressive lesion, treatment for the second eye should begin not later than 20 minutes from the start of infusion
• Rubber gloves and eye protection should be worn during administration of treatment
• Patient should not be exposed to direct sunlight 2-5 days after treatment due to photosensitivity reactions
• Patients who experience severe decrease in vision should not be re-treated until recovery of vision
• Re-evaluation should be done every 3 months

• Do not take more than the recommended dose
• Use with caution in patients with hypersensitivity to any ingredient

• Should be taken after meal for better absorption

• GI effects (Vitamin C and E high dose effects rarely diarrhea, nausea/vomiting, abdominal cramps); Dermatologic effect (yellow or orange skin pigmentation with long term Beta-carotene therapy); Other effects (heartburn, fatigue, flushing, headache, insomnia, sleepiness)

• Should be taken after meal for better absorption
• Contraindicated in patients who smokes or recently stopped smoking, with severe renal function or with renal calculi and with alteration in prothrombin activity and the clotting time