Aflibercept: what it treats, how it is given, side effects
Last updated September 7, 2026.
**Aflibercept is a vascular endothelial growth factor (VEGF) inhibitor, a lab-made fusion protein given as an injection into the eye to treat retinal diseases that cause leaking, swelling, and abnormal blood vessel growth.** It binds VEGF and placental growth factor so those signals cannot reach receptors on blood vessel cells, which slows the growth of fragile new vessels and dries up fluid under and inside the retina. A retina specialist gives it in a clinic after numbing drops and an antiseptic prep, so there is nothing for you to take or measure at home. The safety point that matters most is timing: eye pain, spreading redness, light sensitivity, or worsening vision in the days after an injection needs a same-day eye exam, because it can mean infection inside the eye.
What does it treat?
Aflibercept is FDA approved for neovascular (wet) age-related macular degeneration, macular edema following central or branch retinal vein occlusion, diabetic macular edema, and diabetic retinopathy. It is also approved for retinopathy of prematurity in preterm infants. The typical picture in adults is blurred or distorted central vision, straight lines that look bent or wavy, a gray or blank spot in the middle of your sight, or vision that fades over weeks while side vision stays intact, with imaging (OCT and sometimes fluorescein angiography) showing fluid in or under the retina. Two strengths are sold under different brand names: Eylea (2 mg) and Eylea HD (8 mg), which allows longer gaps between visits for some people. Biosimilars such as Yesafili, Opuviz, Ahzantive, Enzeevu, and Pavblu contain the same active drug. Aflibercept is not the same drug as ziv-aflibercept (Zaltrap), which is given by vein for colorectal cancer and must never be injected into the eye.
How do you take it?
Aflibercept comes as a sterile solution in a single-dose vial or prefilled syringe and is given only as an intravitreal injection by an ophthalmologist, one eye at a time. The standard dose is 2 mg (0.05 mL). For wet AMD, the label is 2 mg every 4 weeks for the first 3 doses, then 2 mg every 8 weeks; some people are kept on monthly dosing, and 2 mg every 12 weeks is an option after the first year for those who respond well, though vision gains can be smaller. For diabetic macular edema and diabetic retinopathy, it is 2 mg every 4 weeks for the first 5 doses, then every 8 weeks. For macular edema after a retinal vein occlusion, it is 2 mg every 4 weeks. For retinopathy of prematurity, it is a single 0.4 mg (0.01 mL) dose per eye. Eylea HD is 8 mg every 4 weeks for the first 3 doses, then every 8 to 16 weeks depending on the condition. The frequency ceiling is firm: the 2 mg dose is not given more often than every 4 weeks, and Eylea HD is not given more often than every 8 weeks after the loading doses. There are no food or drink rules, and no dose to make up at home. If you miss a visit, call the retina clinic to be rescheduled as soon as possible, since long gaps let fluid come back and vision lost to delay may not fully return. Call before your next scheduled injection if you have eye pain, a red eye that is getting worse, sudden floaters or flashes, or a drop in vision.
Side effects to know
- Common: Most people notice a red spot on the white of the eye (subconjunctival hemorrhage), mild eye pain or grittiness, watering, and a few new floaters for a day or two after the injection, and some develop cataract, higher eye pressure, or a vitreous detachment over time.
- Serious: Get help the same day for signs of infection inside the eye (endophthalmitis) or retinal detachment: eye pain, spreading redness, light sensitivity, a sudden shower of floaters or flashes, a curtain or shadow across your vision, or vision that is clearly worse than before the injection. VEGF inhibitors also carry a risk of arterial clot events, so sudden face or arm weakness, trouble speaking, chest pain, or one-sided numbness means 911 right away.
Who should not take it?
Aflibercept must not be given if you have an infection in or around the eye, active inflammation inside the eye (uveitis), or a known allergy to aflibercept. Tell your retina specialist if you have glaucoma or already high eye pressure, since injections raise pressure briefly and can be a problem in eyes that drain poorly, and tell them if you have had a stroke, heart attack, TIA, or blood clot, because that history is weighed against the benefit before starting. There are no known drug interactions that require you to stop other medicines, and blood thinners such as warfarin, apixaban, or clopidogrel are usually continued, but list everything you take, including eye drops and supplements. Alcohol does not interact with aflibercept; the practical rule is to skip it on injection day if it would keep you from noticing new eye symptoms or from getting a ride home. Based on how the drug works, it can harm a fetus, so tell your doctor if you are pregnant or could become pregnant, and use effective contraception during treatment and for at least 1 month after the last 2 mg dose (3 months after Eylea HD). It is not known whether aflibercept passes into breast milk, so breastfeeding is generally not advised during treatment and for the same period afterward; discuss the tradeoffs, since vision loss also affects your ability to care for a baby.
