Restasis alternatives: What can I take instead of Restasis?

In this article:

• Restasis alternatives
• OTC alternatives
• Xiidra
• Tyrvaya
• Cequa
• Miebo
• Vevye
• Natural alternatives
• How to switch

In this article

• Restasis alternatives
• OTC alternatives
• Xiidra
• Tyrvaya
• Cequa
• Miebo
• Vevye
• Natural alternatives
• How to switch

Restasis is a brand-name prescription eye drop used to increase tear production in certain people with chronic dry eye related to inflammation. Its active ingredient, cyclosporine, is an immunosuppressant that belongs to a class of drugs called calcineurin inhibitors. According to a review of the medication, some patients may notice increased tear production after three weeks to three months of consistent use, with clinical trials showing effectiveness by six months, although individual results vary. If Restasis is ineffective, causes bothersome side effects, or is too expensive, several Restasis alternatives are available, including prescription and over-the-counter options. 

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RELATED: What is Restasis?

What can I take instead of Restasis?

Alternatives to Restasis include over-the-counter eye lubricants, generic cyclosporine emulsion eye drops, other prescription ophthalmic cyclosporine formulations, and medications that work differently. The right option depends on the type and cause of dry eye disease, the severity of symptoms, and how well previous treatments have worked.

Dry eye disease affects about 20 million people in the United States. Environmental factors such as low humidity, wind, smoke, allergens, and prolonged screen use may contribute to symptoms. Dry eyes may also be associated with certain medications or underlying health conditions.

Over-the-counter medications for dry eye include artificial tears, gels, and ointments that temporarily lubricate the eyes. Products intended primarily to reduce redness are not substitutes for artificial tears and may cause irritation or rebound redness with repeated use. If OTC products do not provide enough relief, prescription treatment may be needed.

Prescription alternatives include other ophthalmic cyclosporine formulations and treatments with different active ingredients or delivery methods. Generic Restasis, sold as cyclosporine ophthalmic emulsion 0.05%, is also available and may cost less than the brand-name medication. An ophthalmologist or optometrist can help determine which alternative is appropriate.

Over-the-counter alternatives to treat dry eyes

Over-the-counter artificial tears and eye lubricants may be safe and effective means to temporarily relieve burning, irritation, and discomfort caused by dry eyes. However, they do not treat the underlying inflammation in the same way as Restasis and may not provide enough relief for everyone. Some OTC treatments include:

• Bausch & Lomb Advanced Eye Relief Dry Eye (glycerin/propylene glycol ophthalmic)
• Bion Tears (dextran 70/hypromellose ophthalmic)
• Blink GelTears (polyethylene glycol 400 ophthalmic)
• Clear Eyes Advanced Dry & Itchy Relief (glycerin ophthalmic)
• GenTeal Tears Moderate Preservative Free (dextran 70/hypromellose ophthalmic)
• Refresh Classic (polyvinyl alcohol/povidone ophthalmic)
• Soothe Maximum Hydration (glycerin/propylene glycol ophthalmic)
• Systane Original (polyethylene glycol 400/propylene glycol ophthalmic)
• TheraTears Dry Eye Therapy (sodium carboxymethylcellulose ophthalmic)
• Visine Dry Eye Relief All Day Comfort (polyethylene glycol 400 ophthalmic)

OTC dry eye treatments are available as eye drops, gels, and ointments. Because thicker gels and ointments may temporarily blur vision, they are often used at bedtime. Eye drops marketed primarily to reduce redness should be avoided because they may cause additional irritation. 

Restasis prescription alternatives

The following are some of the most common prescription alternatives to Restasis.

1. Xiidra (lifitegrast)

Xiidra is an ophthalmic solution that blocks a cell-surface protein from binding with another protein. This may reduce inflammation and improve eye-dryness symptoms. Like Restasis, Xiidra may take several weeks of consistent use to provide relief. According to the manufacturer, symptom improvement was seen as early as two weeks in two of four clinical studies and at six and 12 weeks in all four studies. A separate 12-week clinical study also found greater improvement in eye dryness with Xiidra than with a placebo. Restasis may take 12 weeks to produce a noticeable increase in tear production, according to a review of the medication, and the drug’s label cites studies showing effectiveness at 24 weeks. According to the Xiidra prescribing information, common side effects include eye irritation after applying a dose, an unusual taste, and blurred vision. 

