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Pegaptanib (United States: Not available): Drug information

Pegaptanib (United States: Not available): Drug information
(For additional information see "Pegaptanib (United States: Not available): Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Macugen [DSC]
Pharmacologic Category
  • Ophthalmic Agent;
  • Vascular Endothelial Growth Factor (VEGF) Inhibitor
Dosing: Adult

Note: Macugen has been discontinued in the United States for >1 year.

Macular degeneration

Macular degeneration ( neovascular age-related): Intravitreous injection: 0.3 mg into affected eye once every 6 weeks.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosing: Older Adult

Refer to adult dosing.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

>10%:

Cardiovascular: Hypertension

Ophthalmic: Anterior chamber inflammation, blurred vision, cataract, conjunctival hemorrhage, corneal edema, decreased visual acuity, eye discharge, eye discomfort, eye irritation, eye pain, increased intraocular pressure, punctate keratitis, visual disturbance, vitreous opacity

1% to 10%:

Cardiovascular: Cerebrovascular accident (1% to 5%), chest pain (1% to 5%), occlusive arterial disease (carotid artery: 1% to 5%), transient ischemic attacks (1% to 5%)

Central nervous system: Dizziness (6% to 10%), headache (6% to 10%), vertigo (1% to 5%)

Dermatologic: Contact dermatitis (1% to 5%)

Endocrine & metabolic: Diabetes mellitus (1% to 5%)

Gastrointestinal: Diarrhea (6% to 10%), nausea (6% to 10%), dyspepsia (1% to 5%), vomiting (1% to 5%)

Genitourinary: Urinary tract infection (6% to 10%), urinary retention (1% to 5%)

Hematologic & oncologic: Bruise (1% to 5%), periorbital hematoma (1% to 5%), vitreous hemorrhage (1% to 5%)

Local: Local inflammation (eye: 1% to 5%), local irritation (eyelid: 1% to 5%)

Neuromuscular & skeletal: Arthritis (1% to 5%), bone spur (1% to 5%)

Ophthalmic: Blepharitis (6% to 10%), conjunctivitis (6% to 10%), photopsia (6% to 10%), vitreous disorder (6% to 10%; includes inflammation), allergic conjunctivitis (1% to 5%), conjunctival edema (1% to 5%), corneal abrasion (1% to 5%), corneal deposits (1% to 5%), epithelial keratopathy (1% to 5%), endophthalmitis (1% to 5%), meibomianitis (1% to 5%), mydriasis (1% to 5%), retinal edema (1% to 5%), swelling of eye (1% to 5%)

Otic: Auditory impairment (1% to 5%)

Respiratory: Bronchitis (6% to 10%), pleural effusion (1% to 5%)

<1%, postmarketing, and/or case reports: Accidental injury, anaphylactoid reaction, anaphylaxis, angioedema, arthropathy, blindness, choroidal detachment, colonic polyps, decreased white blood cell count, dysphagia, feeling abnormal, foreign body sensation of eye, giant-cell arteritis, hematochezia, hemoptysis, hemorrhage, iatrogenic traumatic cataracts, immune thrombocytopenia, increased heart rate, inflammation, intracranial hemorrhage, iridocyclitis, iritis, loss of consciousness, mass (pulmonary), musculoskeletal chest pain, myalgia, neuritis, non-small-cell lung carcinoma (adenocarcinoma), obstructive pulmonary disease, ocular hyperemia, pain, pain at injection site, prolonged partial thromboplastin time, pulmonary disease, pulmonary hemorrhage, retinal detachment, retinal hole without detachment, sclera disease, skin rash, sprue-like symptoms, subretinal neovascularization, syncope, tremor, urticaria, uveitis (intermediate)

Contraindications

Known hypersensitivity to pegaptanib or any component of the formulation; ocular or periocular infections

Warnings/Precautions

Concerns related to adverse effects:

• Endophthalmitis/retinal detachment: Intravitreous injections are associated with endophthalmitis. Proper aseptic injection techniques should be used and patients should be instructed to report any signs of infection (eg, eye pain or redness, photophobia, blurred vision) immediately. Retinal detachment and iatrogenic traumatic cataract have been reported.

• Hypersensitivity: Rare hypersensitivity reactions (including anaphylaxis/anaphylactoid reactions and angioedema) have been associated with use, occurring within several hours of use; monitor closely. Equipment and appropriate personnel should be available for monitoring and treatment of anaphylaxis.

• Increased intraocular pressure: Intraocular pressure may increase within 30 minutes following intravitreal injection. Monitor intraocular pressure and optic nerve perfusion.

• Thromboembolic events: Thromboembolic events (eg, nonfatal stroke/MI, vascular death) have been reported following intravitreal administration of other VEGF inhibitors.

Other warnings/precautions:

• Concurrent administration in both eyes: Safety and efficacy for administration into both eyes concurrently have not been studied.

Product Availability

Macugen has been discontinued in the United States for >1 year.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Solution, Intraocular [preservative free]:

Macugen: 0.3 mg (0.09 mL [DSC])

Generic Equivalent Available: US

No

Pricing: US

Solution (Macugen Intraocular)

0.3 mg (per 0.09 mL): $889.25

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Administration: Adult

For ophthalmic intravitreal injection only. Attach a 30 gauge 1/2 inch needle to the medication syringe. Slowly depress plunger to expel excess air and medication (refer to product labeling for detailed instructions). Injection should be performed under aseptic conditions. Adequate anesthesia and a topical broad spectrum antibiotic should be administered prior to the procedure.

