Photosensitising Agent — Photodynamic Therapy (PDT) Pregnancy: Avoid — insufficient data; teratogenic potential

Verteporfin (Photodynamic Therapy)

Brand names: Visudyne

Adult dose

Dose: 6 mg/m² IV infusion over 10 minutes

Route: Intravenous infusion

Frequency: Single treatment session; can repeat at 3-monthly intervals

Max: 6 mg/m² per session

IV infusion immediately followed by laser activation — 689 nm diode laser delivered to lesion 15 minutes after end of infusion. Patient MUST avoid direct sunlight and bright indoor light for 48 hours after infusion — severe photosensitivity reaction risk. Skin and eyes must be covered outside. Currently limited use — largely superseded by anti-VEGF in most indications.

Paediatric dose

Route:

Not licensed for paediatric use — seek specialist opinion

Dose adjustments

Renal

No dose adjustment — hepatically metabolised and excreted in bile

Hepatic

Moderate-severe hepatic impairment: use with caution — reduced clearance

Clinical pearls

48-hour photosensitivity precaution is ABSOLUTE: verteporfin is retained in skin and exposed to light → severe photoreaction; patients must cover all skin and wear UV-protective eyewear (not standard sunglasses) for 48 hours; even bright indoor fluorescent lighting can cause reactions
Current indications: verteporfin PDT is mainly used for: 1) central serous chorioretinopathy (CSC) — reduced fluence PDT, and 2) polypoidal choroidal vasculopathy (PCV); largely superseded by anti-VEGF for typical nAMD
Treatment timing: laser must be applied 15 minutes after END of infusion (689 nm diode laser, 50 J/cm²); delaying beyond 20 minutes reduces efficacy — coordination between pharmacy, infusion nurse, and laser operator is critical
Porphyria contraindication: verteporfin is a porphyrin derivative — systemic accumulation may precipitate acute porphyria attacks; absolute contraindication
Back pain during infusion: common and alarming but usually benign; slow infusion rate or pause if severe; not an indication to stop treatment permanently

Contraindications

Active severe hepatic impairment
Hypersensitivity to verteporfin or porphyrins
Porphyria

Side effects

Severe photosensitivity reactions — sunburn, severe skin blistering (if light exposure within 48 hours) — CRITICAL patient instruction
Back pain during infusion — injection-site or generalised (up to 40%)
Visual disturbances — blurred vision, reduced visual acuity (common, usually transient)
Subretinal haemorrhage — post-laser complication
Severe visual loss (rare but reported within 7 days in 0.7%)

Interactions

Other photosensitising agents (tetracyclines, thiazides, sulfonamides) — additive photosensitivity risk
Calcium channel blockers — may reduce verteporfin uptake into neovascular tissue
Dimethyl sulphoxide, beta-carotene, ethanol — may quench the reactive oxygen species and reduce PDT efficacy

Monitoring

Fundus fluorescein angiography at 3 months to assess retreatment
Visual acuity
OCT
Skin condition post-treatment (any light exposure burns)

Reference: BNFc; BNF 90; TAP Investigation Group (Arch Ophthalmol 1999); NICE TA68 (Verteporfin); RCOphth PDT Guidelines; SPC Visudyne. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways