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Ilevro (Nepafenac 0.3%)

A once-daily NSAID eye drop for treating inflammation and pain after cataract surgery.

Drug Class: NSAIDs

5 min read

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.

Official website: ilevrohcp.com

Key Takeaways

  • NSAID eye drop for post-cataract surgery
  • Once daily dosing-improved convenience
  • Prodrug design activates inside the eye
  • Shake well before each use
  • Used with steroid drops for optimal post-op care
Ilevro nepafenac ophthalmic suspension 0.3% eye drop bottle and packaging for post-cataract surgery inflammation

How It Works

Infographic on how nepafenac (Ilevro) works: nepafenac is a topical ophthalmic NSAID prodrug that is inactive when applied to the ocular surface, is bioactivated by intraocular hydrolases into its active metabolite amfenac after penetrating into the eye, and then inhibits cyclooxygenase (COX-1 and COX-2) enzymes to reduce prostaglandin synthesis; lower prostaglandin levels decrease ocular inflammation, pain, and swelling; the prodrug design is intended to enhance corneal and intraocular penetration and improve surface tolerability compared with non-prodrug NSAID eye drops, supporting its use for post-cataract-surgery inflammation and prevention of cystoid macular edema

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

Rare But Serious

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

Precautions

Important precautions:

  • Shake well before every use
  • Aspirin/NSAID allergy: May be contraindicated
  • Bleeding disorders: Inform your doctor
  • Corneal problems: Use with caution
  • Contact lenses: Don't wear during treatment
  • Complicated surgery: May need closer monitoring

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.

References

For current U.S. drug labeling, contraindications, boxed warnings, pregnancy/lactation language, and formulation-specific dosing, check the official label databases and your prescriber's instructions.

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