How does this medication work? What will it do for me?

Ranibizumab belongs to the class of medications called antivascular endothelial growth factors. It is used to treat "wet," age-related macular degeneration, a condition where blood vessels behind the retina start to grow and leak blood and fluid. This causes damage to the macula (the centre of the retina) and results in central vision loss that can occur quickly.

Ranibizumab helps to slow down vision loss and may improve vision by stopping the growth and leakage of new blood vessels in the eye.

Ranibizumab is also used to treat decreased vision caused by fluid build-up in the eye as a result of complications of diabetes, blockage of the blood vessel leading away from the macula and a condition called pathological myopia.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are being given this medication, speak to your doctor. Do not stop receiving this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to use this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Each single use vial contains 0.23 mL of sterile, clear, colourless-to-pale-yellow aqueous solution for injection, containing ranibizumab 2.3 mg. Nonmedicinal ingredients: a-a-trehalose dihydrate, histidine, histidine hydrochloride monohydrate, polysorbate 20, and water for injection. Preservative-free. Vial contains a chlorobutyl rubber stopper.

Pre-Filled Syringe
Each syringe contains 0.165 mL of sterile, clear, colourless-to-pale-yellow aqueous solution for injection, containing ranibizumab 1.65 mg. Nonmedicinal ingredients: a-a-trehalose dihydrate, histidine, histidine hydrochloride monohydrate, polysorbate 20, and water for injection. Preservative-free. Syringe plunger and tip cap contain bromobutyl rubber.

How should I use this medication?

This medication is given by your doctor (usually an eye doctor) via injection into the eye under a local anesthetic.

For "wet" age-related macular edema, the usual dose of ranibizumab is 0.5 mg injected into the eye once a month. Injections may be given every 3 months after the first 3 injections, if monthly injections are not possible. However, monthly dosing appears to produce a better response.

For loss of vision because of diabetes or blockage of the retinal vein, the usual dose of ranibizumab is 0.5 mg injected into the eye once a month. Your doctor will deterimine how long treatments should continue depending on your response to treatment.

For pathological myopia, the usual dose of ranibizumab is a single injection of 0.5 mg. Your doctor will monitor your vision to determine if any further treatment is needed.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are receiving the medication without consulting your doctor.

Your doctor will ask you to use antibiotic eye drops for a few days before and after each injection.

It is important this medication be given exactly as recommended by your doctor. If you miss an appointment to receive ranibizumab, contact your doctor as soon as possible to reschedule your appointment.

This medication is stored in the refrigerator and should not be allowed to freeze. It should be protected from light and kept out of the reach of children.

Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not use ranibizumab if you:

  • are allergic to ranibizumab or to any of the ingredients of the medication
  • have inflammation (pain or redness) inside the eye
  • have or may have an infection in or around the eye

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

  • anxiety
  • back pain
  • bloodshot eye
  • diarrhea
  • dry eye
  • eye discharge
  • eye irritation, itching, or discomfort
  • feeling of fullness or tightness in the nose, cheeks, and behind the eyes (sometimes throbbing)
  • feeling of having something in the eye
  • flu-like symptoms
  • headache
  • increased blood pressure
  • increased tear production
  • joint pain
  • nausea
  • reaction at the injection site (e.g., irritation, itching, swelling)
  • skin itching
  • temporary blurred vision or vision changes

Although most of these side effects listed below don't happen very often, they could lead to serious problems if you do not check with your doctor or seek medical attention.

Check with your doctor as soon as possible if any of the following side effects occur:

  • abnormal heart rhythms
  • cloudiness of the lens of the eye
  • increased pressure in the eye
  • pain or redness in the eye
  • persistent blurred vision or vision changes
  • small particles or spots in vision
  • symptoms of an eye infection such as eye discharge, redness, or inflammation
  • symptoms of an infection of the lower airways such as fever and cough
  • symptoms of anemia (low red blood cells) such as shortness of breath and tiredness

Stop taking the medication and seek immediate medical attention if any of the following occur:

  • blindness
  • eye bleeding
  • signs of a blood clot in the leg (deep vein thrombosis or DVT) such as sudden pain in the large muscle of the leg, or warmth and swelling of the lower part of one leg
  • symptoms of a severe allergic reaction such as difficulty breathing; hives; or swelling of the face, mouth, throat, or tongue
  • symptoms of a stroke (e.g., sudden blurred vision, speech difficulty, dizziness, or difficulty moving limbs on one side of the body)

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.

Blood clotting: Treatment with ranibizumab should be stopped for people who develop clots that block their blood vessels. Tell your doctor if you have a history of clotting or are over 65 years of age, as you may be at increased risk of experiencing blood clot-related problems such as heart attack, stroke, or clots in the deep veins of your leg. People with any of these conditions should discuss with their doctor, how this medication may affect their medical condition, how their medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Driving and using machines: Ranibizumab may cause short term blurred vision, affecting your ability to drive or operate machinery. Avoid these and other hazardous tasks until your vision is clear.

Eye problems: Ranibizumab can cause eye problems such as infection of the inside part of the eye, pain or redness, detachment or tear of the retina, or clouding of the lens. If you experience eye pain, increased eye discomfort, worsening eye redness, blurred or reduced vision, increased sensitivity of the eyes to light, or an increase in the number of small particles in your vision, contact your doctor immediately.

Increased eye pressure: Ranibizumab can increase the pressure in the eye for a short period of time after it is injected. Your doctor will do tests to make sure the pressure in your eye is not elevated persistently after treatment.

Vision problems: Ranibizumab can cause temporary vision problems that may affect your ability to drive or operate machines. If you experience vision problems, do not drive or operate machines until your vision returns to normal.

Pregnancy: This medication should not be used during pregnancy unless the benefits outweigh the risks. If there is a chance that you may become pregnant while receiving this medication, talk to your doctor about whether you should use effective contraception during treatment. If you become pregnant while taking this medication, contact your doctor immediately.

Breast-feeding: It is not known if ranibizumab passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding.

Children and adolescents: The safety and effectiveness of using this medication have not been established for children and adolescents.

What other drugs could interact with this medication?

Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them. Depending on your specific circumstances, your doctor may want you to:

  • stop taking one of the medications,
  • change one of the medications to another,
  • change how you are taking one or both of the medications, or
  • leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. In many cases, interactions are intended or are managed by close monitoring. Speak to your doctor about how any drug interactions are being managed or should be managed.