Ranibizumab is a recombinant humanized monoclonal antibody fragment (Fab) designed for intraocular use. It binds to and inhibits the biological activity of all active forms of human vascular endothelial growth factor A (VEGF-A), a key mediator of angiogenesis and vascular permeability. The 2.3mg/0.23mL formulation is a higher-dose option approved for specific retinal vascular conditions, offering a potential for extended durability of effect compared to the standard 0.5mg dose.
Adult: 2.3 mg (0.23 mL of the 10 mg/mL solution) administered by intravitreal injection once a month (approximately every 28 days). After the first 3-4 injections, treatment intervals may be extended based on disease activity as assessed by visual acuity and anatomical parameters (treat-and-extend or pro re nata [PRN] regimens).
Note: FOR INTRAVITREAL USE ONLY. Administer under strict aseptic technique, including use of sterile gloves, drape, and eyelid speculum. Adequate anesthesia (topical or subconjunctival) and a broad-spectrum topical antimicrobial agent are required pre-injection. The injection is given 3.5-4.0 mm posterior to the limbus (in phakic patients) with a 30-gauge needle. Intraocular pressure and perfusion of the optic nerve head must be monitored post-injection.
Ranibizumab is a VEGF-A antagonist. It binds with high affinity to all biologically active isoforms of VEGF-A (e.g., VEGF110, VEGF121, VEGF165), preventing their interaction with VEGF receptors (VEGFR-1 and VEGFR-2) on the surface of endothelial cells. This inhibition blocks key downstream signaling pathways that lead to endothelial cell proliferation, angiogenesis (new blood vessel formation), and increased vascular permeability.
Pregnancy: Category C. Animal studies show fetal risk. VEGF inhibition is implicated in impaired fetal development. Not recommended during pregnancy. A pregnancy test should be considered for women of childbearing potential. Benefits must clearly outweigh risks.
Driving: Patients may experience temporary blurred vision, floaters, or light sensitivity after the injection. They should not drive or operate machinery until their vision has stabilized, usually on the same day after assessment by the physician.
| Other Anti-VEGF Agents (e.g., Aflibercept, Bevacizumab) | Theoretical risk of additive systemic VEGF suppression. Concurrent use in the same eye is not recommended. | Major |
| Anticoagulants/Antiplatelets (e.g., Warfarin, Clopidogrel, Aspirin) | May increase risk of intraocular or conjunctival hemorrhage during injection. Therapy is usually not discontinued but the risk is discussed. | Moderate |
| Antihypertensives | No direct interaction. However, controlling systemic hypertension is crucial in managing retinal vascular diseases. | Minor |