“The competent authority has been pleased to notify the SOPs regarding the off-label intravitreal usage of injection Bevacizumab for hospitals in Punjab,” said a notification by the secretary for Specialised Healthcare and Medical Education Department.

The interim Punjab government slapped a ban on the use of Avastin injection for eye patients for an indefinite period across the province on September 26, 2023 after vision loss among patients due to the injection.

The government launched a portal to collect data on the patients affected by the drug and provide them with treatment facilities.

“Bevacizumab (Avastin) was originally FDA-approved for cancer treatment, its off-label use for eye complications has been supported by numerous studies since 2005,” it said. The off-label indications of intravitreal injection Bevacizumab (Avastin) are diabetic retinopathy, retinal vein occlusion, age-related macular degeneration, eale’s disease, retinotherapy of prematurity, neovascular glaucoma, choroidal neo vascularisatin, corneal graft rejection.

“The common adverse drug reactions (ADRs) include eye redness, dryness, discomfort, and temporary blurred vision. Severe ADRs are rare and include eye pain, infections, detached retina, cataracts, endophthalamitis, etc.

The SOPs include authorised distribution, preparation and dispensing (personnel, workplace/area, method of preparation, microbiological air and surface monitoring), propoer disposal, informed consent, administration, surveillance, measures for ocular infection, reporting adverse events (the drug/therapeutic good, the event), bulk supply or inter-city transportation, record keeping, display of charges, healthcare professionals should not deviate from SOPs, PHC must follow SOPs.

“Transportation will not be provided after Avastin injection dispensing,” it said and the injections for eye use would be administered in the operation theater.

“Avastin injections will come in 20 or 50 dose vials, with all patients getting their dose on the same day. Any remaining doses after initial administration will be discarded within 6 hours,” it said and added that storage of used injections would be prohibited.