Tyrvaya dosage, forms, and strengths

Tyrvaya is a brand-name nasal spray that treats dry eye and is available only with a healthcare provider's prescription. Its active ingredient is varenicline, a chemical similar to nicotine that has long been used to help people stop smoking. Varenicline nasal spray quickly enters the bloodstream through the nasal tissues and stimulates nerves in the face, causing the tear glands to secrete more natural tears. For Tyrvaya to work at its best, people will take two doses per day spaced 12 hours apart. Each dose consists of one spray in one nostril and a second in the other. The dose is small, so serious side effects or problems have not yet been reported. 

Tyrvaya forms and strengths

Tyrvaya is a nasal spray that comes in one dosage form:

• Nasal spray: 0.03 mg per spray (0.05 mL)

Tyrvaya dosage for adults

Tyrvaya is approved by the U.S. Food and Drug Administration (FDA) to treat dry eye disease. Tyrvaya is a nasal spray that passes through the thin skin inside the nose to get directly into the bloodstream in a few minutes. Put the applicator into the nasal passage and aim for the outside wall of the nose, not the septum. The active ingredient stimulates tear production to help manage dry eye symptoms through natural tears. 

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Tyrvaya dosage for dry eye disease

Dry eye disease or keratoconjunctivitis sicca is a chronic condition that can last a lifetime. It can also worsen if not treated properly. There are many possible causes, but the basic problem is that the body can’t keep the eye lubricated. Tyrvaya directly addresses tear production. Its active ingredient, varenicline, is a chemical similar to nicotine. It also acts like nicotine on the body’s nerves, so healthcare providers call it a nicotinic receptor agonist. The oral form of varenicline is a commonly prescribed smoking cessation drug available as brand-name Chantix or generic varenicline tablets. When a Tyrvaya dose is sprayed in the nose, the varenicline solution is absorbed through the nasal tissues, enters the bloodstream, and binds to nicotinic acetylcholine receptors in the facial nerves. It then activates the system that stimulates tear glands. The medication is relatively long-acting, requiring administration every 12 hours for optimal effectiveness. Side effects are minimal due to the small dosage.

• Standard Tyrvaya dosage for dry eye: 1 spray in each nostril every 12 hours (two doses per day)

Tyrvaya dosage for children

Tryvaya is not FDA-approved for its use in children.

Tyrvaya dosage restrictions

There are no dosage restrictions or dosage modifications for people with liver impairment, kidney disease, or any other medical condition.

Tyrvaya dosage for pets

Dry eye disease also affects dogs and cats. It has all the same causes and consequences. Although veterinarians are free to use a human drug like Tyrvaya, they usually treat canine and feline dry eye with eye drops like ophthalmic cyclosporine or ophthalmic tacrolimus to stimulate tear film production. There are no published Tyrvaya dosages for pets.

How to take Tyrvaya

Tyrvaya is a nasal spray, but it is not intended to fix anything in the nose. Instead, it’s absorbed through the nostrils into the bloodstream. The Tyrvaya solution mist should cover the tissues inside the nose to be maximally effective. 

• Use the medication as instructed. Do not take extra doses.

• This medicine should come with a Patient Information sheet. Ask your pharmacist for a copy.

• A one-month supply consists of two bottles of varenicline solution. Each bottle has enough medicine for 15 days. Finish the first bottle before opening the second bottle.

• Only use Tyrvaya in the nostril; do not spray the solution in the eyes or mouth.

• Do not shake the bottle before use.

• Prime Tyrvaya before initial use by removing the cap (or clip) and pumping seven actuations into the air away from the face. Put the cap or clip back on the bottle.

  • If Tyrvaya has not been used for more than five days, re-prime the bottle with one spray into the air before use in the nose. 

• Before use, blow your nose to clear your nostrils which may help the medicine be more effective.

• Remove the cap (or clip) and hold the bottle upright.

• Tilt your head back slightly without lying down. 

• Insert the applicator into the nostril, pointing the tip toward the ear on the same side of the nostril and away from the center (septum) of the nose. Leave a space between the tip and the skin inside the nose.

• Place your tongue on the roof of your mouth and breathe gently while pressing the pump to release the spray. 

• DO NOT spray directly at the septum (the centerline of the nose).

• DO NOT spray straight up the nose into the sinuses.

• DO NOT inhale the mist. Breathe gently through the nose to mist just the inside surface of the nostril. 

• Repeat the process in the other nostril.

