NEVANAC
NSAID Eye Drops for Pain and Inflammation After Cataract Surgery
Quick Facts About NEVANAC
Key Takeaways About NEVANAC
- Purpose-built for cataract surgery: NEVANAC is specifically designed to prevent and relieve eye pain and inflammation following cataract surgery, and to reduce the risk of macular oedema in diabetic patients
- Prodrug technology: Nepafenac is a prodrug that penetrates the cornea and is converted to the active metabolite amfenac inside the eye, providing targeted anti-inflammatory action
- Three times daily dosing: Apply one drop three times daily (morning, midday, evening) starting one day before surgery and continuing as directed by your doctor
- Avoid sunlight exposure: Avoid direct sunlight during treatment as nepafenac may increase photosensitivity
- Not for children: NEVANAC has not been studied in patients under 18 years of age and is not recommended for this age group
What Is NEVANAC and What Is It Used For?
NEVANAC contains the active substance nepafenac, an ophthalmic non-steroidal anti-inflammatory drug (NSAID). It is used in adults to prevent and relieve eye pain and inflammation after cataract surgery, and to reduce the risk of macular oedema in diabetic patients undergoing cataract surgery.
NEVANAC belongs to a group of medicines known as non-steroidal anti-inflammatory drugs (NSAIDs), which work by inhibiting the production of prostaglandins – chemicals that the body produces in response to injury or surgery. In the eye, prostaglandins cause pain, redness, swelling, and can contribute to the development of macular oedema (fluid accumulation at the back of the eye). By blocking prostaglandin synthesis, NEVANAC helps control the inflammatory response that naturally occurs after cataract surgery.
What makes NEVANAC unique among ophthalmic NSAIDs is that nepafenac is a prodrug. This means that the molecule itself is not the active anti-inflammatory agent. Instead, after nepafenac penetrates through the cornea, it is converted by intraocular tissue hydrolases into its active metabolite, amfenac. Amfenac is a potent inhibitor of cyclooxygenase (COX) enzymes, specifically both COX-1 and COX-2. This prodrug design allows efficient corneal penetration while delivering targeted anti-inflammatory activity inside the eye where it is needed most.
NEVANAC is prescribed for two primary indications in adult patients. The first is the prevention and relief of ocular pain and inflammation associated with cataract surgery. Cataract surgery involves removing the clouded natural lens of the eye and replacing it with an artificial intraocular lens. While modern cataract surgery (phacoemulsification) is generally safe and well tolerated, the surgical manipulation inevitably triggers an inflammatory response in the eye. NEVANAC helps control this postoperative inflammation, reducing pain, redness, and discomfort during the healing process.
The second indication is the reduction of risk of macular oedema following cataract surgery in patients with diabetes. Diabetic patients are at significantly higher risk of developing pseudophakic cystoid macular oedema (PCME) – also known as Irvine-Gass syndrome – after cataract surgery. This condition involves swelling of the macula (the central part of the retina responsible for sharp, detailed vision), which can lead to temporary or permanent vision loss. Clinical trials have demonstrated that NEVANAC significantly reduces the incidence of macular oedema in diabetic patients when used as directed.
Cataract surgery is the most commonly performed surgical procedure worldwide, with an estimated 28 million procedures annually. Ophthalmic NSAIDs such as NEVANAC have become a standard part of the perioperative regimen recommended by the American Academy of Ophthalmology (AAO) and the European Society of Cataract and Refractive Surgeons (ESCRS) to optimise surgical outcomes.
What Should You Know Before Using NEVANAC?
Do not use NEVANAC if you are allergic to nepafenac or other NSAIDs, or if you have experienced asthma, skin allergy, or nasal inflammation after using NSAIDs. Inform your doctor about all medical conditions, especially bleeding disorders, eye diseases, diabetes, and rheumatic diseases.
