Ilevro Drug Interactions: What to Avoid and What to Tell Your Doctor

Although Ilevro (nepafenac 0.3%) is applied to the eye rather than taken orally, it can still interact with other medications and conditions. Understanding these interactions is important for your safety, especially in the perioperative period when you may be on multiple medications and recovering from cataract surgery.

How Much of Ilevro Gets Into Your Body?

Systemic absorption from topical eye drops is generally low, but not zero. After once-daily dosing with Ilevro 0.3%, low but measurable plasma concentrations of nepafenac and amfenac are detectable — with peak levels occurring about 30-45 minutes after application. However, studies confirmed that even at concentrations much higher than those achieved in clinical use, Ilevro did not inhibit liver cytochrome P450 (CYP) enzymes involved in metabolizing most drugs. This means Ilevro is unlikely to cause the drug-drug interactions that systemic NSAIDs commonly do.

Interaction 1: Other Topical NSAIDs (Additive Effects)

Using Ilevro together with another topical ophthalmic NSAID (like ketorolac or bromfenac) is generally not recommended. Concurrent use may increase the risk of corneal adverse events including keratitis, corneal thinning, and erosion. If you're prescribed multiple eye drops, confirm with your ophthalmologist that you're not unknowingly using two NSAIDs simultaneously.

Interaction 2: Corticosteroid Eye Drops (Impaired Healing)

Many cataract surgery patients are prescribed both an NSAID eye drop (like Ilevro) and a steroid eye drop (like prednisolone acetate or dexamethasone). When used together, topical NSAIDs and corticosteroids may increase the potential for delayed wound healing. This doesn't mean you shouldn't use both — in fact, combination therapy is standard practice — but it's why your ophthalmologist monitors healing closely at post-op visits.

Interaction 3: Anticoagulants and Blood-Thinning Medications

NSAIDs including Ilevro can interfere with platelet function (thrombocyte aggregation), potentially increasing bleeding time. For patients on systemic anticoagulants or antiplatelet agents, this interaction deserves attention:

Warfarin (Coumadin): Although systemic absorption of ophthalmic nepafenac is very low, report Ilevro use to your anticoagulation care team

Aspirin/clopidogrel/other antiplatelet drugs: Additive bleeding risk; tell your ophthalmologist if you take these regularly

Novel oral anticoagulants (rivaroxaban, apixaban, dabigatran): Theoretically additive effect on bleeding; always disclose to both your surgeon and your prescribing physician

Interaction 4: Oral NSAIDs (ibuprofen, naproxen, aspirin)

If you're already taking oral NSAIDs for arthritis, pain, or other conditions, tell your ophthalmologist before starting Ilevro. The additive anti-inflammatory and antiplatelet effects of combining topical and systemic NSAIDs are not well studied for ophthalmic preparations, but the theoretical risk exists — particularly for bleeding. Your surgeon may advise temporarily holding certain oral NSAIDs around the time of surgery.

Interaction 5: Other Ophthalmic Medications (Timing Issue)

If you use multiple eye drops — glaucoma medications, antibiotic drops, lubricating drops — there's a practical interaction to consider: dilution. Applying eye drops too close together washes out the previous drop before it can be absorbed. The standard recommendation is to wait at least 5 minutes between different eye medications.

Ilevro is compatible with other topical ophthalmic medications such as beta-blockers (for glaucoma), carbonic anhydrase inhibitors, alpha-agonists, cycloplegics, and mydriatics — but they should each be given at least 5 minutes apart.

Interaction 6: Benzalkonium Chloride and Contact Lenses

Ilevro contains benzalkonium chloride (BAK) as a preservative. BAK is well known to:

Damage soft contact lenses — never wear contacts while using Ilevro

Potentially worsen dry eye symptoms with long-term use — if you have severe dry eye disease, discuss with your ophthalmologist whether a preservative-free NSAID alternative might be preferable

Medications and Supplements to Tell Your Doctor About

Before starting Ilevro, disclose these to your ophthalmologist:

All blood thinners (warfarin, heparin, aspirin, clopidogrel, NOACs)

Other NSAID medications (prescription or OTC ibuprofen, naproxen)

All current eye drops, including glaucoma medications, allergy drops, and lubricating drops

Fish oil supplements (omega-3s at high doses have mild antiplatelet activity)

Vitamin E supplements at high doses (antiplatelet effects)

NSAID allergy history — critical contraindication

For a full overview of Ilevro's side effect profile, including serious adverse events to watch for, see our guide: Ilevro Side Effects: What to Expect and When to Call Your Doctor.