Nepafenac (Ophthalmic)

Nepafenac, an ophthalmic route solution or eye drops, is an NSAID medication used post-surgery to keep swelling and inflammation to a minimum as well as relieve pain.

Overview

Nepafenac eye drops are prescribed by doctors to treat painful swelling and inflammation that can occur after cataract surgery. Nepafenac is a prodrug, which means it is not actively medicinal until it interacts with the body, in this case the cornea of the eye. After penetrating the cornea, Nepafenac turns into a powerful NSAID medication known as amfenac.

NSAID medications are non-steroidal anti-inflammatory drugs that reduce pain, eliminate fever symptoms and reduce the chance of swelling and inflammation. Many versions of NSAIDs are available world-wide to treat all sorts of ailments. These drugs are available in both prescription and non-prescription strengths. They work by stopping certain enzymes in the central nervous system from creating sensations of pain and inflammation.

Nepafenac is known as Nevanac and Ilevro in some medical circles and is sold only under the prescription of a medical doctor. Typically dosed in single drop amounts up to three times per day in the affected eye, most physicians start patients on Nepafenac a day prior to their procedure and continue the treatment for a few weeks post-operative.

Patients are advised not to wear contact lenses when they are using Nepafenac after their cataract surgery and to report any vision changes or pain to their physician, should they experience these symptoms. Other medications most likely won't have an effect on Nepafenac eye drops, but patients are advised to avoid other medications that are administered to the eye during this time.

Cataract surgery is required when the lens of a patient's eye becomes cloudy, leading to wide-ranging vision problems. During cataract surgery, the patient's damaged lens is removed and replaced with a lab created version, which restores the transparency of the lens and greatly improves the vision of the patient. Painful conditions that result after cataract surgery are effectively treated with Nepafenac eye drops.

Conditions Treated

  • Inflammation, ocular
  • Pain, ocular

Type Of Medicine

  • NSAID pain reliever
  • Anti-inflammatory

Side Effects

Medical attention may be required if the following adverse effects occur while you are taking Nepafenac eye drops. Report these to your physician:

  • Vision changes
  • Vision decreases
  • Vision is blurry or lost completely
  • Pain in the eye
  • Itching sensation in the eye
  • Swollen, red appearance to the eye

Other patients experience symptoms that are annoying but typically go away after a certain period of time with continued treatment. It is best to inform your doctor of these symptoms, should they occur, in case there is a way to ease them:

  • Sensation of object in the eye
  • Eyelids feel sticky
  • Colors appear strange or altered
  • Coughing
  • Crusted eyelids or corners of the eye
  • Night blindness
  • Dizzy spells
  • Eyes feel dry or irritated
  • Elevated body temperature
  • Headache
  • Light sensitivity
  • Vomiting
  • Nausea
  • Nervous demeanor
  • Ringing or pounding in the ears
  • Sparks or flashes of light
  • Floating dots or veiled effect on vision
  • Irregular heart rhythm, fast or slow
  • Nasal congestion, stuffy or runny
  • Tender cheekbones or eyes
  • Chest tightness
  • Wheezing
  • Difficulty breathing

You may also experience other symptoms than those listed here and, if so, they should be reported to your physician for your own safety.

Dosage

Follow your doctor's prescribed recommendation for your dose of Nepafenac and do not increase the amount that has been determined for your dosage. Do not increase how frequently you are prescribed to take this medication and stop taking it when it is indicated but not before that time.

The typical duration of this medication will be 14 days, with treatment to begin the day prior to your procedure as a preventive measure. If you feel that you will be unable to continue taking Nepafenac as prescribed, consult your physician.

Other eye medications may be prescribed to you during this time and, if so, can be used after a five minute waiting period since you've used Nepafenac. Avoid using contact lenses during your treatment or talk to your doctor about their use if you have any questions.

Prior to using the Nepafenac eye drops, gently shake the bottle well to make sure the medication is properly mixed. Wash your hands and tilt back your head, gently pressing a finger on the lower eyelid to create a gap between the lid and the eye. Drop in a single drop of the medicine or the amount directed and close your eye for at least two minutes to allow the medicine to absorb. Wash your hands again to remove any medication that may have gotten on them. Never touch the dropper tip to your eye or skin and keep the bottle closed tightly to avoid contaminating your medication.

