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Key takeaways
Xiidra (lifitegrast) and Restasis (cyclosporine) are FDA-approved prescription medications for treating dry eye disease.
Xiidra may offer quicker symptom relief within two weeks, whereas Restasis may take up to three months for symptom relief, but effectiveness varies by individual.
Xiidra is not typically covered by Medicare and can be expensive without insurance, while Restasis is usually covered by Medicare and insurance plans, with available coupons to lower costs.
Common side effects of Xiidra include eye irritation, unusual taste, and blurred vision. Restasis may cause burning and irritation in the eyes.
Drug overview & main differences | Conditions treated | Efficacy | Insurance coverage and cost comparison | Side effects | Drug interactions | Warnings | FAQ
Xiidra (lifitegrast) and Restasis (cyclosporine) are brand-name medications used to treat dry eye disease. People with dry eye disease experience a chronic lack of moisture in the eyes and may not be able to produce enough tears to lubricate the eyes. This condition can lead to eye discomfort and problems reading or working on the computer, among other problems. Xiidra and Restasis are eye drop medications used in both eyes daily.
What are the main differences between Xiidra and Restasis?
Xiidra
Xiidra, also known by its generic name, lifitegrast, is manufactured by Shire. It was FDA approved in 2016 in a relatively new class of medications called lymphocyte function-associated antigen 1 (LFA-1) antagonists. The exact way in which it works is unknown. However, it is believed to decrease inflammation and increase tear production by blocking a protein called LFA-1 from interacting with another protein called ICAM-1 in the eyes.
Xiidra is a 5% topical eye solution that is administered as one drop in each eye twice daily (about 12 hours apart). It can help relieve dryness in the eye within two weeks, although it may take up to six to 12 weeks to provide complete relief for some people.
Restasis
Restasis was FDA approved in 1983 to treat dryness in the eyes. It is manufactured by Allergan and is known by its generic name, cyclosporine. Restasis is believed to work by regulating inflammatory processes in the eye that can affect tear production.
Restasis is a 0.05% eye emulsion that is instilled in both eyes twice daily or every 12 hours. It may take up to three months to experience relief with Restasis. For some people, it can take up to six months to experience adequate relief.
| Main differences between Xiidra and Restasis | ||
|---|---|---|
| Xiidra | Restasis | |
| Drug class | Lymphocyte function-associated antigen 1 (LFA-1) antagonist | Calcineurin inhibitor immunosuppressant |
| Brand/generic status | No generic version available | No generic version available |
| What is the generic name? | Lifitegrast | Cyclosporine |
| What form(s) does the drug come in? | Ophthalmic solution | Ophthalmic emulsion |
| What is the standard dosage? | One drop in each eye twice daily or every 12 hours | One drop in each eye twice daily or every 12 hours |
| How long is the typical treatment? | This medication is used as a long-term treatment | This medication is used as a long-term treatment |
| Who typically uses the medication? | Adults and adolescents aged 17 years and older | Adults and adolescents aged 16 years and older |
Conditions treated by Xiidra and Restasis
Xiidra and Restasis are both approved to treat dry eye disease, otherwise known as dry eye syndrome. Dry eye disease may be associated with other eye conditions such as blepharitis, or inflammation of the eyelids, caused by allergies or other problems. These medications help increase tear production and reduce inflammation on the ocular surface.
In addition to dryness, Xiidra and Restasis can help treat other symptoms of dry eye disease, including redness in the eyes, eye fatigue, blurry vision, and itchiness in the eyes. Some doctors may recommend additional treatments while using Xiidra or Restasis, such as warm compresses to soothe the eye.
| Condition | Xiidra | Restasis |
| Dry eye disease | Yes | Yes |
Is Xiidra or Restasis more effective?
There are currently no clinical trials that directly compare the effectiveness of Xiidra versus Restasis for dry eye disease. However, both medications have been shown to be effective in clinical trials when compared to placebo. The most effective medication will be the one that works best for you.
Across four randomized, multicenter clinical trials, the efficacy and safety of lifitegrast was evaluated in 1,181 patients. By the end of 12 weeks, there was a significant improvement in symptoms in those using lifitegrast for dry eye disease. An Eye Dryness Score was used to assess discomfort during treatment.
Cyclosporine, the active ingredient in Restasis, was studied in four randomized trials consisting of about 1,200 patients with moderate to severe dry eye symptoms. After six months, there was significantly increased tear production in 15% of patients treated with cyclosporine versus 5% of patients treated with placebo.
Consult a healthcare provider to determine the best treatment option for you. You may be referred to an eye care specialist or a doctor who specializes in ophthalmology for your condition.
Coverage and cost comparison of Xiidra vs. Restasis
Xiidra is not usually covered by Medicare insurance plans. There is no generic alternative available for Xiidra, so it can often be quite expensive. Copay amounts can vary widely depending on the insurance plan. Without insurance, a SingleCare Xiidra coupon card may be able to help lower the price of the medication to approximately $580. Otherwise, the average retail price of Xiidra is around $730.
Restasis is only available as a brand-name medication. However, most Medicare and insurance plans will cover Restasis. Copays may vary depending on the insurance plan. Without insurance, the average cash price of Restasis is around $389. Using a coupon can help lower the cost of Restasis. A SingleCare Restasis coupon is available for use at participating pharmacies and will lower the cost of Restasis to $255.
| Xiidra | Restasis | |
| Typically covered by insurance? | No | Yes |
| Typically covered by Medicare Part D? | No | Yes |
| Quantity | 60 single-use containers | 60 vials |
| Typical Medicare copay | $3–$637 | $19–$652 |
| SingleCare cost | $578+ | $255+ |
Common side effects of Xiidra vs. Restasis
The most common side effects of Xiidra are irritation and redness in the eyes, eye discharge, headache, and blurred vision. Xiidra may also cause an unusual taste in the mouth, also known as dysgeusia.
