Restasis vs Xiidra: Here’s What You Need To Know

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 two FDA approved prescription medications that your eye doctor can use to treat your dry eye disease. One is called Restasis and the other is called Xiidra. Let’s take a look at the difference between the two. 

Note: At this time, there is not a generic version of Restasis or Xiidra. A generic version of Restasis should be available sometime this year.

Restasis 30 single-use vials
Source: Restasis.com

Restasis

The first one is Restasis, (pronounced Re-stay-sis). This medication contains cyclosporine ophthalmic emulsion. 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 60 single use containers
Source: Xiidra.com

Xiidra

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 recently 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

NEW Restasis Multidose
Source: Restasis.com

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 when putting the drop in
Xiidra iinsider card
Source: Xiidra.com

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

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

 RestasisXiidra
Dosing?One drop twice a day approximately 12 hours apartOne drop twice a day approximately 12 hours apart
FDA approved?20022016
Common side effects?Burning with putting in the drop, redness, and blurry visionEye 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
Cost?Depends on insurance but Restasis does offer a rebate card cardDepends on insurance but Xiidra does offer a rebate card that gives you the first month for free

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Hi, my name is Jaclyn Garlich and I’m an optometrist practicing in Milwaukee, WI. I grew up in St. Louis, MO and I went to optometry school at the New England College of Optometry in Boston, MA. After optometry school, I did a residency in primary care and ocular diseases at the St. Louis VAMC. One thing I love about optometry is making my patients see better but, in particular, those patients with severe corneal dystrophies. I fit a lot of specialty contact lenses and I find it very rewarding to see a patient go from 20/200 vision to 20/20 vision. When I’m not practicing optometry I write an optometry newsletter called 20/20 Glance. It’s a once a week email delivered every Monday morning with a rundown of what’s new in optometry for the past week. It’s an easy way for the busy clinician to stay up-to-date.

2 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.

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