Home Drug Guide Nepafenac

Drug Guide

Generic Name

Nepafenac

Brand Names Nevanac, Ilevro

Classification

Therapeutic: Ophthalmic anti-inflammatory, analgesic

Pharmacological: Nonsteroidal anti-inflammatory drug (NSAID)

FDA Approved Indications

  • Prevention of postoperative pain and inflammation following cataract surgery

Mechanism of Action

Nepafenac is a prodrug that penetrates ocular tissues and is converted to amfenac, which inhibits cyclooxygenase (COX-1 and COX-2) enzymes, reducing prostaglandin synthesis and thereby decreasing inflammation and pain.

Dosage and Administration

Adult: One drop in the affected eye(s) once daily, starting 1 day before surgery and continuing the day after surgery, then as directed by the ophthalmologist.

Pediatric: Safety and effectiveness in pediatric patients have not been established.

Geriatric: No specific dosage adjustments are generally necessary, but caution should be exercised in elderly patients due to potential for age-related ocular or systemic comorbidities.

Renal Impairment: No specific dosage adjustments, but caution advised.

Hepatic Impairment: No specific dosage adjustments.

Pharmacokinetics

Absorption: Rapidly absorbed in ocular tissues when administered topically.

Distribution: Primarily ocular tissues; low systemic absorption.

Metabolism: Converted to active amfenac in ocular tissues.

Excretion: Minor systemic absorption, excreted primarily via the renal route.

Half Life: Approximately 1-3 hours in the ocular tissues.

Contraindications

  • Hypersensitivity to nepafenac, other NSAIDs, or any component of the formulation.

Precautions

  • Use with caution in patients with risk factors for bleeding, during pregnancy and lactation, and in patients with ocular infections.

Adverse Reactions - Common

  • Eye pain, headache (Unknown)
  • Blurred vision (Unknown)
  • Conjunctival hemorrhage (Unknown)

Adverse Reactions - Serious

  • Corneal adverse reactions, such as corneal thinning or ulceration (Uncommon)
  • Allergic reactions including hypersensitivity (Rare)

Drug-Drug Interactions

  • Increased risk of bleeding with concomitant anticoagulants or antiplatelet agents

Drug-Food Interactions

  • None significant

Drug-Herb Interactions

  • Potential increased bleeding risk with herbal products like ginkgo or garlic

Nursing Implications

Assessment: Assess for ocular irritation, pain, or signs of allergic reaction before and during therapy.

Diagnoses:

  • Risk for infection, pain, risk for bleeding.

Implementation: Administer as prescribed, monitor for side effects, educate patient on proper administration.

Evaluation: Evaluate reduction in pain and inflammation, monitor ocular health.

Patient/Family Teaching

  • Instruct on proper eye drop technique.
  • Advise to report any signs of allergic reactions or ocular discomfort.
  • Emphasize importance of adhering to dosing schedule.

Special Considerations

Black Box Warnings:

  • None

Genetic Factors: None established.

Lab Test Interference: No known interference.

Overdose Management

Signs/Symptoms: Ocular irritation, systemic NSAID overdose symptoms (nausea, dizziness) rare.

Treatment: Supportive care, ocular irrigation if topical overdose, monitor and symptomatic treatment.

Storage and Handling

Storage: Store at room temperature, away from light and moisture.

Stability: Stable under recommended storage conditions until expiration date.

🛡️ 5 Critical Medication Safety Tips for Nurses

1

Triple-Check High-Risk Medications

Always have another nurse verify insulin, heparin, warfarin, and chemotherapy drugs. These "high-alert" medications cause the most serious errors. Check concentration, dose calculation, and pump settings twice.

2

Know Look-Alike, Sound-Alike Drugs

Common mix-ups: hydromorphone/morphine, Celebrex/Celexa, Zyprexa/Zyrtec. Always use BOTH generic and brand names, read labels twice, and use barcode scanning when available. One wrong letter can be fatal.

3

Assess Before AND After Giving Meds

Check vitals before cardiac meds, pain levels before analgesics, and blood glucose before insulin. Always reassess within 30 minutes to evaluate effectiveness and watch for adverse reactions.

4

Watch for Drug Interactions

Common dangerous combinations: warfarin + aspirin (bleeding), ACE inhibitors + potassium (hyperkalemia), digoxin + diuretics (toxicity). Always check drug interactions before administering new medications.

5

Educate Your Patients

Teach patients medication names, purposes, major side effects, and what to report. Informed patients catch errors and improve compliance. Always encourage questions - an educated patient is a safer patient.

⚡ Remember: When in doubt, don't give it out! It's always safer to double-check than regret later.

⚠️ Medical Disclaimer

This drug guide is for educational purposes only and is NOT intended for clinical use. Always consult current prescribing information, healthcare providers, and institutional protocols before administering any medication. Do not use this information for patient care decisions.