verteporfin

Therapeutic Classification: none assigned

Pharmacologic Classification: photodynamic agents

Indications ⬆ ⬇

REMS

Age-related macular degeneration in patients with predominantly classic subfoveal choroidal neovascularization.

Action ⬆ ⬇

Vertoporfin is activated by nonthermal red light in the presence of oxygen to form reactive oxygen radicals. The resultant compound produces local damage to neovascular epithelium and subsequent vessel occlusion.

Therapeutic effects:

Improved visual acuity.

Pharmacokinetics ⬆ ⬇

Absorption: IV administration results in complete bioavailability.

Distribution: Transported by lipoproteins.

Metabolism/Excretion: Small amount of metabolism by the liver and plasma esterases; elimination is primarily fecal. Verteporfin in skin is inactivated by photobleaching from ambient indoor lighting.

Half-Life: 5–6 hr.

Time/Action Profile ⬆ ⬇

( improved visual acuity)

ROUTE	ONSET	PEAK	DURATION
IV	1–7 days	unknown	unknown

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Hypersensitivity;
Porphyria;
Exposure to direct sunlight;
Lactation: Lactation.

Use Cautiously in:

Moderate/severe hepatic impairment;
OB: Safety not established in pregnancy;
Pedi: Safety and effectiveness not established in children.

Adv. Reactions/Side Effects ⬆ ⬇

Derm: photosensitivity

EENT: visual disturbances, cataracts, conjunctivitis/conjunctival injection, dry eye, ocular itching, severe vision loss, subconjunctival/subretinal/vitreous hemorrhage

Local: injection site reactions(including extravasation and rash)

MS: back pain (during infusion)

Neuro: headache, weakness

Misc: fever, flu-like syndrome, HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Calcium channel blockers, polymyxin B, or radiation therapy may ↑ the rate of uptake of verteporfin by the vascular epithelium.
Concurrent use of other photosensitizing agents, including thiazide diuretics, sulfonylureas, phenothiazines, sulfonamides, or tetracyclines, may ↑ the risk of skin photosensitivity reactions.
Dimethyl sulfoxide, beta-carotene, alcohol, formate, and mannitol may ↓ the activity of verteporfin.

Route/Dosage ⬆ ⬇

IV (Adults ): 6 mg/m² infused over 10 min, followed by appropriate laser light delivery initiated 15 min after the start of the infusion.

Availability ⬆ ⬇

Lyophilized powder for injection: 15 mg/vial

Assessment ⬆ ⬇

Assess IV site frequently for extravasation. Prior to injection, ensure line is free-flowing and monitor carefully. The largest arm vein, preferably the antecubital, should be used for injection. Avoid small veins in the back of the hand. If extravasation occurs, stop infusion immediately and apply cold compresses. Area of extravasation must be protected from light until swelling and discoloration have faded to prevent a potentially severe local burn. If emergency surgery is necessary within 48 hr after treatment, protect as much internal tissue from intense light as possible.

Lab Test Considerations:

May cause anemia, decreased or increased WBC, elevated liver function tests, increased serum creatinine, and albuminuria.

Implementation ⬆ ⬇

Therapy is a 2-step process requiring administration of verteporfin followed by light administration. Laser light is administered 15 min after start of 10-min infusion.

IV Administration:

Intermittent Infusion: Diluent: Reconstitute each vial of verteporfin with 7 mL of sterile water for injection providing 7.5 mL. Withdraw volume for desired dose and dilute with D5W for a total infusion volume of 30 mLConcentration: 2 mg/mL. Reconstituted solution must be protected from light and used within 4 hr. Solution is a opaque dark green; inspect solution for particulate matter or discoloration.
Rate: Infuse over 10 min at a rate of 3 mL/min, using appropriate syringe pump and in-line filter.
Y-Site Incompatibility: Do not administer other products through infusion tubing.

Patient/Family Teaching ⬆ ⬇

Instruct patient to avoid exposure of skin or eyes to direct sunlight or bright indoor light for 5 days due to photosensitivity. Patients should wear a wrist band to remind them to avoid direct sunlight or bright indoor light (tanning salons, bright halogen lighting, and high-power lighting used in surgical operating rooms and dental offices) for 5 days. If patients must go outdoors during first 5 days after treatment, they should protect all parts of their skin and eyes by wearing protective clothing and dark sunglasses. UV sunscreens are not effective protection. However, patients should not stay in the dark and should be encouraged to expose their skin to ambient indoor light, which will help inactivate the drug in the skin.
Emphasize the importance of follow-up evaluations every 3 mo determine need for repeated therapy.
Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected and to avoid breastfeeding.

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Pronunciation ⬇

Classifications ⬆ ⬇