Nepafenac 0.1% / 0.3% Eye Drops

How it works

Nepafenac is a prodrug that penetrates the cornea and is converted by intraocular hydrolases to amfenac, which inhibits cyclo-oxygenase and reduces prostaglandin-mediated ocular inflammation; the 0.3% formulation allows once-daily dosing.

Prescribing in practice

• Topical ocular NSAIDs can impair corneal epithelial healing and, rarely, cause corneal melt or perforation, so use with particular caution in patients with diabetes, rheumatoid arthritis, dry eye, repeated ocular surgery or corneal denervation.
• Concomitant use with topical corticosteroids may increase the potential for corneal adverse effects and warrants closer review of corneal status.
• Confirm which strength is prescribed, as the 0.1% and 0.3% products differ in dosing frequency.

Monitoring

Monitor corneal integrity on slit-lamp examination, especially if symptoms persist or in higher-risk corneas, and stop if epithelial breakdown develops.

Counselling the patient

• Shake the bottle before use and use only the strength and frequency prescribed.
• Report any increasing eye pain, redness or sensitivity to light, as the drop should be stopped if the cornea is affected.
• Avoid contact lens wear during treatment unless specifically advised otherwise.

Evidence & guidelines

Topical NSAIDs reduce post-cataract-surgery inflammation and cystoid macular oedema, with the MHRA and SPC highlighting the class risk of corneal epithelial adverse effects.