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Anti-VEGF (Vascular Endothelial Growth Factor Inhibitor) Pregnancy: Avoid — anti-VEGF may affect fetal vasculogenesis

Bevacizumab (Intravitreal)

Brand names: Avastin (off-label intravitreal)

Adult dose

Dose: 1.25 mg intravitreal injection monthly for 3 loading doses, then PRN or treat-and-extend.
Route: Intravitreal injection
Frequency: Monthly loading × 3, then PRN
Max: 1.25 mg per intravitreal injection
Off-label for wet AMD (cheaper than ranibizumab). CATT/IVAN trials: non-inferior to ranibizumab for visual acuity. Also used for diabetic macular oedema, CNV, retinal vein occlusion.

Paediatric dose

Route: Intravitreal
Frequency: Monthly
Max: 0.625 mg in ROP (off-label)
Concentration: 25 mg/mL mg/ml
Retinopathy of prematurity (ROP): off-label intravitreal bevacizumab — specialist neonatal/paediatric ophthalmology only

Dose adjustments

Renal

N/A (local injection)

Hepatic

N/A

Clinical pearls

  • CATT/IVAN studies: bevacizumab as effective as ranibizumab for visual acuity in wet AMD; approximately 10× cheaper
  • Off-label but widely used — prescribe with informed consent documenting off-label status
  • Endophthalmitis: most serious complication — patients instructed to report sudden visual loss or eye pain immediately
  • Bilateral same-day injection: not recommended (bilateral endophthalmitis risk — single ocular event but bilateral outcome)

Contraindications

  • Ocular or periocular infection
  • Uncontrolled glaucoma

Side effects

  • Endophthalmitis (0.05% — sight-threatening)
  • Retinal detachment
  • Intraocular haemorrhage
  • IOP rise (transient post-injection)
  • Arterial thromboembolic events (systemic — theoretical)

Interactions

  • None specific for intravitreal route

Monitoring

  • Visual acuity before each injection
  • OCT imaging (retinal fluid)
  • IOP after injection
  • Signs of endophthalmitis

Reference: BNFc; BNF; CATT Trial (NEJM 2011); IVAN Trial (Lancet 2013); RCOphth AMD Guidelines. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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