Intravitreous injections including those with Macugen have been associated with endophthalmitis. Proper aseptic injection technique should always be utilized when administering Macugen. In addition, patients should be monitored during the week following the injection to permit early treatment, should an infection occur (see DOSAGE AND ADMINISTRATION).

Increases in intraocular pressure have been seen within 30 minutes of injection with Macugen. Therefore, intraocular pressure as well as the perfusion of the optic nerve head should be monitored and managed appropriately.

FOR OPHTHALMIC INTRAVITREAL INJECTION ONLY.

Rare cases of anaphylaxis/anaphylactoid reactions, including angioedema, have been reported in the post-marketing experience following the Macugen intravitreal administration procedure (see ADVERSE EVENTS and DOSAGE AND ADMINISTRATION).

Carcinogenicity studies with pegaptanib have not been conducted.

Pegaptanib and its monomer component nucleotides (2-MA, 2-MG, 2-FU, 2-FC) were evaluated for genotoxicity in a battery of in vitro and in vivo assay systems. Pegaptanib, 2-O-methyladenosine (2-MA), and 2-O-methylguanosine (2-MG) were negative in all assay systems evaluated. 2-fluorouridine (2-FU) and 2-fluorocytidine (2-FC) were nonclastogenic and were negative in all S. typhimurium tester strains, but produced a non-dose related increase in revertant frequency in a single E. coli tester strain. Pegaptanib, 2-FU, and 2-FC tested negative in cell transformation assays.

No data are available to evaluate male or female mating or fertility indices.

Pegaptanib produced no maternal toxicity and no evidence of teratogenicity or fetal mortality in mice at intravenous doses of up to 40 mg/kg/day (about 7,000 times the recommended human monocular ophthalmic dose of 0.3 mg/eye). Pegaptanib crosses the placenta in mice.

There are no studies in pregnant women. The potential risk to humans is unknown. Macugen should be used during pregnancy only if the potential benefit to the mother justifies the potential risk to the fetus.

It is not known whether pegaptanib is excreted in human milk. Because many drugs are excreted in human milk, caution should be exercised when Macugen is administered to a nursing woman.

Safety and effectiveness of Macugen in pediatric patients have not been studied.

Approximately 94% (834/892) of the patients treated with Macugen were ≥ 65 years of age and approximately 62% (553/892) were ≥ 75 years of age. No difference in treatment effect or systemic exposure was seen with increasing age.

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