Names and pronunciation
(ran-ih-biz′oo-mab) Byooviz, Lucentis, Susvimo
PDF page 1130
Loading InternPractice…
Drug reference
(ran-ih-biz′oo-mab) Byooviz, Lucentis, Susvimo
PDF page 1130
Func. class.: Ophthalmic Func. class.: H2-Histamine receptor antagonist
PDF pages 1130, 1131
Chem. class.: Selective vascular endothelial growth factor antagonist
PDF page 1130
ACTION: Binds to receptor-binding site of active forms of vascular endothelial growth factor A (VEGF-A), which causes angiogenesis and cell proliferation ACTION: Inhibits histamine at H2- receptor site in parietal cells, which inhibits gastric acid secretion
PDF pages 1130, 1131
USES: Age-related macular degeneration (neovascular) (wet), macular edema after retinal vein occlusion (RVO), diabetic macular edema USES: Duodenal ulcer, Zollinger- Ellison syndrome, gastric ulcers, hyper secretory conditions, gastroesophageal reflux disease, stress ulcers, erosive eso phagitis (maintenance), active duodenal ulcers with Helicobacter pylori in combination with clarithromycin, systemic mastocytosis, multiple endocrine ade noma syndrome, heartburn
PDF pages 1130, 1131
Do not confuse: raNITIdine/amantadine/riMANTAdine Zantac/Xanax/Zofran/ZyrTEC
PDF page 1131
Unlabeled uses: Angioedema, gastritis, urticaria, anaphylaxis
PDF page 1131
CONTRAINDICATIONS: Hyper sensitivity, ocular infections Precautions: Pregnancy, breastfeeding, children, retinal detachment, increased intraocular pressure CONTRAINDICATIONS: Hyper sensitivity Precautions: Pregnancy, breastfeeding, child <12 yr, renal/hepatic disease
PDF pages 1130, 1131
Black Box Warning: Endophthalmitis
PDF page 1130
SIDE EFFECTS CNS: Dizziness, headache, peripheral neuropathy EENT: Blepharitis, cataract, conjunctival hemorrhage/hyperemia, detachment of retinal pigment epithelium, dry eye, irri- tation/pain in eye, visual impairment, vitreous floaters, ocular infection GI: Constipation, nausea MISC: Hypertension, UTI, thromboembo- lism, nonocular bleeding, anemia, arthralgia RESP: Bronchitis, cough, sinusitis, URI, pulmonary embolism INTEG: Impaired wound healing CV: Hypertension, thromboembolism, non- ocular bleeding, anemia, angina, CAD SIDE EFFECTS CNS: Headache, dizziness, confusion, agi- tation, depression; hallucination (geriat- ric patients) EENT: Blurred vision GI: Constipation, abdominal pain, diar- rhea, nausea, vomiting, hepatotoxicity INTEG: Anaphylaxis, angioedema, burn- ing at injection site
PDF pages 1130, 1132
INTERACTIONS Increase: severe inflammation—verte- porfin photodynamic therapy (PDT) INTERACTIONS Increase: effect of pramipexole, procain- amide, trospium, triazolam, calcium channel blockers, memantine, saquina- vir, adefovir Increase: GI obstruction risk—NIFEd ipine ext rel products Increase: toxicity—sulfonylureas, pro- cainamide, benzodiazepines, calcium channel blockers Decrease: absorption of raNITIdine— antacids, anticholinergics Decrease: warfarin clearance—warfarin Decrease: effects of cephalosporins, iron salts, ketoconazole, itraconazole, ata- zanavir, delavirdine Increase: GI obstruction risk—NIFEd ipine ext rel products Drug/Lab Test Increase: AST, ALT, creatinine False positive: urine protein (Multistix)
PDF pages 1130, 1132, 1133
DOSAGE AND ROUTES Neovascular (wet) age-related macular degeneration (AMD)/macular degeneration/macular edema after retinal vein occlusion (RVO) (Lucentis, Byuoviz) • Adult: INTRAVITREAL 0.5 mg (0.05 mL) of 10 mg/mL product monthly or 0.5 mg monthly × 4 mo, then 0.5 mg q3mo;(Susvimo) 2 mg continuously de- livered via ocular implant Diabetic macular edema (Lucentis only) • Adult: INTRAVITREAL 0.3 mg of 6 mg/mL product q28day DOSAGE AND ROUTES GERD • Adult: PO 150 mg bid Erosive esophagitis • Adult/adolescent ≥17 yr: PO 150 mg qid for up to 12 wk • Child ≥1 mo: PO 5-10 mg/kg/day in 2-3 divided doses Duodenal ulcer • Adult: PO 