Restasis alternatives: What can I take instead of Restasis?

In this article:

• What can I take in place of Restasis?
• Compare Restasis alternatives
• Top 5 Restasis alternatives
• Natural alternatives to Restasis
• How to switch to a Restasis alternative

In this article

• What can I take in place of Restasis?
• Compare Restasis alternatives
• Top 5 Restasis alternatives
• Natural alternatives to Restasis
• How to switch to a Restasis alternative

Restasis (cyclosporine ophthalmic emulsion) is the brand name of an ophthalmic prescription medication approved by the U.S. Food and Drug Administration (FDA) to manage dry eye disease. The terms “dry eye disease (DED),” “dry eye syndrome (DES),” “keratoconjunctivitis sicca (KCS),” and “chronic dry eye” all refer to the same condition and can be used interchangeably. Restasis is a calcineurin inhibitor immunosuppressant that can increase tear production, but its onset of action takes up to 12 weeks. Restasis can cause side effects like eye pain and a temporary burning sensation right after administration. This may be unsuitable for those suffering from the disease, for which alternative pharmaceuticals are available. 

RELATED: Restasis dosage, forms, and strengths

What can I take in place of Restasis?

Dry eye disease is epidemiologically a common eye disorder, with a prevalence as high as 50 % in certain regions. In the United States, one study estimated that 6.8% of the adult population has been diagnosed with DED. DED can be the result of environmental factors, like low humidity, wind, allergens, and smoke, or DED can be a side effect of other medications or health conditions. 

Over-the-counter (OTC) products include topical lubricants, with formulations including gels, liquids, and ointments. These are typically first-line treatments and options for those unable to use prescription-only Restasis. Topical lubricants generally include an agent to maintain viscosity, an agent to prevent evaporation, and a preservative to prevent contamination. It is best to avoid products marketed to relieve red eyes since they generally contain medications that can exacerbate symptoms. However, most individuals suffering from DED state that these OTC eye drops alone do not provide substantial relief. 

The alternative second-line therapies are prescription medications and include other formulations of the active ingredient of Restasis, other topicals with different active ingredients, and even a nasal spray. (cyclosporine 0.09% ophthalmic solution) and Vevye (cyclosporine 0.1% ophthalmic solution) contains the same active ingredient as Restasis in slightly higher concentrations and a solution versus oil-based emulsion. If needed, an ophthalmology healthcare provider can provide medical advice to find alternatives to Restasis. 

Other alternatives to Restasis

• Bausch & Lomb Advanced Eye Relief Dry Eye (glycerin/ propylene glycol ophthalmic)
• Bion Tears (dextran 70/ hypromellose ophthalmic)
• Blink Gel Tears (polyethylene glycol 400 ophthalmic)
• Blink Tears (polyethylene glycol 400 ophthalmic)
• Clear Eyes Advanced Dry & Itchy Relief (glycerin ophthalmic)
• Clear Eyes Natural Tears (polyvinyl alcohol/ povidone ophthalmic)
• GenTeal Tears Mild (dextran 70/ hypromellose ophthalmic)
• GenTeal Tears Moderate (dextran 70/glycerin/ hypromellose ophthalmic)
• GenTeal Tears Moderate Preservative Free (dextran 70/ hypromellose ophthalmic)
• GenTeal Tears Severe Gel (hypromellose ophthalmic)
• GenTeal Tears Severe Night-Time Ointment (mineral oil/ white petrolatum ophthalmic)
• Murine Tears for Dry Eyes Original (polyvinyl alcohol/ povidone ophthalmic)
• Refresh Classic (polyvinyl alcohol/ povidone ophthalmic)
• Refresh Optive (carboxymethylcellulose/ glycerin ophthalmic)
• Refresh PM (mineral oil/ white petrolatum ophthalmic)
• Refresh Relieva (carboxymethylcellulose/ glycerin ophthalmic)
• Refresh Tears (carboxymethylcellulose ophthalmic)
• Soothe Hydration (povidone ophthalmic)
• Soothe Maximum Hydration (povidone ophthalmic)
• Soothe Night Time Lubricant (mineral oil/ white petrolatum ophthalmic)
• Soothe Preservative Free Lubricant (glycerin/ propylene glycol ophthalmic)
• Soothe XP (mineral oil ophthalmic)
• Systane (polyethylene glycol 400/ propylene glycol ophthalmic)
• Systane Balance (propylene glycol ophthalmic)
• Systane Complete (propylene glycol ophthalmic)
• Systane Night Gel (hypromellose ophthalmic)
• Systane Nighttime (mineral oil/ white petrolatum ophthalmic)
• TheraTears Liquid Gel (carboxymethylcellulose ophthalmic)
• TheraTears Lubricant Eye Drops (carboxymethylcellulose ophthalmic)
• Visine Dry Eye Relief (polyethylene glycol 400 ophthalmic)
• Visine Dry Eye Relief All Day Comfort (polyethylene glycol 400 ophthalmic)
• Visine Dry Eye Relief Tired Eye (polyethylene glycol 400 ophthalmic)