The most common side effects of Restasis include burning, irritation, and redness in the eyes, as well as blurred vision. Restasis is not known to cause a distorted taste perception; however, it may be more likely than Xiidra to cause a burning sensation in the eyes after administration.
Serious side effects of Xiidra and Restasis include hypersensitivity reactions. Signs and symptoms of hypersensitivity reactions include rash, swelling, itching, and shortness of breath.
| Xiidra | Restasis | |||
| Side effect | Applicable? | Frequency | Applicable? | Frequency |
| Eye irritation | Yes | 5%–25% | Yes | 1%–5% |
| Burning sensation in the eyes | Yes | 1%–5% | Yes | 17% |
| Redness of the eyes | Yes | 1%–5% | Yes | 1%–5% |
| Blurred vision | Yes | 5%–25% | Yes | 1%–5% |
| Unusual taste sensation | Yes | 5%–25% | No | – |
| Eye discharge | Yes | 1%–5% | Yes | 1%–5% |
| Eye discomfort or pain | Yes | 1%–5% | Yes | 1%–5% |
| Headache | Yes | 1%–5% | No | – |
Frequency is not based on data from a head-to-head trial. This may not be a complete list of adverse effects that can occur. Please refer to your doctor or healthcare provider to learn more.
Source: DailyMed (Xiidra), DailyMed (Restasis)
Drug interactions of Xiidra vs. Restasis
No significant drug interactions have been reported with Xiidra or Restasis. Other eye drop medications should be avoided while using Xiidra or Restasis unless directed by a healthcare provider. Tell your doctor about any medications you may be taking, such as prescription medications, vitamins, and herbal supplements.
Warnings of Xiidra and Restasis
Touching the tip of the container, vial, or bottle directly to the eye or surrounding surfaces should be avoided during administration. Doing so could increase the risk of contamination, which could lead to infection in the eyes. Touching the tip of the container, vial, or bottle to the eyes could also cause injury.
Contact lenses should be removed prior to administering Xiidra or Restasis. Contact lenses can be reinserted 15 minutes after using Xiidra or Restasis.
Single-use containers of Xiidra should be used immediately after opening. They should then be discarded after administering the medication.
Consult a healthcare provider for other possible warnings and precautions associated with Xiidra or Restasis.
Frequently asked questions about Xiidra vs. Restasis
What is Xiidra?
Xiidra is a brand-name ophthalmic solution used to treat dry eye disease. It is classified as an LFA-1 antagonist that blocks the interaction of certain proteins to decrease inflammation. The generic name of Xiidra is lifitegrast; however, no generic versions of Xiidra are currently available. Xiidra is administered twice daily to relieve dryness in the eyes. It is manufactured by Shire.
What is Restasis?
Restasis is the brand name for cyclosporine ophthalmic solution, which is manufactured by Allergan. It is administered twice daily to treat symptoms of dryness in the eyes. It works as a calcineurin inhibitor immunosuppressant to decrease inflammation and increase tear production in the eyes. No generic versions of Restasis are currently available.
Are Xiidra and Restasis the same?
Both Xiidra and Restasis have anti-inflammatory properties, but they are not the same. Xiidra is a LFA-1 antagonist while Restasis is a calcineurin inhibitor. They are manufactured by different pharmaceutical companies and come in different formulations. Xiidra is an ophthalmic solution that comes in single-use containers. Restasis is an ophthalmic emulsion that comes in single-use vials or a multi-dose preservative-free bottle.
Is Xiidra or Restasis better?
Xiidra and Restasis are both effective for treating chronic dry eye symptoms. However, Xiidra may relieve dry eye symptoms more quickly than Restasis. Xiidra can start working within two weeks while Restasis usually takes up to three months to start relieving dryness in the eyes.
Can I use Xiidra or Restasis while pregnant?
Using Xiidra or Restasis while pregnant is generally safe. Since Xiidra and Restasis are administered in the eyes, they are not absorbed into the bloodstream in large amounts. Therefore, the risk of birth defects while using Xiidra or Restasis is low. Consult a healthcare provider for medical advice if you are pregnant or breastfeeding.
Can I use Xiidra or Restasis with alcohol?
Xiidra and Restasis are not absorbed in the bloodstream in large amounts. Instead, these medications work in the eyes. Xiidra and Restasis are not known to interact with alcohol.
Can Xiidra cure dry eyes?
Xiidra is used to treat dry eyes associated with dry eye disease or blepharitis. It is used as a long-term treatment to relieve dry eyes. If Xiidra is discontinued, dryness in the eyes may return.
Is Xiidra a steroid?
Xiidra is not a steroid. It contains the active ingredient lifitegrast, which works as a lymphocyte function-associated antigen 1 (LFA-1) antagonist. It works by blocking a protein called LFA-1 from interacting with a protein called ICAM-1. The interaction of these proteins plays a role in inflammatory processes in the eyes.
Does Xiidra reduce inflammation?
Xiidra is an effective medication that helps reduce inflammation and dryness in the eyes. It can start relieving dry eyes within two weeks, although it can take up to 12 weeks to provide complete relief. Xiidra is administered twice daily as an ophthalmic solution.
Is there a cheaper alternative to Restasis?
There may be a cheaper generic alternative to Restasis currently in production but it may not be available yet. Your healthcare provider may recommend an over-the-counter product like artificial tears for occasional dryness or irritation in the eyes. Restasis is a prescribed medication indicated to treat chronic symptoms from dry eye disease.