Class: Nonsteroidal Anti-inflammatory Agents
VA Class: CN104
Chemical Name: 2-amino-3-benzoylbenzeneacetamide
Molecular Formula: C15H14N2O2
Uses for Nepafenac
Postoperative Ocular Inflammation and Pain
Nepafenac Dosage and Administration
Apply topically to the eye as an ophthalmic suspension.1
Avoid contamination of the suspension container.9
Shake suspension container well prior to administration.1
Do not administer to an eye that has a contact lens.1 (See Advice to Patients.)
May be used in conjunction with other topical ophthalmic medications such as β-adrenergic blocking agents, carbonic anhydrase inhibitors, α-agonists, cycloplegics, and mydriatics.1 9 If >1 topical ophthalmic drug is used, administer the drugs 10 minutes apart from nepafenac administration.9
Postoperative Ocular Inflammation and Pain
Patients ≥10 years of age: 1 drop of a 0.1% suspension in the affected eye(s) 3 times daily, beginning 1 day prior to cataract surgery and continuing on the day of the surgery and for 2 weeks after surgery.1
Postoperative Ocular Inflammation and Pain
1 drop of a 0.1% suspension in the affected eye(s) 3 times daily, beginning 1 day prior to cataract surgery and continuing on the day of the surgery and for 2 weeks after surgery.1
Cautions for Nepafenac
Known hypersensitivity to nepafenac or any ingredient in the formulation or to other NSAIAs.1
May inhibit platelet aggregation and prolong bleeding time.1
May cause increased bleeding of ocular tissues (including hyphemas) when used in conjunction with ocular surgery.1
Use with caution in patients with underlying bleeding tendencies or in those receiving drugs known to prolong bleeding time.1
May slow or delay wound healing.1 (See Specific Drugs under Interactions.)
Use may result in keratitis.1 In some susceptible patients, continued use may result in epithelial breakdown, corneal thinning, corneal erosion, corneal ulceration, or corneal perforation; these events may be sight-threatening.1 If manifestations of corneal epithelial breakdown occur, discontinue therapy immediately and monitor for corneal health.1
Patients with complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface diseases (e.g., dry eye syndrome), rheumatoid arthritis, or repeat ocular surgeries within a short period of time may be at increased risk for developing adverse corneal effects that may become sight-threatening.1 Use with caution in these patients.1
Use >1 day prior to surgery or use beyond 14 days postoperatively may precipitate or exacerbate adverse corneal effects.1
No substantial effect on intraocular pressure reported; however, changes in intraocular pressure may occur following cataract surgery.1
Avoid use in late pregnancy because of known effects on fetal cardiovascular system (possible closure of the ductus arteriosus).1
Safety and efficacy not established in children <10 years of age.1
No substantial differences in safety and efficacy relative to younger adults.1
Common Adverse Effects
Capsular opacity, decreased visual acuity, ocular foreign body sensation, increased intraocular pressure, ocular sticky sensation, conjunctival edema, corneal edema, dry eye, lid margin crusting, ocular discomfort, ocular hyperemia, ocular pain, ocular pruritus, photophobia, tearing, vitreous detachment, headache, hypertension, nausea, vomiting, sinusitis.1
Interactions for Nepafenac
Does not inhibit CYP isoenzymes 1A2, 2C9, 2C19, 2D6, 2E1, or 3A4 in vitro.1
Drugs Metabolized by Hepatic Microsomal Enzymes
Pharmacokinetic interactions with drugs metabolized by CYP isoenzymes 1A2, 2C9, 2C19, 2D6, 2E1, or 3A4 unlikely.1
Pharmacokinetic interaction unlikely.1
Increased potential for wound-healing complications1
Prodrug; penetrates the cornea following topical application to the eye and converted by ocular tissue hydrolases to amfenac.1
Following 3 times daily bilateral topical ophthalmic application, low, but quantifiable, plasma concentrations of nepafenac and amfenac observed 2 and 3 hours postdose, respectively.1
Converted by ocular tissue hydrolases to amfenac.1 (See Bioavailability under Pharmacokinetics.)
