LUCENTIS (ranibizumab)

LUCENTIS (ranibizumab)

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