What is the dosage and administration of Nepafenac (nepafenac) eye drops for post-cataract surgery pain and inflammation management?

Nepafenac Eye Drop Dosage and Administration for Post-Cataract Surgery Pain and Inflammation

For post-cataract surgery pain and inflammation management, nepafenac 0.1% ophthalmic suspension should be applied as one drop to the affected eye three times daily beginning 1 day prior to cataract surgery, continued on the day of surgery, and through the first 2 weeks of the postoperative period. 1

Dosing Protocol

• One drop of nepafenac 0.1% should be applied to the affected eye three times daily (TID) 1
• Begin administration 1 day before cataract surgery 1
• Continue administration on the day of surgery 1
• Maintain treatment through the first 2 weeks after surgery 1
• Shake the container well prior to each dose 1
• An additional drop may be administered 30-120 minutes prior to surgery 2

Administration with Other Eye Medications

• Nepafenac 0.1% may be administered in conjunction with other topical ophthalmic medications (beta-blockers, carbonic anhydrase inhibitors, alpha-agonists, cycloplegics, and mydriatics) 1
• If using multiple topical ophthalmic medications, administer them at least 5 minutes apart 1
• Preferably use preservative-free formulations when possible, especially in high-risk patients, to minimize ocular surface irritation 3

Clinical Efficacy

• Nepafenac 0.1% TID dosing has been shown to significantly reduce treatment failures compared to placebo 2
• TID dosing achieves statistical significance in reducing inflammation beginning on day 3 post-surgery 2
• Significantly increases the proportion of patients with resolved ocular inflammation beginning on day 1 for TID dosing 2
• Significantly increases the percentage of pain-free patients beginning on day 1 with TID dosing 2

Precautions and Monitoring

• Monitor for signs of delayed healing, as topical NSAIDs may slow or delay healing 1
• Be cautious in patients with known bleeding tendencies, as nepafenac may increase bleeding time due to interference with thrombocyte aggregation 1
• Watch for corneal effects including keratitis, epithelial breakdown, corneal thinning, or erosion 1
• Patients with complicated ocular surgeries, corneal denervation, corneal epithelial defects, diabetes mellitus, ocular surface diseases, rheumatoid arthritis, or repeat ocular surgeries may be at increased risk for corneal adverse events 1
• Do not administer while using contact lenses 1

Follow-up Recommendations

• Perform postoperative follow-up on day 1 to check for signs of infection or inflammation 3
• Schedule additional follow-ups during weeks 1 and 2 to check for infection, dry eye occurrence, or ocular surface damage 3
• Evaluate treatment effect at 1 month post-surgery 3
• Consider that topical NSAIDs and topical steroids are recommended for use within the first post-surgical month based on current evidence and clinical expertise 3

Common Side Effects

• Most common adverse reactions (5% to 10%) include capsular opacity, decreased visual acuity, foreign body sensation, increased intraocular pressure, and sticky sensation 1
• Discontinue use immediately if there is evidence of corneal epithelial breakdown 1