Advice to Patients
Importance of learning and adhering to proper administration techniques to avoid contamination of the ophthalmic suspension with common bacteria that can cause ocular infections.9
Importance of administering different topical ophthalmic preparations 10 minutes apart from nepafenac administration.9
Importance of not using topical NSAIAs >1 day prior to surgery or beyond 14 days after surgery.1
Importance of informing clinicians of existing or contemplated concomitant therapy, including prescription and OTC drugs, as well as any concomitant illnesses.1
Importance of informing patients of other important precautionary information.1 (See Cautions.)
Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.
Nevanac (with benzalkonium chloride)
This pricing information is subject to change at the sole discretion of DS Pharmacy. This pricing information was updated 02/2013. Actual costs to patients will vary depending on the use of specific retail or mail-order locations and health insurance copays.
Nevanac 0.1% Suspension (ALCON VISION): 3/$144.00 or 9/$412.97
This report on medications is for your information only, and is not considered individual patient advice. Because of the changing nature of drug information, please consult your physician or pharmacist about specific clinical use.
The American Society of Health-System Pharmacists, Inc. and Drugs.com represent that the information provided hereunder was formulated with a reasonable standard of care, and in conformity with professional standards in the field. The American Society of Health-System Pharmacists, Inc. and Drugs.com make no representations or warranties, express or implied, including, but not limited to, any implied warranty of merchantability and/or fitness for a particular purpose, with respect to such information and specifically disclaims all such warranties. Users are advised that decisions regarding drug therapy are complex medical decisions requiring the independent, informed decision of an appropriate health care professional, and the information is provided for informational purposes only. The entire monograph for a drug should be reviewed for a thorough understanding of the drug's actions, uses and side effects. The American Society of Health-System Pharmacists, Inc. and Drugs.com do not endorse or recommend the use of any drug. The information is not a substitute for medical care.
AHFS Drug Information. © Copyright, 1959-2013, Selected Revisions March 31, 2011. American Society of Health-System Pharmacists, Inc., 7272 Wisconsin Avenue, Bethesda, Maryland 20814.
1. Alcon Laboratories, Inc. Nevanac (nepafenac ophthalmic suspension) 0.1% prescribing information. Fort Worth, TX; 2005.
2. O’Brien TP. Emerging guidelines for use of NSAID therapy to optimize cataract surgery patient care. Curr Med Res Opin. 2005; 21:1131-37.
3. Takahashi K, Saishin Y, Saishin Y et al. Topical nepafenac inhibits ocular neovascularization. Invest Ophthalmol Vis Sci. 2003; 44:409-15. [PubMed 12506103]
4. Lane SS, Modi SS, Holland EJ et al. Pre- and post-operative nepafenac ophthalmic suspension, 0.1% for anterior segment inflammation after cataract surgery. Paper presented at the annual ASCRS/ASOA symposium and congress. Washington, DC: 2005 Apr 18.
5. Stewart WC, Stewart R, Maxwell WA et al. Pre- and post-operative clinical posology evaluation of nepafenac ophthalmic suspension, 0.1% for anterior segment inflammation after cataract surgery. Paper presented at the annual ASCRS/ASOA symposium and congress. Washington, DC: 2005 Apr 18.
6. Gamache DA, Graff G, Brady MT et al. Nepafenac, a unique nonsteroidal prodrug with potential utility in the treatment of trauma-induced ocular inflammation: I. Assessment of anti-inflammatory efficacy. Inflammation. 2000; 24:357-70. [PubMed 10850857]
7. Ke TL, Graff G, Spellman JM et al. Nepafenac, a unique nonsteroidal prodrug with potential utility in the treatment of trauma-induced ocular inflammation: II. In vitro bioactivation and permeation of external ocular barriers. Inflammation. 2000; 24:371-84. [PubMed 10850858]
8. Kapin MA, Yanni JM, Brady MT et al. Inflammation-mediated retinal edema in the rabbit is inhibited by topical nepafenac. Inflammation. 2003; 27:281-91. [PubMed 14635785]
9. Alcon Laboratories, Inc., Fort Worth, TX: Personal Communication.