Top 5 Restasis alternatives

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

1. Xiidra (lifitegrast)

Xiidra is an ophthalmic solution manufactured by Novartis. Its active ingredient, lifitegrast, combats T-cell-mediated inflammation as an integrin antagonist. Xiidra works by blocking the binding of two essential cell surface proteins—lymphocyte function-associated antigen 1 (LFA-1) and intercellular adhesion molecule 1 (ICAM-1) and has demonstrated improvement on a standardized eye dryness score. Like Restasis, Xiidra can take several weeks of consistent administration so that patients can experience symptom relief. However, its onset may be slightly quicker—six to 12 weeks with Xiidra versus 12 to 24 weeks with Restasis. About 25% of patients experience a side effect of an unusual taste or eye irritation, which are the most common side effects. 

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 DED. Approved by the United States FDA in 2021 following clinical trials demonstrating improvement in DED symptoms, Tyrvaya works by varenicline’s anticholinergic effects to activate a nerve pathway in the sinuses that increases tear production. The benefit of Tyrvaya over topical ophthalmic products is its ease of administration for those who do not like topically applying products to their eyes, and it eliminates the burning sensation associated with many topical eye administrations. Tyrvaya’s active ingredient, varenicline, is also the active ingredient in Chantix for smoking cessation; interestingly, both can be taken simultaneously for their unique indications because Tyrvaya’s absorption into the system is minimal. Sneezing is a common side effect, which may be bothersome to patients. 

3. Eysuvis (loteprednol)

Eysuvis (loteprednol) is the first ocular corticosteroid approved by the FDA for managing dry eye flares. Due to the side effects of prolonged steroid use, it should only be used for a maximum of two weeks at a time. The dose is four drops per day in each eye. The benefit of Eysuvis over immunomodulatory medications like Restasis is that it works much more quickly and can be used in conjunction with other classes of ophthalmic prescription drugs to alleviate severe symptoms. 

4. Miebo (perfluorohexyloctane ophthalmic solution)

Miebo (perfluorohexyloctane) is an eye drop that treats DED due to meibomian gland dysfunction, which occurs when glands near the eyelids aren’t producing enough high-quality oil. Miebo works by forming a lipid layer over the air-liquid interface of the tear film, which reduces tear evaporation. Like many ophthalmic products, contact lenses should be removed before administration and should not be reinserted for at least 30 minutes. Side effects are mild and include blurred vision and redness of the eyelid. 

5. Xdemvy (lotilaner 0.25% ophthalmic solution)

Xdemvy (lotilaner) is the first FDA-approved treatment for demodex blepharitis, a very specific condition causing dry eye disease due to the overgrowth of Demodex mites on eyelids. The condition causes eye irritation and redness along the eyelids, which can cause dry eyes. Because the symptoms of this specific condition are similar to other causes of DED, it is sometimes misdiagnosed. It goes untreated if not evaluated by a healthcare provider who is well-educated on eye conditions. Xdemvy is administered into the affected eye(s) twice daily for six weeks and can cause a burning sensation in the eyes. 

Natural alternatives to Restasis

According to the American Academy of Ophthalmology (AAO), the management of DED is different for each patient. Still, initial approaches include addressing modifiable risk factors and conditions to supplement tear production, slow tear evaporation, reduce tear resorption, and reduce ocular surface inflammation. Environmental modifications include assessment of other medications contributing to dryness, use of contact lenses, evaluation of malnutrition related to vitamin A deficiency, and conditions that contribute to the disease, such as malposition of eyelids and smoking. Non-pharmacological strategies to trial initially include encouraging frequent blinking, minimizing exposure to air conditioning and heating, using humidifiers wherever a patient spends a large amount of time, and avoiding second-hand smoke, dust, or allergens. Lubricant eye drops may be tried; gel drops or ointments are best for overnight application. Eye drops marketed for redness relief should be avoided as they may worsen the sensation of dry eyes. 

Additional natural alternatives used to improve the symptoms associated with DED include supplementation with omega-3 fatty acids, but a large 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 over supplement brands. A diet rich in omega-3s and otherwise well-rounded may be considered important for dry eye symptoms and overall eye health. Acupuncture is a strategy for which some small studies have demonstrated improved DED signs and symptoms. Otherwise, over-the-counter eye lubricants like artificial tears are reasonable starting points, with no specific evidence of a combination of best ingredients for all patients. 

How to switch to a Restasis alternative

When switching eye medications to an alternative, discussing options with healthcare professionals is always best. OTC options could be discussed with your local pharmacist, but prescription eye drops for DED should be reviewed with an eye care professional like an ophthalmologist. If an alternative to Restasis is needed, it can be initiated immediately.