Restasis for dogs: Dosage and safety

In this article:

• What is Restasis used for in dogs?
• Safety
• Dosage
• Alternatives
• Summary

In this article

• What is Restasis used for in dogs?
• Safety
• Dosage
• Alternatives
• Summary

Restasis (ophthalmic cyclosporine) is a prescription eye drop medication for humans with chronic dry eye disease. However, it was originally developed as a veterinary eye ointment for dogs with chronic dry eye disease. Veterinarians usually do not use Restasis in dogs because the dosage strength is too low. Instead, they use higher-strength, brand-name Optimmune eye ointment or generic eye drops. Cyclosporine is the active ingredient in Restasis, Optimmune, and the generic versions. It modulates the immune system response and reduces inflammation of the tear ducts. Ophthalmic cyclosporine is not a cure for chronic dry eye disease. Instead, it’s a lifelong supportive treatment that increases tear production to prevent permanent injury to the eye.

RELATED: Save up to 80% on Restasis

What is Restasis used for in dogs?

Optimmune and other veterinary formulations of Restasis are used to treat chronic dry eye (chronic keratoconjunctivitis sicca, or KCS) and chronic superficial dry eye (chronic superficial keratitis, or CSK). 

Chronic dry eye

Chronic dry eye is swelling of the eye’s surface and the inner surface of the eyelids due to tear deficiency. 

Dry eye is a common problem in dogs. About 1 in 20 dogs will have a problem with dry eye at least once, but most cases are temporary and mild. Some breeds are more genetically prone to dry eye than others, particularly Boston Terriers, Shih Tzus, West Highland Terriers, and English Bulldogs.

Veterinarians get involved when chronic dry eye does not improve or starts damaging the eye. Chronic dry eye is a significant condition that can result in permanent damage and blindness.

Chronic dry eye has many causes, but the immune response plays a major role. One role it plays is causing tear ducts to swell, reducing tear output. It’s also a key driver of a cascade of causes called the “dry eye cycle.” 

Optimmune and other veterinary versions of Restasis help restore normal tear function. It’s only used when the disease has an inflammatory component. Ophthalmic cyclosporine may not help dogs with dry eyes due to other causes, such as infection. 

Although ophthalmic cyclosporine is effective—about 82% of treated dogs will show improvement)—it is not a cure for chronic dry eye. Instead, it controls the problem and helps prevent permanent damage to the eye’s surface or the tear ducts. It’s usually a lifelong treatment.

Don’t expect results right away. It may take days or weeks to notice improvements in the dog’s symptoms.

Ophthalmic cyclosporine comes as an ointment or a suspension (eye drops). Some veterinarians may prescribe a combination eye drop with the immune suppressant tacrolimus.

Brand-name Restasis is not used in dogs. The dosage strength is too low. A dog’s eye does not take up cyclosporine as efficiently as human eyes. While Restasis has a dosage strength of 0.05%, Optimmune for dogs has a dosage strength of 0.2%. Some compounded formulations of ophthalmic cyclosporine can have concentrations as high as 1% or 2%. 

Is Restasis safe for dogs?

Ophthalmic cyclosporine is safe for dogs, provided owners administer the ointment or eye drops correctly and avoid contaminating the bottle tip or the medicine.

Ophthalmic cyclosporine is not safe to give to dogs that have had an allergic reaction to cyclosporine. Veterinarians will avoid using Restasis in dogs with viral or fungal eye infections, though such use is not strictly forbidden.

Pet parents should be cautious about giving ophthalmic cyclosporine to dogs that are pregnant, nursing, or using any other immune-suppressing drug. Make sure the prescribing veterinarian knows about all the conditions the dog has and all the drugs the dog is taking.

Ophthalmic cyclosporine may not be safe to give to puppies. 

Side effects of Restasis in dogs

The most common side effects of ophthalmic cyclosporine in dogs are:

• Eye problems including burning, stinging, redness, watery eyes, and pain
• Eyelid twitching
• Hair loss around the eye

Eye irritation and eyelid spasms are usually temporary and are generally at their worst right after a dose is applied. Remember that dogs with dry eye can be more sensitive to eye drops or ointments than normal. Their eyes don’t produce enough tears in response to an irritant, so the chemicals remain undiluted on the eye’s surface for longer.

Possible serious side effects of Optimmune and other veterinary versions of Restasis include:

• Severe allergic reactions
• Immune suppression (though clinical studies suggest ophthalmic cyclosporine does not seem to affect the body’s immune system)

Take the dog to a veterinarian if you notice:

• Continual eye irritation, redness, eyelid spasms, or excessive rubbing of the eye for seven days or longer
• Difficulty breathing or throat swelling
• Tiredness, weakness, infections, fever, or unexplained bleeding or bruising

Interactions of Restasis with other pet meds

To avoid possible drug interactions, make sure the veterinarian knows about all the pet medications and supplements the dog is being given.

