Ilevro (Nepafenac 0.3%)

Ilevro (nepafenac ophthalmic suspension 0.3%) is a nonsteroidal anti-inflammatory drug (NSAID) eye drop used to treat pain and inflammation after cataract surgery. It's a prodrug that becomes active after penetrating the eye.

How It Works

Nepafenac is a prodrug:

• Inactive when applied to the eye surface
• Converted to active form (amfenac) inside the eye
• Inhibits COX enzymes, reducing prostaglandins
• Decreases inflammation, pain, and swelling

The prodrug design may improve penetration and tolerability.

Common Uses

• Pain and inflammation after cataract surgery
• Prevention of cystoid macular edema (CME)
• Part of post-operative medication regimen

How to Use

• Dosing: One drop in the operative eye once daily
• Shake well before each use (it's a suspension)
• Timing: Start 1 day before surgery, day of surgery, and for 14 days after
• Contact lenses: Don't wear during treatment
• Multiple drops: Wait at least 5 minutes between different medications

Typical Post-Cataract Surgery Regimen

Usually includes:

1. Antibiotic drop—prevent infection
2. Steroid drop—control inflammation
3. NSAID drop (Ilevro)—additional anti-inflammatory, prevent CME

What to Expect

• Helps manage post-surgical inflammation
• Contributes to comfortable recovery
• Complete full course as directed

Side Effects

Common

• Capsular opacity (posterior capsule opacification—can occur anyway after cataract surgery)
• Eye pain
• Increased intraocular pressure
• Headache
• Foreign body sensation
• Eye irritation

Less Common

• Blurred vision
• Eye redness
• Light sensitivity
• Corneal issues (with prolonged use)

Rare But Serious

• Corneal problems (erosion, perforation)—more likely with prolonged use or corneal disease
• Delayed wound healing

Precautions

Corneal Considerations

NSAIDs can affect corneal healing. Use with caution in:

• Pre-existing corneal disease
• Repeated eye surgeries
• Complicated surgical cases

Ilevro vs. Other NSAID Eye Drops

Medication	Active Drug	Dosing	Notes
Ilevro	Nepafenac 0.3%	Once daily	Prodrug, suspension
Prolensa	Bromfenac 0.07%	Once daily	Solution
Nevanac	Nepafenac 0.1%	Three times daily	Lower concentration
Ketorolac	Ketorolac 0.5%	Four times daily	Generic available

Why NSAIDs After Eye Surgery?

Complementary to Steroids

• Different anti-inflammatory mechanism
• Enhanced inflammation control together
• May allow lower steroid doses

CME Prevention

• Cystoid macular edema (retinal swelling) can occur after surgery
• Can affect vision significantly
• NSAIDs help prevent this complication

Pain Management

• Reduces post-operative discomfort
• Targets inflammatory pain at source

Frequently Asked Questions

What's the difference between Ilevro and Nevanac?

Both contain nepafenac, but Ilevro (0.3%) is dosed once daily while Nevanac (0.1%) is dosed three times daily. Ilevro's higher concentration allows less frequent dosing.

Why do I need to shake Ilevro?

Ilevro is a suspension—the medication particles settle. Shaking ensures you get the correct dose with each drop.

Can I skip the NSAID if I'm using a steroid drop?

Your surgeon prescribed both for a reason. NSAIDs provide additional benefits, particularly in preventing macular swelling. Follow your surgeon's complete regimen.

How long do I use Ilevro?

Typically start 1 day before surgery and continue through 14 days after (total of about 16 days). Follow your surgeon's specific instructions.

What if I'm allergic to aspirin?

If you have aspirin-sensitive asthma or severe NSAID allergy, tell your surgeon. An alternative may be needed.

Can I use Ilevro for other eye conditions?

Ilevro is specifically approved for post-cataract surgery use. Other uses would be off-label and based on your doctor's clinical judgment.