Use: Labeled Indications

Macular degeneration (neovascular age-related): Treatment of neovascular (wet) age-related macular degeneration (AMD)

Medication Safety Issues
Sound-alike/look-alike issues:

Pegaptanib may be confused with PAZOPanib, pegcetacoplan, peginesatide, pegaspargase, pegfilgrastim, peginterferon, pegvisomant, PONATinib

Metabolism/Transport Effects

Inhibits CYP2J2 (weak)

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.

Pegloticase: May diminish the therapeutic effect of PEGylated Drug Products. Risk C: Monitor therapy

Pegvaliase: PEGylated Drug Products may enhance the adverse/toxic effect of Pegvaliase. Specifically, the risk of anaphylaxis or hypersensitivity reactions may be increased. Risk C: Monitor therapy

Reproductive Considerations

Evaluate pregnancy status prior to use in females of reproductive potential. Based on information from other VEGF inhibitors, women of reproductive potential should use effective contraception prior to initial dose, during treatment, and for at least 3 months after the last intravitreal injection (Peracha 2016).

Pregnancy Considerations

Pegaptanib is a vascular endothelial growth factor (VEGF) inhibitor; VEGF is required to achieve and maintain normal pregnancies. Reports of intravitreal VEGF inhibitor use in pregnancy are limited and information specific to use of pegaptanib has not been located (Peracha 2016). Based on studies in nonpregnant adults, VEGF inhibitors can alter systemic concentrations of VEGF and placental growth factor following intravitreal administration (Peracha 2016; Zehtner 2015). Until additional information is available, intravitreal use during the first trimester should be avoided and use later in pregnancy should be based on patient specific risks versus benefits (Peracha 2016; Polizzi 2015).

Breastfeeding Considerations

It is not known if pegaptanib is present in breast milk.

The manufacturer recommends that caution be exercised when administering pegaptanib to breastfeeding women.

Monitoring Parameters

Optic nerve head perfusion (immediately after injection), intraocular pressure (within 30 minutes and during the week after injection); signs of infection/inflammation (for first week following injection) or hypersensitivity; retinal perfusion, endophthalmitis, visual acuity

Mechanism of Action

Pegaptanib is an apatamer, an oligonucleotide covalently bound to polyethylene glycol, which can adopt a three-dimensional shape and bind to vascular endothelial growth factor (VEGF). Pegaptanib binds to extracellular VEGF, selectively inhibiting VEGF from binding to its receptors and thereby suppressing neovascularization and slowing vision loss.

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Slow systemic absorption following intravitreous injection

Metabolism: Metabolized by endo- and exonucleases

Half-life elimination: Plasma: 10 ± 4 days

Brand Names: International
International Brand Names by Country
For country code abbreviations (show table)

  • (AT) Austria: Macugen;
  • (BE) Belgium: Macugen;
  • (BG) Bulgaria: Macugen;
  • (BR) Brazil: Macugen;
  • (CH) Switzerland: Macugen;
  • (CZ) Czech Republic: Macugen;
  • (DE) Germany: Macugen;
  • (EE) Estonia: Macugen;
  • (ES) Spain: Macugen;
  • (FI) Finland: Macugen;
  • (FR) France: Macugen | Pegaptanib;
  • (GB) United Kingdom: Macugen;
  • (GR) Greece: Macugen;
  • (HU) Hungary: Macugen;
  • (IE) Ireland: Macugen;
  • (IN) India: Macugen;
  • (IT) Italy: Macugen;
  • (JP) Japan: Macugen;
  • (LV) Latvia: Macugen;
  • (MX) Mexico: Macugen;
  • (NL) Netherlands: Macugen;
  • (NO) Norway: Macugen;
  • (PH) Philippines: Macugen;
  • (PL) Poland: Macugen;
  • (PR) Puerto Rico: Macugen;
  • (PT) Portugal: Macugen;
  • (SE) Sweden: Macugen;
  • (SI) Slovenia: Macugen;
  • (TH) Thailand: Macugen;
  • (TR) Turkey: Macugen;
  • (TW) Taiwan: Macugen;
  • (UA) Ukraine: Macugen
  1. American Academy of Ophthalmology Retina/Vitreous Panel Preferred Practice Pattern® Guidelines, "Age-Related Macular Degeneration," San Francisco, CA: American Academy of Ophthalmology; 2011 Available at http://www.aao.org. Accessed May 24, 2013.
  2. Gragoudas ES, Adamis AP, Cunningham ET, et al. Pegaptanib for Neovascular Age-Related Macular Degeneration. N Engl J Med. 2004;351(27):2805-2816. [PubMed 15625332]
  3. Macugen (pegaptanib) [prescribing information]. Bridgewater, NJ: Bausch & Lomb. July 2016.
  4. Peracha ZH, Rosenfeld PJ. Anti-vascular endothelial growth factor therapy in pregnancy: what we know, what we don't know, and what we don't know we don't know. Retina. 2016;36(8):1413-1417.
  5. Polizzi S, Mahajan VB. Intravitreal anti-VEGF injections in pregnancy: case series and review of literature. J Ocul Pharmacol Ther. 2015;31(10):605-610. [PubMed 26302032]
  6. Zehetner C, Bechrakis NE, Stattin M, et al. Systemic counterregulatory response of placental growth factor levels to intravitreal aflibercept therapy. Invest Ophthalmol Vis Sci. 2015;56(5):3279-3286. [PubMed 26024110]
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