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
Last review date: December 2, 2013