RELATED: Xiidra vs. Restasis: differences, similarities, and which is better for you

2. Tyrvaya (varenicline)

Tyrvaya (varenicline) is a first-of-its-kind nasal spray to treat dry eye disease. Approved in 2021, Tyrvaya activates a nerve pathway in the nose that increases natural tear production. A clinical trial found that it increased tear production and improved some measures of eye dryness. Because Tyrvaya is sprayed into the nose instead of applied directly to the eyes, it may be easier to use for people who dislike eye drops. It also avoids putting medication directly into the eyes, although nasal side effects can occur. The standard Tyrvaya dosage is one spray in each nostril twice daily. Tyrvaya contains varenicline, the same active ingredient used in oral smoking-cessation medication. Anyone taking oral varenicline should double-check with their healthcare provider before starting Tyrvaya, because a small amount of varenicline is absorbed systemically after using the nasal spray. Sneezing is the most common side effect of Tyrvaya and may be bothersome to some people.

3. Cequa (cyclosporine .09% solution) 

Cequa contains the same active ingredient as Restasis. Both eye treatments are designed to increase tear production and relieve dry eye symptoms. However, Cequa has a higher concentration of cyclosporine than Restasis: 0.09% versus 0.05%. While Restasis is an emulsion, Cequa uses NCELL technology to help the medication pass through the tear layer and reach the tissues on the eye’s surface. Cequa is only available as a brand-name medication, while a generic version of Restasis is available and may cost less.

4. Miebo (perfluorohexyloctane ophthalmic solution)

Miebo is an eye drop used to treat the signs and symptoms of dry eye disease. It may be particularly useful when dry eye is associated with meibomian gland dysfunction, which occurs when glands in the eyelids do not produce enough oil or good-quality oil. Miebo is a tear stabilizer that forms a thin layer over the tear film to reduce tear evaporation. As with many ophthalmic products, contact lenses should be removed before administration and not reinserted for at least 30 minutes. Side effects are mild and include blurred vision and eye redness. 

5. Vevye (cyclosporine 0.1% solution) 

Vevye (cyclosporine 0.1% solution) also contains the same active ingredient as Restasis. The concentration is higher, and it uses a different type of solvent to deliver the medication. According to the manufacturer, this formulation helps cyclosporine reach the eye’s tissues and may reduce irritation caused by certain additives. This may result in faster relief compared with Restasis. In a Phase II study, the formulation used in Vevye produced earlier improvement in signs of dry eye than Restasis, with effects seen as early as two weeks. Vevye is only available as a brand-name medication, while Restasis is available as a generic that may cost less. 

Natural alternatives to Restasis

According to the American Academy of Ophthalmology (AAO), the management of dry eye disease varies from patient to patient. Still, initial approaches include addressing modifiable risk factors and conditions to increase tears and reduce inflammation. 

Environmental modifications include:

• Review medications that may be contributing to dry eyes 
• Ensure correct use of contact lenses
• Avoid cigarette smoke
• Protect your eyes when it’s windy or dusty
• Use an air filter and a humidifier at home
• Reduce exposure to allergens
• Rest your eyes often when reading, watching TV, or using screens
• Use warm compresses to increase natural oil production

Additional natural alternatives that have been tried to improve symptoms associated with dry eye disease include omega-3 fatty acid supplementation. However, a 2018 clinical study found that supplementation did not improve dry eye symptoms. This may be partly due to a need for more standardization in content and quality across supplement brands. 

Acupuncture, combined with lubricant eye drops, is an effective strategy for dry eye disease, according to a systematic review. 

How to switch to a Restasis alternative

When switching eye medications, discuss options with a healthcare professional. Over-the-counter options can be discussed with your local pharmacist, but prescription eye drops for dry eye disease should be reviewed with an eye care professional, such as an ophthalmologist.