150 mg bid or 300 mg/day after PM meal or at bedtime; mainte- nance 150 mg at bedtime • Infant/child: PO 2-4 mg/kg bid, max 300 mg/day Zollinger-Ellison syndrome • Adult: PO 150 mg bid, may increase if needed up to 6 g/day in those with severe disease Gastric ulcer • Adult: PO 150 mg bid × 6 wk, then 150 mg at bedtime • Infant/child: PO 2-4 mg/kg bid, max 300 mg/day Renal dose • Adult: PO CCr <50 mL/min, give 50% of dose or extend dosing interval Stress gastritis prophylaxis (unlabeled) • Adult: IM/INT IV INFUSION 50 mg q6-8hr or CONT IV INFUSION 6.25 mg/ hr (150 mg/24 hr) Severe, acute urticaria/angioedema (unlabeled) • Adult: INT IV INFUSION 50 mg with H1-blocker
PDF pages 1130, 1131
Available forms: Sol for inj 6 mg/mL, 10 mg/mL; prefilled syringe 0.3-mg dose; 0.5 mg/0.05 mL solution for injection; 100 mg/mL solution for injection Available forms: Tabs 75, 150, 300 mg; sol for inj 25 mg/mL; caps 150, 300 mg; syr 15 mg/mL R
PDF pages 1130, 1131
Administer: • By ophthalmologist via intravitreal in- jection using adequate anesthesia; use 19-gauge filter • Store in refrigerator; do not freeze • Protect from light Administer: PO route • Antacids 1 hr before or 1 hr after raNITIdine • Without regard to meals • Store at room temperature • Give daily dose at bedtime IM route • No dilution needed; inject in large muscle mass, aspirate Direct IV route • Dilute to max 2.5 mg/mL (50 mg/20 mL) using 0.9% NaCl (nonpreserved) or D5W, give dose over ≥5 min (max 4 mg/mL) Intermittent IV INFUSION route • Dilute to max 0.5 mg/mL with D5W, NS, give over 15-20 min (5-7 mL/min); pre- mixed ready-to-use bags as 1 mg/mL (50 mg/50 mL), infusion over 15-20 min Continuous 24-hr IV INFUSION route • Adult: dilute 150 mg/250 mL of D5W or NS; run over 24 hr (6.25 mg/hr or as directed); use infusion device; use within 48 hr; Zollinger-Ellison syndrome: di- lute in D5W, NS; max concentration 2.5 mg/mL, use infusion device Y-site compatibilities: Acyclovir, aldes- leukin, alemtuzumab, alfentanil, allopuri- nol, amifostine, amikacin, aminophylline, amphotericin B liposome, amsacrine, anakinra, anidulafungin, ascorbic acid, atracurium, atropine, aztreonam, bivaliru- din, bumetanide, buprenorphine, butor- phanol, calcium chloride/gluconate, CAR- BOplatin, ceFAZolin, cefepime, cefonicid, cefoperazone, cefotaxime, cefoTEtan, cefOXitin, cefTAZidime, ceftizoxime, cef- TRIAXone, cefuroxime, chloramphenicol, chlorproMAZINE, cimetidine, ciprofloxa- cin, cisatracurium, CISplatin, clindamy- cin, cyanocobalamin, cyclophosphamide, cycloSPORINE, cytarabine, DACTIN omycin, DAPTOmycin, dexamethasone, dexmedetomidine, digoxin, diltiazem, DOBUTamine, DOCEtaxel, DOPamine, doripenem, doxacurium, doxapram, DOXOrubicin, DOXOrubicin liposome, doxycycline, enalaprilat, ePHEDrine, EPI- NEPHrine, epirubicin, epoetin alfa, ertapenem, erythromycin, esmolol, etopo- side, etoposide phosphate, famotidine, fenoldopam, fentaNYL, filgrastim, flucon- azole, fludarabine, fluorouracil, folic acid, foscarnet, furosemide, ganciclovir, gem- citabine, gentamicin, glycopyrrolate, granisetron, heparin, hydrocortisone, HYDROmorphone, IDArubicin, ifos- famide, imipenem/cilastatin, inamrinone, indomethacin, isoproterenol, ketorolac, labetalol, levofloxacin, lidocaine, line- zolid, LORazepam, magnesium sulfate, mannitol, mechlorethamine, melphalan, meperidine, metaraminol, methotrexate, methoxamine, methyldopate, methyl- PREDNISolone, metoclopramide, meto- prolol, metroNIDAZOLE, midazolam, mil- rinone, mitoXANtrone, morphine, multivitamin, nalbuphine, naloxone, nesiritide, niCARdipine, nitroglycerin, nitroprusside, norepinephrine, octreotide, ondansetron, oxacillin, oxali- platin, oxytocin, PACLitaxel, palonosetron, pancuronium, papaverine, PEMEtrexed, penicillin G, pentamidine, pentazocine, PENTobarbital, PHENobarbital, phentol- amine, phenylephrine, phytonadione, piperacillin/tazobactam, potassium chlo- ride, procainamide, prochlorperazine, promethazine, propofol, propranolol, protamine, pyridoxine, remifentanil, riTUXimab, rocuronium, sargramostim, sodium acetate/bicarbonate, succinylcho- line, SUFentanil, tacrolimus, teniposide, theophylline, thiamine, thiopental, thio- tepa, ticarcillin/clavulanate, tigecycline, tirofiban, tobramycin, tolazoline, trastu- zumab, trimethaphan, urokinase, vanco- mycin, vecuronium, vinCRIStine, vinorel- bine, warfarin, zidovudine, zoledronic acid