Ophthalmic topical drugs like Optimmune and other veterinary versions of Restasis usually have minimal drug interactions. Very little of the drug gets into the bloodstream. 

Veterinarians may avoid prescribing ophthalmic cyclosporine to dogs that are taking immune suppressants.

Restasis dosage for dogs

Restasis is not used in dogs, but stronger veterinary versions are. These are available as ointments, suspensions, or corn or olive oil ophthalmic solutions. Doses are applied directly to the cornea or conjunctival sac. 

The recommended dose is a single dose (1/4 inch of ointment or one or more eye drops) placed on each affected eye once every 12 hours.

Can dogs overdose on Restasis?

Only give a dog one Optimmune or ophthalmic cyclosporine dose every 12 hours. Do not increase the dose or give it more frequently than prescribed.

Veterinarians aren’t sure what will happen if a dog gets too much ophthalmic cyclosporine. In clinical studies, dogs were dosed twice daily, 10 times the recommended dose, without any side effects. 

Immediately call a veterinarian or veterinary hospital if too much cyclosporine is given. If the dog consumes any ophthalmic cyclosporine, contact a veterinary poison control helpline or take the dog to an emergency veterinary hospital. Eating too much cyclosporine may cause kidney or liver problems.

Can I give my dog Restasis every day?

Optimmune and other veterinary versions of Restasis must be given to a dog twice daily. When the medication is stopped, the clinical signs, symptoms, and problems of dry eye quickly return. 

Ophthalmic cyclosporine is usually not used for temporary cases of dry eye, such as those due to an infection or medication. It’s usually reserved for chronic cases. That means the dog will require twice-daily doses for a long time or even the rest of its life.

Ophthalmic cyclosporine has been used in dogs for 30 years and in people for 20 years. At that time, no side effects or complications due to long-term use were identified.

How to give your dog Restasis

Pet parents give their dogs twice-daily doses of ophthalmic cyclosporine. They can choose between an ointment and eye drops. Compounding pharmacies supply the eye drops, so the instructions may vary.

• Ophthalmic cyclosporine is for use on the eyes only. Do not feed it to a dog or apply it to any other area on a dog.
• Follow the veterinarian’s instructions when giving this medicine.
• When giving ophthalmic cyclosporine, do not touch the tip of the tube or eye dropper or allow that tip to touch any other surface.
• Before administering a dose, remove debris from around or in the eye with a nonirritating solution.
• Place a 1/4  inch strip of the ointment directly onto the cornea or in the pocket in the lower eyelid.
• Cyclosporine eye drops will have different instructions, but doses are given twice a day. Make sure to shake the dropper bottle well before administering a dose.
• Wait at least five minutes before applying any other type of eye medication.
• If you miss a dose, give it when you remember. If it’s almost time for the next dose, skip the missed dose and give the next dose as scheduled.
• Store Optimmune at room temperature.
• Follow the package instructions when storing compounded ophthalmic cyclosporine.

Restasis alternatives for dogs

Veterinary formulations of Restasis restore tear function in dogs with chronic dry eyes. If topical cyclosporine is not suitable, a veterinarian may turn to tacrolimus, another immunosuppressant. 

If deficient tear production is due to a nerve problem, a veterinarian will not use cyclosporine or tacrolimus. The drug of choice is usually pilocarpine, which stimulates nerves to the tear gland.

The other part of dry eye treatment is tear replacement, which uses artificial tears or other topical treatments to replace tear water or the tear film. Pet parents typically administer ophthalmic cyclosporine along with regular eye drops to restore tears. 

Other therapies may be used to treat specific problems caused by dry eye:

• If swelling is an issue, a veterinarian may use an ophthalmic corticosteroid like prednisolone or dexamethasone unless there are corneal ulcers. 
• Excess mucus build-up is usually treated with frequent eye flushing and, if bad enough, a mucolytic drug like acetylcysteine.
• Ulcers on the ocular surface are usually treated with antibiotics and lubricants.

In the most severe cases, a veterinary ophthalmologist can perform a surgical procedure that reroutes a duct from a salivary gland to the eye to provide moisture to the eye’s surface.

Summary

Restasis is not used in dogs, but its active ingredient, ophthalmic cyclosporine, treats chronic dry eye in dogs. Cyclosporine increases tear production. Doses are given twice daily, usually for the rest of the dog’s life. Be careful when using ophthalmic cyclosporine to not contaminate the medicine by touching the medicine’s tip with your hands or any other surface.