Photosensitising Agent — Photodynamic Therapy (PDT) Pregnancy: No clinical data on exposed pregnancies; animal studies showed teratogenic effects in one species (rat) and the potential risk for humans is unknown — should not be used during pregnancy unless clearly necessary (only if the benefit justifies the potential risk to the foetus). Verteporfin and its diacid metabolite are excreted in human milk in low amounts — it should not be administered to nursing mothers, or breastfeeding should be interrupted for 48 hours after administration.

Verteporfin (Photodynamic Therapy)

Brand names: Visudyne

Verteporfin is a light-activated photosensitising agent used for photodynamic therapy of choroidal neovascularisation, classically in wet age-related macular degeneration and certain other macular conditions, given as a controlled intravenous infusion followed by laser activation at the retina.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: 6 mg/m² body surface area, diluted in 30 mL infusion solution

Route: Intravenous infusion over 10 minutes, followed by light activation of the drug in the eye

Frequency: Two-step process per treatment: the 10-minute intravenous infusion, then light activation 15 minutes after the start of the infusion. Re-evaluate patients every 3 months; in the event of recurrent CNV leakage therapy may be repeated

Max: Up to 4 treatments per year

Applies to adults including the elderly (≥ 65 years old). Must be administered only by ophthalmologists experienced in the management of patients with age-related macular degeneration or pathological myopia. LIGHT ACTIVATION (step 2): a diode laser generating non-thermal red light of wavelength 689 nm ± 3 nm via a slit-lamp-mounted fibre optic device and a suitable contact lens; at the recommended light intensity of 600 mW/cm² it takes 83 seconds to deliver the required light dose of 50 J/cm². SPOT SIZE: estimate the greatest linear dimension of the choroidal neovascular lesion by fluorescein angiography and fundus photography (fundus cameras with magnification 2.4–2.6X recommended); the treatment spot should cover all neovasculature, blood and/or blocked fluorescence, with an additional margin of 500 µm around the visible lesion; the nasal edge of the treatment spot must be at least 200 µm from the temporal edge of the optic disc; the maximum spot size used for the first treatment in clinical studies was 6,400 µm. SECOND EYE: no clinical data support concomitant treatment of the second eye, but if deemed necessary, light should be applied to the second eye immediately after light application in the first eye and no later than 20 minutes from the start of the infusion. HEPATIC: contraindicated in severe hepatic impairment; consider carefully in moderate hepatic dysfunction or biliary obstruction (no experience); no dose adjustment required in mild hepatic impairment. PAEDIATRIC (non-numeric — not structured): safety and efficacy in the paediatric population have not been established and the product is not indicated in this population. US label cross-check (Visudyne, Bausch & Lomb) states the same 6 mg/m² dose: reconstitute each 15 mg vial with 7 mL Sterile Water for Injection to give 7.5 mL at 2 mg/mL, dilute the required volume with 5% Dextrose for Injection to a total infusion volume of 30 mL (do not use saline), and infuse intravenously over 10 minutes at a rate of 3 mL/minute using a syringe pump and in-line filter.

Dose adjustments

Renal

Not studied in patients with renal impairment; the pharmacological characteristics do not indicate any need to adjust the dose

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients
Porphyria
Severe hepatic impairment

Side effects

Injection site reactions — pain, oedema, inflammation, extravasation, rashes, haemorrhage, discolouration (common); extravasation can cause severe pain, blistering and local necrosis, especially if the area is exposed to light
Visual impairment — blurred or fuzzy vision, photopsia, reduced visual acuity, visual field defects including scotoma and black spots; severe reduction in visual acuity (common)
Photosensitivity reaction (common) — patients are photosensitive for 48 hours after the infusion
Syncope, headache, dizziness, vasovagal reactions; hypersensitivity reactions (common), anaphylactic reaction (not known)
Infusion-related chest pain and infusion-related reaction presenting primarily as back pain (common); dyspnoea, nausea, hypercholesterolaemia (common)
Retinal detachment, retinal or vitreous haemorrhage, retinal oedema (uncommon); retinal ischaemia (rare)

Interactions

US label §7: no human drug interaction studies conducted; based on the mechanism of action, calcium channel blockers, polymyxin B or radiation therapy could enhance the rate of verteporfin uptake by the vascular endothelium
US label §7: other photosensitising agents (e.g. tetracyclines, sulfonamides, phenothiazines, sulfonylurea hypoglycaemic agents, thiazide diuretics, griseofulvin) could increase the potential for skin photosensitivity reactions
US label §7: compounds that quench active oxygen species or scavenge radicals (dimethyl sulfoxide, β-carotene, ethanol, formate, mannitol) would be expected to decrease verteporfin activity
US label §7: drugs that decrease clotting, vasoconstriction or platelet aggregation (e.g. thromboxane A2 inhibitors) could decrease the efficacy of therapy

Clinical monograph

How it works

After intravenous administration it accumulates in abnormal neovascular endothelium and, when activated by non-thermal red laser light, generates reactive oxygen species that cause local vascular occlusion of the targeted neovascular membrane.

Prescribing in practice

Patients become markedly photosensitive after infusion and must avoid direct sunlight and bright indoor light to the skin and eyes until the drug has cleared, as severe phototoxic skin burns can occur.
Administered only by clinicians trained in ophthalmic photodynamic therapy, with the timed laser activation following the infusion window precisely.
Extravasation can cause local tissue damage and severe pain, so secure intravenous access and infusion-site monitoring are essential.

Monitoring

Monitor the infusion site for extravasation during administration and review visual acuity and macular response at scheduled follow-up.

Counselling the patient

Avoid direct sunlight and bright light exposure to skin and eyes for the advised period; wear protective clothing and a wide-brimmed hat outdoors.
Report any infusion-site pain, swelling or visual disturbance promptly.

Evidence & guidelines

The TAP and VIP trials established verteporfin photodynamic therapy for neovascular age-related macular degeneration, a role since largely supplanted by anti-VEGF therapy.

Reference: TAP Investigation Group (Arch Ophthalmol 1999); NICE TA68 (Verteporfin); RCOphth PDT Guidelines; SPC Visudyne; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways