Restasis vs Xiidra vs Cequa: Evaluating Rx Dry Eye Drops

If you’ve been diagnosed with dry eye disease (also known as dry eye syndrome), you may be wondering…

“Is there a prescription medication that can help improve my dry eye symptoms?”

I’m happy to tell you, the answer is YES! In fact, there are now three FDA approved prescription medications that your eye doctor can use to treat your dry eye disease – Restasis, Xiidra, and Cequa. Let’s take a look at the similarities and differences between the three. 

Note: At this time, there is not a generic version of these medications. However, a generic version of Restasis is expected to be available soon.

Restasis 30 single-use vials

Restasis FAQ

The first one is Restasis, (pronounced Re-stay-sis). This medication contains cyclosporine ophthalmic emulsion 0.05%. It was FDA approved in 2002 to treat dry eye disease and millions of prescriptions have been written since.

Restasis has an anti-inflammatory effect and works to increase tear production and reduce the inflammation that is present in patients with dry eye disease. Let’s address some common questions I receive from patients.

How often do I take it?

Restasis is a preservative-free eye drop that is used twice a day in each eye approximately 12 hours apart. Also, it’s important to note this eye drop should not be used while wearing contact lenses. Instead, wait 15 minutes after using Restasis before you put in your contacts 

Do I need to take it forever?

In most cases, yes. Dry eye disease is a chronic disease. Therefore, when the medication is stopped, symptoms of this disease often return.

What are the side effects?

The most common side effect patients notice is burning when putting in the drop (17%). In addition, patients occasionally experience redness and blurry vision (1-5%).

How does it work?

Restasis is an immunosuppressive medication that works to increase tear production and reduce the inflammation that is often present in dry eye syndrome.

How long does it take to work?

The typical patient notices an improvement in symptoms after three months of use.

Tell me about the clinical trials

There were four multi-center, randomized, clinical studies performed on approximately 1,200 patients with moderate to severe dry eye syndrome. In these studies, Restasis showed significant improvement in tear production after 6 months of use.

RELATED: The Truth About Artificial Tears and Dry Eye Disease

Xiidra FAQ

The second prescription medication that treats the signs and symptoms of dry eye disease is called Xiidra (pronounced Zy-dra, like Hydra). This medication contains lifitegrast ophthalmic solution and was FDA approved in July of 2016. Similar to Restasis, Xiidra works to reduce the inflammation that is present in dry eye.

How often do I take it?

Xiidra is a preservative-free eye drop that is used twice a day in each eye approximately 12 hours apart. Like Restasis, it’s important to note this eye drop should not be used while wearing contact lenses. Instead, wait 15 minutes after using Xiidra before you put in your contacts 

Do I need to take it forever?

In most cases, yes (sound familiar). Dry eye disease is a chronic disease. Therefore, like Restasis, when the medication is stopped, symptoms of this disease often return.

What are the side effects?

The most common side effects of Xiidra include eye irritation, discomfort or blurred vision, and an unusual taste sensation (5-25%).

How does it work?

Xiidra works by inhibiting part of the inflammatory process associated with dry eye. It is similar to Restasis in that it has an anti-inflammatory effect.

Tell me about the clinical trials

There were four multi-center, randomized clinical trials involving more than 1,000 patients. The trial results showed that the patients using Xiidra had a significant clinical improvement in the signs and symptoms of dry eye.

How long does it take to work?

In the clinical studies, symptoms were shown to improve as early as the two-week mark.

RELATED: Dry Eye Disease: Here’s Why Your Eyes Water All the Time

Cequa FAQ

The third (and newest) prescription medication that treats the signs and symptoms of dry eye disease is called Cequa (pronounced See-Kwah).

This medication contains cyclosporine ophthalmic solution 0.09% and was recently FDA approved in August of 2018. Similar to Restasis and Xiidra, Cequa works to reduce the inflammation that is present in dry eye.

How often do I take it?

Cequa is a preservative-free eye drop that is used twice a day in each eye approximately 12 hours apart. Like Restasis and Xiidra, it’s important to note this eye drop should not be used while wearing contact lenses. Instead, wait 15 minutes after using Cequa before you put in your contacts 

Do I need to take it forever?

