Bevacizumab – Intravitreal

[Mason Russell]

I have inquiry regarding Intravitreal preparations using Bevacizumab vials (100mg) which is marketed and approved for IV use only, yet it is being successfully used off label to treat age related macular degeneration.

I need to get feedback from you, especially from pharmacists who have dealt with it regarding requirements and precautions of this preparation.

[Ava Green]

“Various different doses of bevacizumab have been used in the published evidence sources, as well as different dose frequency schedules. The issue of optimal dose and frequency of bevacizumab has still not been conclusively resolved however this submission specifically relates to a standard dose of 1.25 mg of bevacizumab, and this is the dose most commonly used in published studies.” The 1.25 mg dosage is administered monthly.

“Pre-packaged syringes of bevacizumab for intravitreal use are available to purchase from special manufacturing units. Moorfields Pharmaceuticals, of Moorfields NHS hospital, can supply syringes of 1.25 mg in 0.05 ml at £85 per syringe, excluding VAT and delivery charges.

We prepare in BSC of the left over of the CRC regimen including Bevacizumab in the regimen, with the all the precautions.

Regards

[Bartholomew Price]

I am working in Specialist Eye Hospital and ( Bevacizumb) is one of the main anti-VEGF medication with high daily consumption
Yet, it is off labels use for AMD but it has a satisfactory safety profile so far and more cost saving compering to the other approved anti-VEGF
We prepared it in the IV room under standard aseptic techniques at dose 1.25mg/0.5ml is intravitreal injection and at 2.5mg/ml as subconjunctival injection

If you need more information I will be more than happy to assist

Regards

[Candace Butler]

We used to prepare bevacizumab intravitreal syringes 1.25 mg/0.05 ml in BSC with BUD of 90 days in literature but we used 30 days BUD

[Chancellor Evans]

We batch them in the Sterile Preparation Center, and store them in the Pyxis fridge , which make enhanced the workflow as the medication will be readily available in the unit.

Below are the recipe of each one

BEVACIZUMAB 1.25 MG/0.05 ML INTRAOCULAR

Equipment:
1 mL luer-lock TB syringe Quantity: ~25
Mini-spike Quantity: 1

Procedure:
*PRESERVATIVE FREE*
1. Attach a mini-spike to the bevacizumab 25 mg/mL 4 mL vial.
2.Withdraw 0.12 mL of bevacizumab 25 mg/mL into 1 mL syringes to make ~25 syringes.
3. Place luer tip cap on syringe, label and seal

Storage: Refrigerate and protect from light
Expiration: 9 days

References:
CCHS Recipes
McElhiney, Linda F. Compounding Guide for Ophthalmic Preparations, American Pharmacists Association, 2013
Ophthalmic Drug Facts, 22nd Edition, Wolters Kluwer, Health, Facts & Comparisons, 2011

BEVACIZUMAB 2.5 MG/0.1 ML SUBCONJUNCTIVAL

Equipment:
1 mL TB syringe Quantity: 7
Dispensing pin Quantity: 1
10 mL syringe Quantity: 1

Procedure:
*PRESERVATIVE FREE*
1. Using a 10 mL syringe withdraw entire contents from bevacizumab 25 mg/mL vial
2. Transfer 0.5 mL of Bevacizumab (25 mg/mL) into 1 mL syringes
3. Repeat until 7 syringes have been pulled
4. Place luer tip cap on syringe, seal and label

Storage: Refrigerate and protect from light
Expiration: 9 days

References:
CCHS Recipes
McElhiney, Linda F. Compounding Guide for Ophthalmic Preparations, American Pharmacists Association, 2013
Ophthalmic Drug Facts, 22nd Edition, Wolters Kluwer, Health, Facts & Comparisons, 2011

[Chancellor Rogers]

The practice here is to use bevacizumab for intravitreal injection as (1.25mg/0.05ml) injection where we prepared it and dispensed it as a prefilled injection for Retina Clinics
It is prepared under regular aseptic techniques with 2 weeks validity from day of preparation.
As for lidocaine we use the topical gel form and this is regular practice as patient is already receive (Oxybuprocaine Hydrochloride) at assessment which will do the anesthesia

Hope I could help

[Author]

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