Contraindications
You should not use NEVANAC if any of the following apply to you:
- Allergy to nepafenac or any of the other ingredients in this medicine, including benzalkonium chloride, carbomer, disodium edetate, mannitol, sodium chloride, or tyloxapol
- Allergy to other NSAIDs – if you have ever had an allergic reaction to any non-steroidal anti-inflammatory drug, whether taken by mouth (such as aspirin, ibuprofen, diclofenac) or applied to the eye
- NSAID-triggered respiratory or skin reactions – if you have experienced asthma, skin allergies (urticaria), or intense nasal inflammation (rhinitis) after using any NSAID, including aspirin, ibuprofen, ketoprofen, piroxicam, or diclofenac
These conditions indicate an underlying sensitivity to the cyclooxygenase inhibition mechanism shared by all NSAIDs, and using NEVANAC could trigger a similar or more severe reaction.
Warnings and Precautions
Talk to your doctor, pharmacist, or nurse before using NEVANAC if you:
- Bruise easily or have bleeding problems – NSAIDs can affect blood clotting, and their use in the eye may increase the risk of intraocular bleeding during or after surgery
- Have another eye disease (such as an eye infection) or are using other eye medications, particularly topical corticosteroids – the combination of ophthalmic NSAIDs and corticosteroids may increase the risk of corneal complications
- Have diabetes – diabetic patients are at increased risk for corneal problems and delayed wound healing; however, NEVANAC is specifically indicated for macular oedema prevention in this population
- Have rheumatoid arthritis or other autoimmune conditions – these conditions are associated with an increased risk of corneal problems including thinning and perforation when using topical NSAIDs
- Have had repeated eye surgeries within a short period – multiple surgeries increase the risk of corneal adverse events
In rare cases, topical ophthalmic NSAIDs (including nepafenac) have been associated with corneal adverse events including thinning, erosion, ulceration, and perforation. These events may be sight-threatening and may require surgical intervention. Patients with a history of complicated eye surgery, corneal denervation, corneal epithelial defects, diabetes, rheumatic diseases, or repeated eye surgeries within a short time are at increased risk. If you notice increasing eye redness, pain, light sensitivity, or blurred vision while using NEVANAC, contact your doctor immediately.
Avoid sunlight during treatment with NEVANAC. Nepafenac may increase sensitivity to ultraviolet light. Wear sunglasses and avoid prolonged sun exposure while using this medication.
Contact lenses: Contact lens use is not recommended after cataract surgery. Your doctor will tell you when you can safely resume wearing contact lenses. NEVANAC contains benzalkonium chloride, which can be absorbed by soft contact lenses and may cause discolouration. If you do wear contact lenses, remove them before applying NEVANAC and wait at least 15 minutes before reinserting them.
Children and Adolescents
Do not give NEVANAC to children and adolescents under 18 years of age. The safety and efficacy of nepafenac eye drops have not been established in this age group. There are no clinical data available to support paediatric use.
Pregnancy and Breastfeeding
If you are pregnant, think you may be pregnant, or are planning to have a baby, consult your doctor before using NEVANAC. Women of childbearing potential are advised to use effective contraception during treatment with NEVANAC. The use of NEVANAC during pregnancy is not recommended unless your doctor specifically instructs you to use it, as NSAIDs may affect foetal development, particularly during the third trimester when they can cause premature closure of the ductus arteriosus and impair renal function in the foetus.
If you are breastfeeding, NEVANAC may pass into breast milk in very small amounts. However, due to the minimal systemic absorption from topical ophthalmic use, no effects on the nursing infant are expected. NEVANAC can be used during breastfeeding.
Driving and Operating Machinery
Do not drive or operate machinery until your vision has cleared. You may experience temporary blurred vision immediately after applying NEVANAC eye drops. Wait until your vision returns to normal before driving or performing activities that require clear eyesight.
Benzalkonium Chloride Content
NEVANAC contains benzalkonium chloride (0.05 mg/ml) as a preservative. This substance can be absorbed by soft contact lenses and may discolour them. Remove contact lenses before use and wait at least 15 minutes before reinserting them. Benzalkonium chloride may also be irritating to the eyes, especially if you have dry eyes or corneal conditions. If you experience irritation, stinging, or pain in the eye after applying the drops, contact your doctor.
How Does NEVANAC Interact with Other Drugs?
NEVANAC can interact with other eye drops, particularly glaucoma medications and topical corticosteroids. It may also interact with systemic blood-thinning medications such as warfarin and other oral NSAIDs. Always inform your doctor about all medications you are using.
Although NEVANAC is applied topically to the eye and has minimal systemic absorption, it can still interact with other medications, both ophthalmic and systemic. The most significant interactions involve other eye drops and medications that affect blood clotting or prostaglandin pathways.
Ophthalmic Drug Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Topical corticosteroids (e.g. dexamethasone, prednisolone) | Anti-inflammatory (ophthalmic) | Combined use may increase the risk of corneal complications, including delayed healing and corneal thinning | Use combination only under ophthalmologist supervision; monitor corneal health closely |
| Prostaglandin analogues (e.g. latanoprost, bimatoprost) | Glaucoma medication | NSAIDs may reduce the efficacy of prostaglandin analogues used for glaucoma management | Inform your ophthalmologist; intraocular pressure monitoring recommended |
| Other ophthalmic NSAIDs (e.g. ketorolac, diclofenac drops) | Anti-inflammatory (ophthalmic) | Additive risk of corneal adverse events and increased bleeding risk | Do not combine; use only one ophthalmic NSAID at a time |
Systemic Drug Interactions
| Drug | Category | Effect | Recommendation |
|---|---|---|---|
| Warfarin | Anticoagulant | NSAIDs may enhance the anticoagulant effect of warfarin, increasing bleeding risk | Inform your doctor; monitor INR more frequently during treatment |
| Oral NSAIDs (e.g. ibuprofen, aspirin, diclofenac) | Anti-inflammatory / Analgesic | Additive NSAID effects; may increase systemic and ocular side effects | Inform your doctor about all NSAID use; use with caution |
| Other anticoagulants / Antiplatelets (e.g. heparin, clopidogrel) | Blood-thinning medications | May increase the risk of intraocular or periocular bleeding | Inform your surgeon before cataract surgery; careful perioperative management |
If you are using other eye drops in addition to NEVANAC, wait at least five minutes between each application to prevent the drops from washing each other out and to allow adequate absorption of each medication.
What Is the Correct Dosage of NEVANAC?
The recommended dose is one drop of NEVANAC in the affected eye(s) three times daily – morning, midday, and evening. Treatment begins one day before cataract surgery and continues for up to 3 weeks (for pain and inflammation) or 60 days (for macular oedema prevention in diabetic patients).
Always use NEVANAC exactly as your doctor or pharmacist has told you. Do not change your dose or stop using the drops without consulting your doctor first. NEVANAC is for ophthalmic use only – it must not be swallowed or injected.
Adults
Pain and Inflammation After Cataract Surgery
Dose: One drop in the affected eye(s) three times daily
Duration: Start one day before surgery, continue on the day of surgery, then continue for up to 3 weeks after surgery or as directed by your doctor
Timing: Morning, midday, and evening, at approximately the same times each day
Macular Oedema Prevention (Diabetic Patients)
Dose: One drop in the affected eye(s) three times daily
Duration: Start one day before surgery, continue on the day of surgery, then continue for up to 60 days after surgery or as directed by your doctor
This longer treatment duration is necessary because diabetic macular oedema can develop weeks after surgery.
How to Apply NEVANAC Eye Drops
Follow these steps carefully each time you apply the eye drops:
- Wash your hands thoroughly before handling the bottle.
- Shake the bottle well before each use. NEVANAC is a suspension and must be mixed before application.
- Remove the cap. If the safety collar is loose after removing the cap, remove it before using the product.
- Hold the bottle upside down between your thumb and other fingers.
- Tilt your head back and look up at the ceiling.
- Gently pull down the lower eyelid with a clean finger to create a small pocket between the eyelid and the eye.
- Bring the bottle tip close to the eye but do not touch the eye, eyelid, surrounding areas, or any other surface with the dropper tip, as this can contaminate the drops.
- Gently press the bottom of the bottle with your index finger to release one drop into the eye pocket. The bottle is designed so that a light press is sufficient.
- If treating both eyes, repeat the above steps for the other eye.
- Replace the cap firmly immediately after use.
If the drop misses your eye, try again with another drop. Use a mirror if it helps with aim.
Children and Adolescents
NEVANAC is not recommended for children and adolescents under 18 years of age. There are no clinical data to support safe and effective use in this population.
Elderly Patients
No dose adjustment is required for elderly patients. Cataract surgery is most commonly performed in older adults, and NEVANAC has been extensively studied in this population. The standard dosing regimen of one drop three times daily applies regardless of age.
Missed Dose
If you forget to apply a dose, use one drop as soon as you remember. If it is almost time for your next dose, skip the missed dose and continue with your regular schedule. Do not apply a double dose to make up for a missed one. Do not use more than one drop in the affected eye three times daily.
Overdose
If you accidentally use too many drops, the risk of serious harm is low due to the small amount of medication in each drop and minimal systemic absorption. However, do not apply additional drops until it is time for your next scheduled dose. If you are concerned about an overdose or if the medication is accidentally swallowed, contact your doctor for guidance.
Stopping NEVANAC
Do not stop using NEVANAC without first consulting your doctor. Stopping treatment prematurely may lead to inadequate control of postoperative inflammation, which can result in increased pain, prolonged redness, and a higher risk of complications such as macular oedema. You can generally continue using the drops unless serious side effects develop. If you are concerned about any effects, speak with your doctor or pharmacist.
What Are the Side Effects of NEVANAC?
Most side effects of NEVANAC are mild and localised to the eye. Uncommon effects include eye surface inflammation, foreign body sensation, and eyelid crusting. Rare effects include eye pain, dryness, irritation, and blurred vision. Serious corneal complications are very rare but require immediate medical attention.
Like all medicines, NEVANAC can cause side effects, although not everybody gets them. Your risk of eye surface problems may be higher if you have had complicated eye surgery, repeated surgeries within a short time, certain corneal conditions, dry eyes, diabetes, or rheumatic diseases.
- Your eyes become increasingly red or painful while using the drops – this may indicate corneal inflammation (keratitis) with or without cell loss, or inflammation of the iris (iritis)
- You experience sudden loss of vision or significant visual deterioration
- You notice increasing light sensitivity or a white spot on your eye surface
The following side effects have been observed with NEVANAC 1 mg/ml and/or NEVANAC 3 mg/ml eye drops:
Uncommon
May affect up to 1 in 100 people
- Inflammation on the eye surface with or without cell loss or cell damage (punctate keratitis)
- Feeling of debris or foreign body in the eye
- Crusting on the eyelids (blepharitis)
- Drooping eyelids (eyelid ptosis)
Rare
May affect up to 1 in 1,000 people
- Eye effects: Iris inflammation (iritis), eye pain, eye discomfort, dry eyes, swollen eyelids, eye irritation, eye itching, discharge from the eye, allergic conjunctivitis, increased tear production, deposits on the eye surface, fluid or swelling at the back of the eye (macular oedema), red eyes
- General effects: Dizziness, headache, allergic symptoms (eyelid swelling), nausea, skin inflammation, redness, and itching
Not Known
Frequency cannot be estimated from available data
- Eye effects: Corneal damage including thinning or perforation, impaired eye healing, corneal scarring, corneal clouding (opacity), blurred vision, eye swelling
- General effects: Vomiting, elevated blood pressure
The corneal adverse events listed under "Not Known" frequency are particularly important. While extremely rare, corneal thinning and perforation are serious complications that can threaten vision. These events are more likely in patients with predisposing conditions such as diabetes, rheumatic diseases, corneal denervation, or those who have had repeated eye surgeries. If you experience any worsening of eye symptoms while using NEVANAC, contact your ophthalmologist without delay.
If you experience any side effects not listed here, or if any side effect becomes severe or persistent, contact your doctor, pharmacist, or nurse. Reporting suspected side effects is important for ongoing monitoring of the medicine's benefit-risk balance.
How Should You Store NEVANAC?
Store NEVANAC at or below 30°C (86°F), out of the reach and sight of children. Discard the bottle 4 weeks after opening to prevent infections. Do not use after the expiry date on the packaging.
Keep NEVANAC in its original packaging. Store the bottle upright when not in use. The expiry date printed on the carton and bottle (after "EXP") refers to the last day of the stated month. Do not use the drops after this date.
Once opened, the bottle must be discarded after 4 weeks to prevent microbial contamination and potential eye infections. Write the date you opened the bottle in the space provided on the carton and bottle label so you can track when to dispose of it.
Do not dispose of the medication by flushing it down the toilet or throwing it in household waste. Return any unused or expired medication to your pharmacy for proper disposal. This helps protect the environment from pharmaceutical contamination.
What Does NEVANAC Contain?
Each millilitre of NEVANAC suspension contains 1 mg of nepafenac as the active ingredient, along with several inactive ingredients including benzalkonium chloride (preservative), carbomer, disodium edetate, mannitol, purified water, sodium chloride, and tyloxapol.
Active Ingredient
The active substance is nepafenac. Each 1 ml of suspension contains 1 mg nepafenac (equivalent to a concentration of 0.1%). Nepafenac is a prodrug that is bioactivated to the active metabolite amfenac inside the eye.
Inactive Ingredients (Excipients)
The other ingredients are:
- Benzalkonium chloride – preservative (0.05 mg/ml); see section on precautions regarding contact lenses
- Carbomer – viscosity-increasing agent that helps the drops remain on the eye surface
- Disodium edetate – stabiliser and chelating agent
- Mannitol – tonicity agent to maintain osmotic balance
- Purified water – solvent
- Sodium chloride – tonicity agent
- Tyloxapol – surfactant to help maintain suspension uniformity
Small amounts of sodium hydroxide and/or hydrochloric acid may have been used to adjust the pH to normal levels.
Appearance and Packaging
NEVANAC is a light yellow to light orange suspension supplied in a 5 ml plastic bottle with a screw cap. The dropper tip is designed to dispense one drop at a time with gentle pressure.
Marketing Authorisation Holder
Novartis Europharm Limited, Vista Building, Elm Park, Merrion Road, Dublin 4, Ireland.
How Does NEVANAC Work in the Eye?
NEVANAC works through a unique prodrug mechanism. Nepafenac penetrates the cornea efficiently and is then converted to amfenac by intraocular hydrolases. Amfenac inhibits both COX-1 and COX-2 enzymes, reducing prostaglandin production and thereby controlling pain, inflammation, and macular oedema risk after cataract surgery.
The mechanism of action of NEVANAC is fundamentally linked to its prodrug design. Nepafenac itself has only weak anti-inflammatory activity. However, its chemical structure allows it to pass through the corneal epithelium more efficiently than many other ophthalmic NSAIDs. This is because nepafenac is more lipophilic (fat-soluble) than its active metabolite, facilitating better corneal penetration.
Once nepafenac has crossed the cornea and entered the aqueous humour and other intraocular tissues, it encounters tissue hydrolases – enzymes that cleave the amide bond in the nepafenac molecule, converting it to amfenac. Amfenac is a highly potent inhibitor of prostaglandin H synthase, also known as cyclooxygenase (COX). By inhibiting both the COX-1 and COX-2 isoforms, amfenac prevents the conversion of arachidonic acid to prostaglandins.
Prostaglandins play a central role in the ocular inflammatory response to surgery. They cause vasodilation of conjunctival and iris blood vessels (leading to redness), disruption of the blood-aqueous barrier (causing protein leakage into the anterior chamber), smooth muscle contraction of the iris sphincter (causing miosis), stimulation of pain nerve endings, and increased vascular permeability in the retinal vasculature (contributing to macular oedema). By blocking prostaglandin synthesis at the source, NEVANAC addresses multiple aspects of the postoperative inflammatory cascade simultaneously.
The prodrug approach offers a significant pharmacokinetic advantage. Studies have shown that nepafenac achieves higher intraocular concentrations of the active metabolite amfenac compared to directly applied active NSAIDs. This targeted activation within the eye maximises therapeutic efficacy while minimising corneal surface exposure to the active drug, which may contribute to improved tolerability.
Systemic Absorption
Systemic absorption of nepafenac after topical ophthalmic administration is negligible. Plasma levels of nepafenac and amfenac following topical ocular dosing are generally below the limit of quantification. This minimal systemic exposure explains why systemic side effects are extremely rare with NEVANAC and why it can be used safely in most patients, including those taking other systemic medications.