Different patients will have different requirements with regard to their dosage of Nepafenac eye drops, which will depend on their overall health condition and other factors. Follow your doctor's prescribed instructions exactly and ask any questions necessary to ensure your safety when administering this medication.

Patients prescribed the Nevanac brand of Nepafenac eye drops will most likely be instructed to administer one drop three times daily to the eye that is affected. This treatment should begin the day prior to their cataract surgery and will continue for two weeks after the surgery is completed.

Those prescribed Ilevro brand Nepafenac eye drops will be directed to use one drop of the medication in the eye on a once daily basis. This dosage will begin the day prior to surgery with another drop administered from one to two hours before the actual procedure. The patient will be directed to continue this medication for at least two weeks after their procedure as well.

If you miss a dose of Nepafenac, take it as soon as you realize you've missed it unless it is nearly time for your next scheduled dose. In that case, skip the dose in favor of returning to your regular schedule. If in doubt, seek advice from your doctor if you've missed a dose of this medication.

Interactions

If you have had a hypersensitive reaction to any other eye drops in the past including Nepafenac, make sure your doctor is aware of this. You should also communicate any other adverse reactions you've had to animals, preservatives, foods, dyes or perfumes.

Children under the age of 10 have not been studied in order to provide proof of the safety of them taking Nepafenac eye drops, nor has this medication been proven effective for any conditions they have. Use in this age group is not advised.

Geriatric patients should experience the same level of effectiveness and safety as adult patients and be generally able to take this medication as directed.

Women who are pregnant and women who are breastfeeding have not been studied with regard to the effect Nepafenac has on their children, who may or may not be affected by the medication through breast milk or in the womb. Use of Nepafenac in these groups should be based on the required health conditions of the mother.

Avoid using any other medications, especially those administered in the eye, while you are on Nepafenac eye drops, if possible. Let your doctor know what medications you are taking and include any that can be purchased without a prescription as well as herbal, vitamin and holistic remedies.

Nepafenac should not be taken if you are already on Ketorolac for any reason, as the two medications do not interact well with each other and can cause severe health symptoms. Let your doctor know if you are taking Ketorolac.

The following medications, while not ideally suited to be used with Nepafenac, may be necessary for your treatment regimen. Inform your physician if you are taking any of the following medications:

  • Abciximab
  • Acemetacin
  • Aceclofenac
  • Amiloride
  • Acenocoumarol
  • Amitriptyline
  • Amineptine
  • Amoxapine
  • Amitriptylinoxide
  • Anagrelide
  • Amtolmetin Guacil
  • Ardeparin
  • Apixaban
  • Aspirin
  • Argatroban
  • Bemiparin
  • Balsalazide
  • Benzthiazide
  • Bendroflumethiazide
  • Betamethasone
  • Beta Glucan
  • Bivalirudin
  • Bismuth Subsalicylate
  • Budesonide
  • Bromfenac
  • Bumetanide
  • Bufexamac
  • Celecoxib
  • Cangrelor
  • Chlorothiazide
  • Certoparin
  • Choline Magnesium Trisalicylate
  • Chlorthalidone
  • Cilostazol
  • Choline Salicylate
  • Clomipramine
  • Citalopram
  • Clopamide
  • Clonixin
  • Cortisone
  • Clopidogrel
  • Cyclosporine
  • Cyclopenthiazide
  • Dalteparin
  • Dabigatran Etexilate
  • Deflazacort
  • Danaparoid
  • Desirudin
  • Desipramine
  • Dexamethasone
  • Desvenlafaxine
  • Dexketoprofen
  • Dexibuprofen
  • Dibenzepin
  • Diazoxide
  • Diflunisal
  • Diclofenac
  • Dipyridamole
  • Digoxin
  • Dothiepin
  • Dipyrone
  • Droxicam
  • Doxepin
  • Edoxaban
  • Duloxetine
  • Eplerenone
  • Enoxaparin
  • Eptifibatide
  • Epoprostenol
  • Ethacrynic Acid
  • Escitalopram
  • Etofenamate
  • Etodolac
  • Felbinac
  • Etoricoxib
  • Fepradinol
  • Fenoprofen
  • Feverfew
  • Feprazone
  • Flufenamic Acid
  • Floctafenine
  • Fluoxetine
  • Fluocortolone
  • Fluvoxamine
  • Flurbiprofen
  • Furosemide
  • Fondaparinux
  • Gossypol
  • Ginkgo
  • Hydrochlorothiazide
  • Heparin
  • Hydroflumethiazide
  • Hydrocortisone
  • Iloprost
  • Ibuprofen
  • Indapamide
  • Imipramine
  • Ketoprofen
  • Indomethacin
  • Levomilnacipran
  • Lepirudin
  • Lofepramine
  • Lithium
  • Loxoprofen
  • Lornoxicam
  • Magnesium Salicylate
  • Lumiracoxib
  • Meclofenamate
  • Meadowsweet
  • Melitracen
  • Mefenamic Acid
  • Mesalamine
  • Meloxicam
  • Methyclothiazide
  • Methotrexate
  • Metolazone
  • Methylprednisolone
  • Morniflumate
  • Milnacipran
  • Nadroparin
  • Nabumetone
  • Nefazodone
  • Naproxen
  • Niflumic Acid
  • Nepafenac
  • Nimesulide Beta Cyclodextrin
  • Olsalazine
  • Nimesulide
  • Nortriptyline
  • Oxaprozin
  • Opipramol
  • Paramethasone
  • Oxyphenbutazone
  • Parnaparin
  • Parecoxib
  • Pemetrexed
  • Paroxetine
  • Pentoxifylline
  • Pentosan Polysulfate Sodium
  • Phenprocoumon
  • Phenindione
  • Phenyl Salicylate
  • Phenylbutazone
  • Piroxicam
  • Piketoprofen
  • Pralatrexate
  • Polythiazide
  • Prednisolone
  • Prasugrel
  • Proglumetacin
  • Prednisone
  • Proquazone
  • Propyphenazone
  • Protriptyline
  • Protein C
  • Reviparin
  • Reboxetine
  • Rofecoxib
  • Rivaroxaban
  • Salicylic Acid
  • Salicylamide
  • Sertraline
  • Salsalate
  • Sodium Salicylate
  • Sibutramine
  • Sulfasalazine
  • Spironolactone
  • Tacrolimus
  • Sulindac
  • Tianeptine
  • Tenoxicam
  • Ticagrelor
  • Tiaprofenic Acid
  • Tinzaparin
  • Ticlopidine
  • Tolfenamic Acid
  • Tirofiban
  • Torsemide
  • Tolmetin
  • Triamterene
  • Treprostinil
  • Trimipramine
  • Trichlormethiazide
  • Valdecoxib
  • Trolamine Salicylate
  • Vilazodone
  • Venlafaxine
  • Vortioxetine
  • Vorapaxar
  • Xipamide
  • Warfarin

Instances of certain ill effects on your health can be amplified if you combine Nepafenac eye drops with the following medications:

  • Acebutolol
  • Alacepril
  • Atenolol
  • Azilsartan Medoxomil
  • Betaxolol
  • Azilsartan
  • Benazepril
  • Candesartan
  • Bisoprolol
  • Carteolol
  • Captopril
  • Celiprolol
  • Carvedilol
  • Delapril
  • Cilazapril
  • Enalaprilat
  • Enalapril
  • Esmolol
  • Eprosartan
  • Imidapril
  • Fosinopril
  • Labetalol
  • Irbesartan
  • Lisinopril
  • Levobunolol
  • Metipranolol
  • Losartan
  • Moexipril
  • Metoprolol
  • Nebivolol
  • Nadolol
  • Oxprenolol
  • Olmesartan
  • Pentopril
  • Penbutolol
  • Pindolol
  • Perindopril
  • Propranolol
  • Practolol
  • Ramipril
  • Quinapril
  • Spirapril
  • Sotalol
  • Temocapril
  • Telmisartan
  • Trandolapril
  • Timolol
  • Zofenopril
  • Valsartan

When in doubt about taking another medication while you are treating your eye with Nepafenac, it is best to contact your physician for advice before you combine any drugs.

