What are the potential side effects of Razumab, especially in patients with a history of eye conditions?

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Razumab Side Effects

Razumab (ranibizumab) most commonly causes conjunctival hemorrhage, eye pain, vitreous floaters, and increased intraocular pressure, with serious but rare complications including endophthalmitis (<0.1%), retinal detachment, and thromboembolic events. 1

Common Ocular Side Effects (Occurring in >5% of Patients)

The most frequently reported ocular adverse reactions in ranibizumab-treated patients include 1:

  • Conjunctival hemorrhage - most common injection-related effect
  • Eye pain - typically mild and transient
  • Vitreous floaters - reported in clinical trials
  • Increased intraocular pressure (IOP) - occurs both pre- and post-injection 1
  • Blepharitis (3-12% depending on indication) 1
  • Dry eye (5-12%) 1
  • Visual disturbance or blurred vision (8-18%) 1
  • Eye pruritus (4-12%) 1
  • Ocular hyperemia (7-11%) 1

Serious Ocular Complications (Rare but Vision-Threatening)

Endophthalmitis and retinal detachment occur in <0.1% of intravitreal injections and require immediate recognition and treatment. 1

Additional serious complications include 1:

  • Rhegmatogenous retinal detachment - injection-related
  • Iatrogenic traumatic cataract - procedure-related
  • Retinal vasculitis with or without occlusion - typically in patients with pre-existing intraocular inflammation 1
  • Tear of retinal pigment epithelium - reported in postmarketing surveillance among AMD patients 1

Transient IOP Elevation

Post-injection IOP increases occur transiently in 22.6% of ranibizumab-treated eyes and require monitoring. 2 Patients should be monitored following each injection for sustained IOP elevation 1.

Systemic Adverse Events

Thromboembolic Risk

There is a potential risk of arterial thromboembolic events (including stroke and myocardial infarction) following intravitreal use of VEGF inhibitors, though rates are similar between ranibizumab and control groups. 1

Fatal Events in Diabetic Patients

In patients with diabetic macular edema and diabetic retinopathy at baseline, fatal events occurred more frequently with monthly ranibizumab (6.4% over 3 years) compared to control (1.2% over 2 years), though the relationship to drug cannot be definitively established. 1

Common Non-Ocular Reactions (≥5% incidence)

Non-ocular adverse reactions occurring at ≥1% higher frequency than control include 1:

  • Upper respiratory tract infection (7-9%)
  • Headache (6-12%)
  • Nasopharyngitis (10%)
  • Bronchitis (4-11%)
  • Nausea (5-10%)
  • Influenza (3-7%)
  • Arthralgia (3-11%)
  • Wound healing complications (uncommon but reported) 1

Immunogenicity

After 6-24 months of monthly dosing, antibodies to ranibizumab develop in approximately 1-9% of patients. 1 Among AMD patients with highest immunoreactivity levels, some developed iritis or vitritis, though intraocular inflammation was not observed in DME, DR, or RVO patients with high immunoreactivity 1.

Special Considerations for Patients with Pre-existing Eye Conditions

Patients with History of Inflammation

Discontinue ranibizumab in patients who develop retinal vasculitis with or without occlusion, particularly those with pre-existing intraocular inflammation or previous treatment with other intravitreal agents. 1

Combination with Photodynamic Therapy (PDT)

When ranibizumab is used adjunctively with PDT, 11% of patients developed serious intraocular inflammation; in 10 of 12 cases, this occurred when ranibizumab was administered 7 days (±2 days) after PDT. 1 This combination has not shown additional benefit and may worsen ocular adverse reactions 3.

Monitoring Requirements

Patients should be instructed to report any of the following immediately 1:

  • Sudden vision changes
  • Eye pain or discomfort beyond mild irritation
  • Increased eye redness
  • Photophobia (light sensitivity)
  • Increased floaters

Common Pitfalls to Avoid

  • Do not dismiss transient IOP elevation - while usually self-limited, sustained elevation requires treatment 2
  • Do not combine with PDT within 7 days - significantly increases inflammation risk 1
  • Do not ignore unilateral symptoms in bilateral treatment - may indicate infection or other serious complication requiring urgent evaluation
  • Do not overlook systemic thromboembolic risk factors - particularly in elderly patients with cardiovascular disease 1

References

3
Research

Ranibizumab for neovascular age-related macular degeneration.

American journal of health-system pharmacy : AJHP : official journal of the American Society of Health-System Pharmacists, 2008

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.

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