PDF pages 1130, 1131, 1132
Assess: • Eye changes: redness; sensitivity to light, vision change; increased intraocular pres- sure change; report infection to ophthal- mologist immediately, complete procedure with anesthesia and antibiotic before use, check perfusion of optic nerve after use • Hypersensitivity: monitor for inflam- mation • Infection: UTI, URI, wound/skin Assess: • GI symptoms: nausea, vomiting, diar- rhea, cramps, abdominal discomfort, jaundice; report immediately • I&O ratio, BUN, creatinine, LFTs, se- rum, stool guaiac before, periodically during therapy • For vitamin B12 deficiency if product is taken long term, >2 yr • Beers: avoid in older adults with de- lirium or at high risk for delirium; may induce delirium or make it worse; report confusion
PDF pages 1130, 1133
Evaluate: • Therapeutic response: prevention of increasing macular degeneration Evaluate: • Therapeutic response: decreased ab- dominal pain, heartburn, healing of ul- cers, absence of gastroesophageal reflux
PDF pages 1131, 1133
CLINICAL CONSIDERATIONS CLINICAL CONSIDERATIONS
PDF pages 1130, 1133
Patient and caregiver information: • If eye becomes red, sensitive to light, painful, or if there is a change in vision, to seek immediate care from ophthal- mologist • About reason for treatment, expected results; that product is injected into the eye, an anesthetic will be used (ra-nit′i-deen) Pylorid , Zantac, Zantac C , Zantac 75, Zantac 150, Zantac 300 Patient and caregiver information: • To avoid driving, other hazardous ac- tivities until stabilized on product • That product must be continued for prescribed time to be effective • Not to take maximum OTC daily dose for >2 wk • To take once-daily dose before bedtime • To report immediately coffee-ground emesis, black tarry stools, abdominal pain, cramping • To notify prescriber if pregnancy is planned or suspected; to avoid breastfeeding
PDF pages 1131, 1133
PHARMACOKINETICS Elimination half-life 9 days, peak 1 day PHARMACOKINETICS PO: Peak 2-3 hr; duration 8-12 hr; metabolized by liver; excreted in urine (30% unchanged, PO), breast milk; half- life 2-3 hr; protein binding 15%
PDF pages 1130, 1132
• Adult: INTRAVITREAL 0.5 mg (0.05 mL) of 10 mg/mL product monthly or 0.5 mg monthly × 4 mo, then 0.5 mg q3mo;(Susvimo) 2 mg continuously de- livered via ocular implant Diabetic macular edema (Lucentis only)
PDF pages 1130, 1131
• Adult: INTRAVITREAL 0.3 mg of 6 mg/mL product q28day DOSAGE AND ROUTES GERD
PDF pages 1130, 1131
• Adult: PO 150 mg bid Erosive esophagitis
PDF pages 1130, 1131
• Adult/adolescent ≥17 yr: PO 150 mg qid for up to 12 wk
PDF pages 1130, 1131
• Adult: PO 150 mg bid or 300 mg/day after PM meal or at bedtime; mainte- nance 150 mg at bedtime
PDF pages 1130, 1131
• Adult: PO 150 mg bid, may increase if needed up to 6 g/day in those with severe disease Gastric ulcer
PDF pages 1130, 1131
• Adult: PO 150 mg bid × 6 wk, then 150 mg at bedtime
PDF pages 1130, 1131
• Adult: PO CCr <50 mL/min, give 50% of dose or extend dosing interval Stress gastritis prophylaxis (unlabeled)
PDF pages 1130, 1131
• Adult: IM/INT IV INFUSION 50 mg q6-8hr or CONT IV INFUSION 6.25 mg/ hr (150 mg/24 hr) Severe, acute urticaria/angioedema (unlabeled)
PDF pages 1130, 1131
• Adult: INT IV INFUSION 50 mg with H1-blocker
PDF pages 1130, 1131