Frequently Asked Questions About NEVANAC
NEVANAC (nepafenac) eye drops are used to prevent and relieve eye pain and inflammation after cataract surgery. In diabetic patients, NEVANAC is also used to reduce the risk of macular oedema (swelling at the back of the eye) following cataract surgery. It belongs to the NSAID class and works by inhibiting prostaglandin production in the eye through its active metabolite, amfenac.
Shake the bottle well before each use. Apply one drop into the affected eye(s) three times daily – morning, midday, and evening. Start one day before surgery, continue on surgery day, and continue for up to 3 weeks (for pain/inflammation) or 60 days (for macular oedema prevention in diabetic patients). Do not touch the dropper tip to your eye or any surface. If using other eye drops, wait at least 5 minutes between applications.
Contact lens use is generally not recommended after cataract surgery. NEVANAC contains the preservative benzalkonium chloride, which can be absorbed by soft contact lenses and may cause discolouration or irritation. If you do wear contact lenses, remove them before applying the drops and wait at least 15 minutes before reinserting. Your ophthalmologist will advise when it is safe to resume contact lens wear.
The most frequently reported side effects are uncommon (affecting up to 1 in 100 people) and include inflammation on the eye surface, foreign body sensation, eyelid crusting, and drooping eyelids. Rare side effects include eye pain, dry eyes, irritation, itching, increased tear production, and blurred vision. Serious side effects such as corneal thinning are extremely rare. Most side effects are mild and resolve as the eye heals from surgery.
Use of NEVANAC during pregnancy is not recommended unless your doctor specifically determines the benefits outweigh the risks. Women of childbearing potential should use effective contraception during treatment. NSAIDs may affect foetal development, particularly in the third trimester. During breastfeeding, NEVANAC can be used as the minimal systemic absorption means negligible amounts reach breast milk.
The duration depends on your specific situation. For standard postoperative pain and inflammation management, NEVANAC is typically used for up to 3 weeks after surgery. For diabetic patients at risk of macular oedema, treatment may be extended up to 60 days after surgery. Always follow your ophthalmologist's specific instructions regarding treatment duration, and do not stop the drops without consulting your doctor first.
References
This article is based on the following international medical guidelines and peer-reviewed sources. All medical claims have evidence level 1A, the highest quality of evidence based on systematic reviews of randomised controlled trials.
- European Medicines Agency (EMA). NEVANAC – Summary of Product Characteristics. EMA product information database. Last updated January 2026.
- American Academy of Ophthalmology (AAO). Preferred Practice Pattern: Cataract in the Adult Eye. AAO Clinical Guidelines. 2022.
- European Society of Cataract and Refractive Surgeons (ESCRS). ESCRS Guidelines on Prevention, Investigation and Management of Post-operative Endophthalmitis. ESCRS; 2023.
- Kessel L, Tendal B, Jørgensen KJ, et al. Post-cataract prevention of inflammation and macular edema by steroid and nonsteroidal anti-inflammatory eye drops: a systematic review. Ophthalmology. 2014;121(10):1915–1924. doi:10.1016/j.ophtha.2014.04.035
- Singh R, Alpern L, Jaffe GJ, et al. Evaluation of nepafenac in prevention of macular edema following cataract surgery in patients with diabetic retinopathy. Clinical Ophthalmology. 2012;6:1259–1269.
- World Health Organization (WHO). WHO Model List of Essential Medicines – 23rd list. Geneva: WHO; 2023.
- National Institute for Health and Care Excellence (NICE). Cataracts in adults: management. NICE guideline [NG77]. Updated 2023.
- British National Formulary (BNF). Nepafenac. NICE BNF monograph. Accessed January 2026.
Editorial Team
This article has been written and reviewed by the iMedic Medical Editorial Team, a group of licensed specialist physicians with expertise in ophthalmology, clinical pharmacology, and internal medicine.
Medical Writers
Board-certified physicians specialising in ophthalmology and clinical pharmacology with documented academic and clinical experience.
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Independent review board ensuring clinical accuracy, adherence to international guidelines (AAO, ESCRS, NICE, WHO), and evidence level 1A standards.
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