Patients who suffer from the following medical conditions will want to inform their physician of this fact prior to taking a dose of Nepafenac:

  • NSAID sensitivity' past reactions to Advil, aspirin, celecoxib, etodolac, diclofenac, ibuprofen, nabumetone, indomethacin, naproxen, nabumetone, piroxicam, valdecoxib, rofecoxib, Aleve, Ecotrin, Celebrex, Motrin, Ecotrin, Voltaren or others
  • Bleeding issues
  • Denervation of the cornea
  • Epithelial defect of the cornea
  • Diabetes
  • Eye disease or surgical complications
  • Rheumatoid arthritis

These conditions could become worse with use of Nepafenac or they could limit the effectiveness that the active ingredients in the eye drops have on your condition. Communicate your full medical history to your doctor and ask any questions about conditions that may concern you.

Warnings

Your physician will schedule regular follow-up appointments with you in order to monitor your progress after surgery, including the effect that Nepafenac has on your pain and swelling from the operation. You will also want to make sure you mention any adverse health symptoms you've experienced as the result of taking this drug.

If your eye becomes inflamed or is painful after surgery, even with the use of Nepafenac, be sure to tell your doctor immediately. You may need alternate treatment or you may be reacting poorly to this medication.

It may take you longer to heal if you continue to take this medication post surgery. Combining this drug with a topical corticosteroid medication such as hydrocortisone or betamethasone will exacerbate this problem. Check with your doctor if you have concerns about healing duration while taking this medication.

Keratitis is a condition of the cornea that is at a higher risk while you are taking Nepafenac. If you notice symptoms such as deterioration or blurring of your vision, redness in the eye, irritated eye sensations or pain in your eyes, let your doctor know about these conditions right away.

This medication should be avoided in the latter stages of pregnancy, if possible. Make sure your physician is aware that you are pregnant prior to prescribing Nepafenac eye drops.

Avoid the use of other medications, vitamins or non-prescription remedies unless you have discussed them with your doctor first. You may cause adverse health reactions if you combine seemingly harmless medications with Nepafenac.

Storage

Never touch the tip of the dropper bottle to any surface including your finger, skin or eye. Do not attempt to clean the dropper with any solvents or chemicals. Keep the bottle tightly closed to prevent contamination of the contents.

Keep the original packaging and use it to store your dosage of Nepafenac at room temperature. Protect the medication from exposure to heat, moisture and excessive light and do not allow it to freeze. If allowed to freeze, dispose of the medication safely. Store this medication and others out of sight and reach of children and pets. Should you have unused or expired Nepafenac, follow the safety instructions on the disposal of this medication that have been given to you by your doctor or pharmacist.

Summary

Nepafenac is an NSAID pain relief eye drop medication that doctors prescribe to patients who will be having cataract and other ocular surgeries. NSAID medications are effective in fighting painful symptoms that occur with surgery as well as in the prevention of swelling, inflammation and redness that can occur. These types of medications are widely prescribed world-wide and are even available over the counter in some formulations. They are considered safe and effective for most people.

Typically patients will be instructed to administer this drug to the affected eye the day before surgery. Depending on the brand and strength, the dosage amount will vary from one drop daily to three drops daily. Dosage also depends on the condition of the patient and other health factors. In general, patients are prescribed a two week dosage of this medication, which should see them clear of any pain symptoms that may occur post-surgery.

Nepafenac can be taken with other eye medications, but it is best to wait at least five minutes between medicines for safety. Avoid wearing contact lenses after administering your dosage of Nepafenac to avoid any irritations to your eye. Report any worsening of your symptoms to your physician right away, especially if your sight has deteriorated or become blurry or if you have any pain.

Patients should avoid Nepafenac if they are pregnant, especially those in the latter stages of pregnancy. Women who are breastfeeding should not be treated with Nepafenac due to possible complications that could occur to their infant's development. It is not advised that this medication be used on the pediatric population for the same reason.

Nepafenac may increase the time it takes for your eye to heal, which is why it is important to stick to the dosage duration of 14 days at a maximum. Report any symptoms that become worse to your doctor while you are taking this medication. Avoid combining Nepafenac with any other drug or nutritional supplement to avoid dangerous health reactions. Consult your doctor before taking anything else with this drug.

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Last Reviewed:
March 26, 2018
Last Updated:
April 13, 2018
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