In most cases, yes. Dry eye disease is a chronic disease. Again, like Restasis and Xiidra, when the medication is stopped, symptoms of this disease often return.

What are the side effects?

The most common side effects of Cequa include instillation site pain (22%) and redness (6%).

How does it work?

Cequa is an immunosuppressive medication that works to increase tear production and reduce the inflammation that is often present in dry eye syndrome. It is similar to Restasis and Xiidra in that it has an anti-inflammatory effect.

Tell me about the clinical trials

There were two multi-center, randomized clinical trials involving more than 1,000 patients. The trial results showed significant improvement in different dry eye outcome measures (central corneal staining and total corneal staining).

How long does it take to work?

In the clinical studies, symptoms were shown to improve as early as the three months.

RELATED: Best Artificial Tears for Dry Eye Disease

NEW Restasis Multidose

Restasis pros

  • Restasis has been FDA approved for over a decade. Therefore, most eye doctors have a lot of experience with the medication and subsequent side effects.
  • There are two different ways to receive this medication. One option is single-use individual vials. The other is the new Restasis MultiDose bottle (shown above). Some patients feel this bottle is easier to use.

Restasis cons

  • Restasis usually takes 3 months or longer for patients to feel an improvement in their symptoms.
  • Depending on your insurance coverage, it can be expensive (although there is a rebate card available).
  • Restasis can cause burning and redness when putting in the drop.
Xiidra iinsider card

Xiidra pros

  • There can be improvements in symptoms in as early as two weeks.
  • With the Xiidra rebate card, the first month of Xiidra is free. This allows you to try out the medication to see if it’s working.

Xiidra cons

  • Depending on your insurance coverage, it can be expensive (although there is a rebate card available from your eye doctor).
  • It can cause irritation and a strange taste in your mouth. This unusual taste bothers some patients more than others.

Cequa pros

  • Has the highest FDA approved concentration of cyclosporine.
  • With the Cequa Support Card, commercially insurance patients pay as little as $5 for a one month supply and $10 for a three month supply.

Cequa cons

  • Cequa usually takes three months or longer for patients to feel an improvement in their symptoms.
  • Depending on your insurance coverage, it can be expensive (although there is a support card available from your eye doctor).
  • Cequa can cause burning and redness when putting in the drop.

Thankfully, we now have three medications that can help patients with their dry eyes! Wondering if you’re a candidate for Restasis, Xiidra, or Cequa? Talk to your eye care professional for more information.

 RestasisXiidraCequa
Dosing?One drop twice a day approximately 12 hours apartOne drop twice a day approximately 12 hours apartOne drop twice a day approximately 12 hours apart
FDA approval year200220162018
Common side effects?Burning with putting in the drop, redness, and blurry visionEye irritation, discomfort or blurred vision, and an unusual taste sensationEye irritation, discomfort or blurred vision, and an unusual taste sensation
When do symptoms start to improve?Roughly 3 monthsCan be as early as 2 weeks
Roughly 3 months
Cost?Depends on insurance but Restasis does offer a rebate cardDepends on insurance but Xiidra does offer a rebate card that gives you the first month for freeDepends on insurance but Cequa does offer a support card

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4 COMMENTS

  1. Knowing you can’t stop using the drops to keep the eyes hydrated. Sometimes it’s difficult to insert Restasis or Xiidra every 12 hours. How strict a routine do you need to continue, for instance what happens if you insert them at 6 a.m. but it’s not until 10 p.m. you take the evening dose? How much does this interfere with being successful?

  2. Honestly, twice a day dosing (morning and night) is ideal. If either of these medications are going to work for you, your overall success is going to be based on consistency (i.e. using the drops twice a day as indicated). Therefore, it shouldn’t have much of an impact if you’re unable to use the drops exactly 12 hours apart each day.

  3. Great question, Jeanie. I’m sure they would if the could. Unfortunately, this is a published and known side effect of Xiidra that many people have to deal with.

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