When is it an emergency?
Call 911 for sudden weakness or numbness on one side, drooping face, trouble speaking, chest pain, trouble breathing, throat or tongue swelling, hives with faintness, or collapse after an injection. Call your retina clinic or an eye emergency service the same day for eye pain that keeps building, a red eye getting worse instead of better, strong light sensitivity, a sudden increase in floaters or flashes, a dark curtain moving across your sight, or vision that drops after the injection; these are how endophthalmitis, retinal detachment, and a spike in eye pressure show up, and hours matter. True overdose is unusual because the dose is fixed and given in clinic, but a larger than intended injection volume raises eye pressure and causes deep eye pain and blurred vision, which needs urgent eye care. For any accidental exposure, swallowing, or a suspected dosing error, call Poison Control at 1-800-222-1222, which is free and open 24 hours; call 911 if the person collapses, has a seizure, or cannot breathe.
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Common questions
How much aflibercept can I get, and how often?
The standard dose is 2 mg (0.05 mL) injected into one eye, and it is not given more often than every 4 weeks in that eye. For wet AMD the label is 2 mg every 4 weeks for 3 doses, then every 8 weeks. For diabetic macular edema and diabetic retinopathy it is 2 mg every 4 weeks for 5 doses, then every 8 weeks. Eylea HD is 8 mg every 4 weeks for 3 doses, then every 8 to 16 weeks, and it is not repeated more often than every 8 weeks after those first doses. If both eyes need treatment, each eye gets its own separate vial or syringe.
Can I drink alcohol while I am on aflibercept?
There is no interaction between alcohol and aflibercept, and the label sets no alcohol limit. The sensible rule is to avoid drinking on injection day, since your vision is already blurry from the drops and the eye shield, and you want to be able to tell the difference between normal soreness and a problem that needs a call. Alcohol also raises blood pressure and blood sugar over time, which works against you if you are being treated for diabetic eye disease. Keep to standard limits on other days and tell your doctor how much you drink.
Is aflibercept safe during pregnancy or breastfeeding?
Aflibercept blocks VEGF, which a fetus needs for normal blood vessel development, so it can cause fetal harm based on how it works. There are no adequate human data, and the label advises effective contraception during treatment and for at least 1 month after the last 2 mg dose, or 3 months after the 8 mg dose. Tell your retina specialist if you are pregnant, planning a pregnancy, or become pregnant during treatment. It is not known whether the drug passes into breast milk, so breastfeeding is generally not advised during treatment and for the same period after, and your doctor will weigh that against the vision loss risk of stopping.
Do I need to fast or change what I eat before the injection?
No. Aflibercept is injected into the eye, not swallowed, so food, coffee, and timing of meals make no difference to how it works. Eat normally and take your usual medicines, including blood thinners, unless your doctor tells you otherwise. If you have diabetes, keep your regular meal and insulin schedule so your blood sugar does not drop while you are waiting in the clinic. Arrange a ride home, since the numbing drops, dilation, and antiseptic leave your vision blurry for several hours.
What are the signs that something has gone wrong after an injection?
Expect a red spot on the white of the eye, mild grittiness, watering, and a few floaters for a day or two, all improving. The warning pattern is the opposite: pain that builds instead of fading, redness that spreads, sensitivity to light, thick discharge, or vision that gets worse over hours to days. That combination points to endophthalmitis, an infection inside the eye, and it needs same-day evaluation by an eye doctor. A sudden burst of new floaters, flashing lights, or a shadow moving across your field can mean a retinal detachment or a tear and is also same-day. Sudden face or arm weakness, slurred speech, or chest pain is a 911 call.
Does aflibercept interact with my other medicines?
No drug interaction studies require you to stop other medicines for aflibercept, and the drug stays mostly in the eye with very little reaching the bloodstream. Blood thinners such as warfarin, apixaban, rivaroxaban, clopidogrel, and aspirin are usually continued, though they can make the red patch on your eye larger and last longer. Tell the clinic about glaucoma drops and any steroid drops, since eye pressure is checked around the injection. If you have had a stroke, heart attack, or clot, mention it, because VEGF inhibitors carry a risk of arterial clot events and that history changes the discussion. Bring a current list of everything you take, including over-the-counter products and supplements.