Ilevro Drug Information
Generic name: NEPAFENAC
Nonsteroidal Anti-inflammatory Drug [EPC]
Uses of Ilevro
® 0.3% is indicated for the treatment of pain and inflammation associated with cataract surgery. ILEVRO ® 0.3% is a nonsteroidal, anti-inflammatory prodrug indicated for the treatment of pain and inflammation associated with cataract surgery.
Dosage & Administration of Ilevro
Recommended Dosing One drop of
ILEVRO ® 0.3% should be applied to the affected eye one time daily beginning 1 day prior to cataract surgery, continued on the day of surgery and through the first 2 weeks of the postoperative period. An additional drop should be administered 30 to 120 minutes prior to surgery.
Use with Other Topical Ophthalmic Medications
ILEVRO ® 0.3% may be administered in conjunction with other topical ophthalmic medications such as beta-blockers, carbonic anhydrase inhibitors, alpha-agonists, cycloplegics, and mydriatics. If more than one topical ophthalmic medication is being used, the medicines must be administered at least 5 minutes apart.
Side Effects of Ilevro
Serious and Otherwise Important Adverse Reactions
The following adverse reactions are discussed in greater detail in other sections of labeling. Increased Bleeding Time Delayed Healing Corneal Effects
Ocular Adverse Reactions
The most frequently reported ocular adverse reactions following cataract surgery were capsular opacity, decreased visual acuity, foreign body sensation, increased intraocular pressure (IOP), and sticky sensation. These reactions occurred in approximately 5% to 10% of patients. Other ocular adverse reactions occurring at an incidence of approximately 1% to 5% included conjunctival edema, corneal edema, dry eye, lid margin crusting, ocular discomfort, ocular hyperemia, ocular pain, ocular pruritus, photophobia, tearing, and vitreous detachment.
Some of these reactions may be the consequence of the cataract surgical procedure.
Non-Ocular Adverse Reactions Non-ocular adverse reactions reported at an incidence of 1%
to 4% included headache, hypertension, nausea/vomiting, and sinusitis.
Warnings & Cautions for Ilevro
Increased Bleeding Time With some
NSAIDs including ILEVRO ® 0.3%, there exists the potential for increased bleeding time due to interference with thrombocyte aggregation. There have been reports that ocularly applied nonsteroidal anti-inflammatory drugs may cause increased bleeding of ocular tissues (including hyphema) in conjunction with ocular surgery. It is recommended that ILEVRO ® 0.3% be used with caution in patients with known bleeding tendencies or who are receiving other medications which may prolong bleeding time.
Delayed Healing Topical
NSAIDs including ILEVRO ® 0.3%, may slow or delay healing. Topical corticosteroids are also known to slow or delay healing. Concomitant use of topical NSAIDs and topical steroids may increase the potential for healing problems.
Corneal Effects Use of topical
NSAIDs may result in keratitis. In some susceptible patients, continued use of topical NSAIDs may result in epithelial breakdown, corneal thinning, corneal erosion, corneal ulceration, or corneal perforation. These events may be sight threatening.
Patients with evidence of corneal epithelial breakdown should immediately discontinue use of topical NSAIDs including ILEVRO ® 0.3% and should be closely monitored for corneal health. Postmarketing experience with topical NSAIDs suggests that 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 corneal adverse events, which may become sight threatening. Topical NSAIDs should be used with caution in these patients.
Postmarketing experience with topical NSAIDs also suggests that use more than 1 day prior to surgery or use beyond 14 days post-surgery may increase patient risk and severity of corneal adverse events.
Contact Lens Wear
ILEVRO ® 0.3% should not be administered while using contact lenses.
Pregnancy Safety for Ilevro
Pregnancy Teratogenic Effects. Pregnancy Category C: Reproduction studies performed with nepafenac in rabbits and rats at oral doses up to 10 mg/kg/day have revealed no evidence of teratogenicity due to nepafenac, despite the induction of maternal toxicity. At this dose, the animal plasma exposure to nepafenac and amfenac was approximately 70 and 630 times human plasma exposure at the recommended human topical ophthalmic dose for rats and 20 and 180 times human plasma exposure for rabbits, respectively.
In rats, maternally toxic doses greater than or equal to 10 mg/kg were associated with dystocia, increased postimplantation loss, reduced fetal weights and growth, and reduced fetal survival. Nepafenac has been shown to cross the placental barrier in rats. There are no adequate and well-controlled studies in pregnant women.
Because animal reproduction studies are not always predictive of human response, ILEVRO ® 0.3% should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus. Non-teratogenic Effects Because of the known effects of prostaglandin biosynthesis inhibiting drugs on the fetal cardiovascular system (closure of the ductus arteriosus), the use of ILEVRO ® 0.3% during late pregnancy should be avoided.
Pediatric Use of Ilevro
Pediatric Use The safety and effectiveness of ILEVRO ® 0.3% in pediatric patients below the age of 10 years have not been established.
Contraindications for Ilevro
® 0.3% is contraindicated in patients with previously demonstrated hypersensitivity to any of the ingredients in the formula or to other nonsteroidal anti-inflammatory drugs (NSAIDs). Hypersensitivity to any of the ingredients in the formula or to other non-steroidal anti-inflammatory drugs (NSAIDS).
Clinical Studies of Ilevro
In two double masked, randomized clinical trials in which patients were dosed daily beginning one day prior to cataract surgery, continued on the day of surgery and for the first two weeks of the postoperative period, ILEVRO ® 0.3% demonstrated superior clinical efficacy compared to its vehicle in treating postoperative pain and inflammation. Treatment effect over vehicle for resolution of ocular pain occurred as early as Day 1 post-surgery. Treatment effect over vehicle for resolution of inflammation was significantly better than vehicle in both studies at Day 7 and Day 14 post-surgery.
Table 1: Inflammation and Ocular Pain Resolution Results of Nepafenac Ophthalmic Suspension, 0.3% versus Vehicle at Day 14 Post-surgery (All-Randomized Population) Study Treatment Inflammation Resolution at Postop Day 14 Ocular Pain Resolution at Postop Day 14 Abbreviation: CI, confidence interval. n/N is the ratio of those with complete resolution of anterior chamber cell and flare by the postoperative Day 14 visit over all randomized subjects. Difference is Nepafenac ophthalmic suspension, 0.3% (n/N) – vehicle. The 95% CI is derived using asymptotic approximation.
Study 1 Nepafenac ophthalmic suspension, 0.3% (n/N) 552/851 (65%) 734/851 (86%) NEVANAC (n/N) 568/845 (67%) 737/845 (87%) Vehicle (n/N) 67/211 (32%) 98/211 (46%) Difference (95% CI) 33% (26%, 40%) 40% (32%, 47%) Study 2 Nepafenac ophthalmic suspension, 0.3% (n/N) 331/540 (61%) 456/540 (84%) Vehicle (n/N) 63/268 (24%) 101/268 (38%) Difference (95% CI) 38% (31%, 45%) 47% (40%, 54%)
Drug information sourced from the FDA. This content is for informational purposes only and does not constitute medical advice. Consult a healthcare professional before making any medication decisions.
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