Is Faricimab (anti-vascular endothelial growth factor) injections contraindicated in a female of childbearing age with a history of eye conditions, taking Diane 35 (cyproterone acetate and ethinyl estradiol)?

Faricimab is NOT contraindicated with Diane-35

There is no known drug interaction or contraindication between faricimab (intravitreal anti-VEGF injection) and Diane-35 (cyproterone acetate/ethinyl estradiol oral contraceptive). These medications work through completely different mechanisms in separate anatomical compartments—faricimab acts locally in the eye while Diane-35 works systemically—and no evidence suggests any pharmacological interaction between them.

Key Clinical Considerations

Pregnancy Prevention is Critical

• The primary concern with faricimab in women of childbearing age is pregnancy prevention, not drug interactions. Anti-VEGF medications including faricimab are FDA pregnancy category C, with animal studies showing embryo-fetal toxicity and theoretical risks to the developing fetal vasculature 1.
• Diane-35 actually serves a protective role here by providing effective contraception while the patient receives faricimab treatment 1.

No Systemic Absorption Issues

• Intravitreal faricimab has minimal systemic absorption due to local administration directly into the vitreous cavity 1.
• The small molecular amounts that might reach systemic circulation would not interact with oral contraceptive metabolism or efficacy 2, 3.

Documented Safety of Combined Use

• One clinical trial specifically evaluated exenatide + metformin + Diane-35 in women with PCOS, demonstrating that Diane-35 can be safely combined with other therapeutic agents without contraindication 1.
• While this study involved different medications, it establishes precedent that Diane-35 does not have broad contraindications with injectable therapies.

Practical Management Algorithm

For women of childbearing age requiring faricimab:

1. Verify effective contraception is in place - Diane-35 fulfills this requirement 1.

2. Counsel about pregnancy risks - Document that patient understands anti-VEGF therapy must be discontinued immediately if pregnancy occurs 1.

3. Proceed with faricimab treatment - No dose adjustment or special monitoring needed for the Diane-35 interaction 2, 3.

4. Monitor for faricimab-specific adverse events - Watch for ocular complications (endophthalmitis, retinal vasculitis, intraocular inflammation) which occur independently of contraceptive use 4, 5.

Important Caveats

Thrombotic Risk Considerations

• Diane-35 (containing cyproterone acetate) carries a 50-80% higher VTE risk compared to levonorgestrel-containing contraceptives, with rates of approximately 10 per 10,000 woman-years 1.
• However, this is a contraceptive-related risk, not a faricimab interaction. The decision to use Diane-35 should be based on standard contraceptive risk assessment, not concerns about faricimab 1.

If Pregnancy Occurs

• Discontinue faricimab immediately and switch to alternative treatments such as macular laser photocoagulation or intravitreal corticosteroids, which are reasonable first-line approaches during pregnancy 1.
• Anti-VEGF use in pregnancy may only be justified if potential benefit clearly outweighs fetal risk 1.

Gender-Specific Faricimab Adverse Events

• Recent pharmacovigilance data suggests some ocular adverse events with faricimab may differ between genders, though this does not relate to contraceptive use 4.
• Most adverse events occur within 91-180 days of treatment initiation 4.