• Wipe the applicator with a clean tissue after each use.

• Replace the cap or clip.

• Store the nasal spray bottle at room temperature. Do not freeze the bottle.

• Throw away the bottle 30 days after it’s been opened, even if there’s medicine left in the bottle.

Tyrvaya dosage FAQs

How long does it take Tyrvaya to work?

The active ingredient in Tyrvaya enters the bloodstream within five minutes of taking a dose. The dose hits its peak effectiveness in about two hours. However, varenicline stays in the system for a long time, so people should feel dry eye relief persistently if they take doses every 12 hours.

How long does Tyrvaya stay in your system?

Tyrvaya is a long-acting drug. Its half-life, the time it takes the body to clear half a dose, is 19 hours, although this duration varies in individuals. That means the body will take about four days or even longer to eliminate the last dose.

What happens if I miss a dose of Tyrvaya?

If a dose of Tyrvaya is missed, skip the missed dose. Take the next dose as scheduled.

How long can you take Tyrvaya?

Dry eye disease is a chronic condition, so Tyrvaya is intended for long-term use. Clinical trials only studied Tyrvaya for 28 days, so researchers and healthcare providers do not have long-term information about side effects. However, varenicline tablets have been given for years and are taken in much larger doses—1 mg twice daily—to help people stop smoking. Therapy typically lasts eight to 11 weeks but could last for six months or more. Taking varenicline tablets over time raises the risk of kidney or pancreas problems. Remember that these daily doses are 30 times greater than Tyrvaya daily doses, so serious side effects are unlikely when taking Tyrvaya. If there are any worries, ask the doctor.

How do I stop taking Tyrvaya?

Tyrvaya is not addictive and does not cause dependence. The doses are small, so the drug can be stopped at any time. No tapering is needed. However, when the drug is stopped, the symptoms of dry eye disease may reappear or worsen. Make sure that there’s an adequate treatment in place before stopping Tyrvaya. The only firm reason to stop the use of Tyrvaya is if there’s an allergic reaction, but the manufacturer’s drug information does not indicate allergic reactions are a problem. 

What is the maximum dosage for Tyrvaya?

The FDA and the manufacturer have not specified a maximum dosage, so the recommended dosage should be considered the most that anyone should take.

Can you overdose on Tyrvaya?

A Tyrvaya overdose is extremely unlikely. The varenicline in each Tyrvaya dose is minuscule. A 30-day supply of Tyrvaya (two bottles) contains less varenicline than there is in two 1 mg varenicline tablets, the standard daily oral dose used for smoking cessation. 

What interacts with Tyrvaya?

Tyrvaya has no known drug interactions. However, please inform the prescribing healthcare provider and pharmacist about the medications you’re taking, including prescription drugs, over-the-counter medications, vitamins, and supplements, before taking Tyrvaya. 

What happens when you mix Tyrvaya and alcohol?

There are no known drug interactions between Tyrvaya and alcohol. However, alcohol may worsen the symptoms of dry eye, so it’s advisable to moderate alcohol intake.

Is it safe to take Tyrvaya during pregnancy?

There are no studies on the safety of Tyrvaya during pregnancy. Animal studies did not show evidence of birth defects. If a woman is pregnant or considering pregnancy during Tyrvaya treatment, ask the prescribing healthcare professional for medical advice. 

Is it safe to take Tyrvaya while breastfeeding?

There are no studies or other information about whether varenicline affects lactation, is present in breast milk, or causes effects in a nursing infant. 

What should I know about Tyrvaya's possible side effects?

The most common side effect of Tyrvaya is sneezing. In clinical studies, about 82% of participants reported sneezing as an adverse effect. Sneezing is only a transient problem, lasting about one minute after a dose. Ninety-eight percent of participants considered the sneezing to be mild. Other common adverse reactions include cough, throat, and nose irritation at the instillation site. 

Sources

• Dry eye syndrome, StatPearls

• Keratoconjunctivitis sicca (KCS) or dry eye in cats, VCA Animal Hospitals

• Keratoconjunctivitis sicca (KCS) or dry eye in dogs, VCA Animal Hospitals

• The relationship between alcohol consumption and dry eye, The Ocular Surface

• Tyrvaya, Oyster Point Pharma, Inc.

• Tyrvaya HCP, Oyster Point Pharma, Inc.

• Tyrvaya varenicline spray prescribing information, DailyMed (NIH National Library of Medicine)