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Medically reviewed by, Russell Braun RPH
Xiidra and Restasis are both used to treat dry eye disease (DED). DED is a chronic lack of moisture and lubrication in the eyes. DED can cause a decrease in quality of life and visual performance for key functions from driving to reading.
According to a study from the University of Utah the overall cost of DED to the healthcare system is estimated at $3.84 billion. It is reported that 30 million Americans suffer from dry eyes though that number is probably low as most don’t seek medical advice and instead use over the counter treatments.
There are 7 essential tips that can help you eliminate that dry eye feeling and not break the bank in the process.
Tip #1 First line treatments
Both Xiidra and Restasis come with a big price tag. If you have not checked into the common first line treatments yet you will want to start there.
Most common treatments:
- Artificial tears
- Punctual Plugs – inserted by a doctor to block tear ducts
- Warm compresses
A free resource for you on these remedies is your community pharmacist. Often people do not use over the counter medications properly. Take a few minutes to ask your pharmacist to show you how to use the eye drops, plugs or compresses properly.
Tip #2 Restasis will be generic soon
Cyclosporine, the chemical that is in Restasis is a drug that had been on the market for many years. It has been used orally as a immune suppressant and in 2003 was approved in the eye drop form knows as Restasis. The drug acts in the eye by regulating immune system cells that may affect tear production.
At this point in time, the manufacturer of Restasis, Allergan has done quite a job to keep the patent rights as long as possible. However, a generic manufacturer Mylan has applied for it’s own generic patent and the game has almost come to an end for brand name Restasis.
Keep in mind:
- Typical month supply of Brand Restasis can cost around $500-600
- Insurance will require a prior authorization
- Once the first generic is approved the price will drop slightly
- 6 months after the first generic the price should fall significantly
- A brand Restasis coupon can be found here
- If you are pregnant or breastfeeding ask your doctor before using
Dose and side effects:
- Dosing is the same as Xiidra, at one drop in each eye twice a day.
- Can take 6 months to see full effects
- Side effects: Burning in eyes, blurry vision
- Stinging upon administering drops sometimes requires steroid eye drop to lessen pain
Tip #3 Xiidra works faster
Xiidra was more recently approved by the FDA in 2016. The chemical name is Lifitegrast. Unlike Restasis no generic will be available for a long time. Xiidra is thought to work in a slightly different way on the immune system to treat dry eyes.
In clinical trials and since approval Xiidra seems to work faster than Restasis. The range is from two to six weeks most patients are seeing relief and the majority by twelve weeks. It is believed that the slight difference in how the drug works on the immune system vs Restasis provides the benefit of earlier symptom relief.
If you follow my pharmacist recommendation on using drugs on a trial basis and journaling to see if they are truly effective prior to committing to paying the high prices, then the Xiidra will have a shorter duration for the trial period for sure.
Most doctors will have samples so I would encourage you to ask for those.
Keep in mind:
- Cost of a months supply cash is about $500-$600
- Insurance will require a prior authorization
- Dont expect a generic anytime soon
- Find a manufacturer coupon here
- If you are pregnant or breastfeeding check with your doctor before using
Dose and Side effects:
- Dosing is the same as Restasis, at one drop in each eye twice a day
- Many see relief in 2-6 weeks
- Side effects: Irritation, blurry vision or changes in taste
- Less stinging and may not require steroid to alleviate stinging
Tip #4 Xiidra treats symptoms and increases tear production
When the FDA approves a drug they grant approval based on what they manufacturer can show the drug is effective for. The manufacturer of Xiidra won approval for treatment of the signs and symptoms of dry eye disease (DED), such as dryness, redness, pain, headaches, irritation.
Restasis on the other hand is only FDA approved for increasing tear production. What does that really mean? Well more tears produced equals less DED symptoms. However, Restasis on approval didn’t show that is helped with dryness, redness, pain, headaches and irritation. However, keep in mind that Restasis has been used since 2013 with thousands of patients treated. On the other hand Xiidra is fairly new and has been used in far fewer patients.
Tip #5 Have an inflammatory disease?
Research has shown that inflammatory diseases are linked to a higher incidence of dry eye disease. Common inflammatory diseases include Rhematoid arthritis, Psoriasis Ulcerative Colitis, Crohn’s disease and Lupus to name a few. Over time if not treated with a drug such as Restasis or Xiidra the eye condition would worsen even if the patient was using only artificial tears.
When you think about how Restasis and Xiidra work, this makes sense. Both drug work on cells called T-cells in your immune system. While the T-cell overactivity is causing symptoms of dry eyes it is also leading to the other inflammatory disease problems.
Tip #6 Contact Lenses
Contact lenses can be a great thing for people who don’t want to wear glasses, but what if you take a drug like Xiidra or Restasis? Will that impact your contacts?
First of all I think a lot of patients get confused by the advice they get in this area. You should remove your contacts prior to instilling the drops! That is important.
The good news is you can instill the drops in the morning before you put contacts in and then again in the evening after you take them out to give your eyes a break from contacts.
For both medications you may put your contacts back in 15 minutes after you have used the eye drops.
Tip #7 Pearls of wisdom
The good news is that both Xiidra and Restasis are very effective at treating dry eyes. Here are a few tips, you may not have heard from your doctor or pharmacist.
- If you use another eye drop at the same time as your Xiidra or Restasis stop! At least make sure you space them out by 15 minutes. The human eye can only hold about 10 micro-liters of fluid, 1 drop from an eye drop is ~25 micro-liters. If you use them back to back you will be just washing an expensive eye drop right down the old tear duct and not helping your condition much at all.
- Stinging or burning your eye, try placing the bottle in the refrigerator. Cold eye drops usually feel better and do not sting.
- When Restasis becomes generic the price difference may make it cheap enough to justify using a steroid before Restasis to prevent burning. The cost of both may be less than the brand name Xiidra.
- If you use Xiidra and a copay coupon, with your insurance, make sure you confirm with your insurance they do not have a copay accumulator. The amount the coupon pays toward your deductible may not count as an out of pocket expense. If that is the case, when the coupon runs out you could be stuck with a HUGE bill!
- A steroid may be needed to reduce a burning feeling, it can normally be stopped after 4-6 weeks once the patient has become accustomed to the Xiidra or Restasis.
- Funny taste in your mouth after using the drop is normal. The tear duct drains down into your throat and that may result in a funny taste. If you notice this try drinking some water, chewing some gum or using some mouthwash to remove the taste.
More treatments are coming
The pipeline of drugs to treat dry eyes is growing. As manufacturers discover new mechanisms to look at to treat dry eye as medical knowledge grows this trend is likely to increase.
That being said if you have tried over the counter treatments, Xiidra and Restasis and still are not getting relief, then I recommend you ask your doctor if there is a clinical trial you could participate in. There are pros and cons to consider, but at least look at the option if you just can’t shake the dry eye problem.
A great resource for dry eye sufferers
For much more in depth review of dry eye causes and ways to reduce symptoms check out The Dry Eye Remedy. Dr. Latkany offers ways to reduce dry eye symptoms without surgery.
Click here to get Dr. Jason Reed’s exclusive list of medication questions you MUST ask your doctor, for FREE!
Share your story
Have you tried any of the treatments discussed here? What worked and what didn’t? Dry eyes can wreak havoc on your sense of well being. Please chime in below with your comments and thoughts. Hopefully, we can prevent more people from suffering with dry eyes.