Restasis vs. Xiidra: Which Medication Is Better for Treating Dry Eye?

Dry eye is a medical condition that affects your eye’s natural ability to produce tears. If you’re dealing with chronic dry eye, your optometrist or ophthalmologist (eye doctor) may have recommended prescription treatments, such as Restasis or Xiidra. While both prescription eye drops are FDA-approved to treat chronic (long-term) dry eye disease, they contain different active ingredients that work in different ways and may have varying side effects. 

Understanding their effectiveness, costs, and potential side effects can help you and your eye doctor determine which medication best suits your needs. Below, we’ll examine the key differences between Restasis and Xiidra to assist you in making an informed choice.

What Are Restasis & Xiidra?

Restasis and Xiidra are prescription eye drops used to treat chronic dry eye, which disrupts the normal production of tears. This can occur when you either don't produce enough tears or when your tears evaporate too quickly. In both cases, your eyes lack adequate moisture, leading to discomfort and potentially affecting your vision.  

Common dry eye symptoms can include itching, burning, eye redness, blurred vision, or a scratchy feeling in the eyes.

Restasis (cyclosporine ophthalmic emulsion) acts as an immunosuppressant to reduce inflammation in the tear glands. This prescription eye drop works by blocking the activity of calcineurin, an enzyme that contributes to inflammation. By reducing inflammation, Restasis can help improve tear production over time. 

You should use Restasis exactly as your doctor instructed. The usual dose of Restasis is one drop in each eye twice daily, approximately 12 hours apart. Dry eye symptom relief usually takes several weeks to a few months to become noticeable. Maximum effects may take up to 6 months.   

Like Restasis, the recommended dose for Xiidra (lifitegrast ophthalmic solution) is one drop in each eye twice daily, approximately 12 hours apart.  Xiidra contains the active ingredient lifitegrast 5%, a lymphocyte function-associated antigen-1 (LFA-1) antagonist (blocker). 

Lymphocyte function-associated antigen-1 (LFA-1) is a protein found on cell surfaces that plays a crucial role in inflammation. Xiidra works by blocking LFA-1, preventing its interaction with other molecules that can promote inflammation. This mechanism of Xiidra helps promote tear production and enhance consistency, thus alleviating dry eye symptoms over time.  

In a twelve-week, double-blinded, multicenter study, Xiidra alleviated dry eye symptoms for some participants as early as two weeks. However, it may take between six and twelve weeks to experience the full benefits.

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Differences Between Restasis & Xiidra: An Overview

While Restasis and Xiidra are both effective at treating chronic dry eye, it’s helpful to have the differences side by side. That way, you and your eye doctor can decide on the right eye drops.

Which Drug is More Effective at Treating Dry Eye Disease?

Neither Xiidra nor Restasis is an optometrist’s first choice for chronic dry eye disease. Instead, experts usually recommend over-the-counter (OTC) eye drops. Two of the most popular are artificial tears and lubricant eye drops. These drops mimic natural tears, lubricate and protect the eyes, and flush away debris or other irritants that cause inflammation. 

If artificial tears or other over-the-counter (OTC) drops don’t work, doctors may recommend prescription drops like Restasis or Xiidra. Both eye drops work differently to treat dry eye. 

However, your doctor may recommend one over the other based on the cost, symptoms, and whether you need immediate relief. For example, while Xiidra works within a few weeks, Restasis can take up to six months to have any effect. Xiidra has no generic form, making it a higher-cost drop than Restasis. 

Ultimately, the choice is based on your needs, your eye doctor's recommendations, and what treatment will keep your eyes healthy in the long term. 

Restasis & Xiidra Side Effects

Both prescription eye drops come with slightly different side effects. Luckily, no matter which drops you use, the adverse effects are usually mild and not life-threatening. Side effects for Restasis and Xiidra can include the following. 

Restasis side effects

Restasis typically comes with more side effects than Xiidra, including: 

• Burning sensation

• Stinging

• Itchy eyes

• Eye redness

• Blurry vision 

• Foreign body sensation (feeling like something is in your eye) 

• Discharge 

• Pain

Xiidra side effects

While Xiidra has fewer side effects and works faster, it’s more expensive. Side effects can include: 

• Temporary blindness

• Irritation 

• Eye discomfort

• Redness on the white part of the eyes or eyelids

• Bad taste in the mouth

How to Save on Restasis & Xiidra Prescriptions

Xiidra and Restasis are available as brand-name prescriptions to treat dry eye disease. Restasis also has a lower-cost generic (cyclosporine ophthalmic emulsion), while Xiidra doesn’t. BuzzRX can help you pick and choose how to save on your prescription eye drops.

1. Get a BuzzRX prescription card or use the app to save on medications. The BuzzRX prescription card and app can help you save money on the generic version of Restasis or brand-name Xiidra. With a free BuzzRX coupon, your Restasis prescription could cost around $100, and Xiidra could cost around $700—almost $100 less than the retail price.  

2. Use manufacturer savings programs. Drug manufacturers sometimes offer coupons to help reduce the cost of their products. For Restasis, Allergan (now part of AbbVie) often provides a Restasis Multidose Savings Card, which can lower copays for eligible patients with commercial insurance coverage. For Xiidra, Novartis provides a Xiidra Savings Card that may reduce the monthly cost to as little as $0.

3. Look into patient assistance programs. If you’re uninsured or can’t afford medication even with insurance, you may be eligible for Xiidra and Restasis patient assistance programs, which offer free medication.

4. Order in bulk or use mail-order pharmacies. Mail-order services through your insurance may offer 90-day supplies of Restasis or Xiidra at a discount, which can be beneficial for long-term treatment.  

Are There Alternatives to Restasis & Xiidra? 

Yes, there are several medical and natural alternatives to Restasis and Xiidra. While these two prescription medications are the most common treatments for moderate to severe dry eye disease, they may not be effective for everyone. You may not tolerate them well, see little to no improvement, or find them too costly. 

If this is the case, your healthcare provider may suggest alternative options. 

Other prescriptions

Xiidra and Restasis aren’t the only prescriptions on the market. If you’re still seeking non-OTC medical treatments, these are excellent alternatives. 

• Cequa^® (cyclosporine 0.09%). This newer formulation is similar to Restasis but has a higher concentration of cyclosporine and is a solution (clear, water-based) rather than an emulsion (mix of oil and water).   

• Tyrvaya (varenicline) nasal spray. Clinical trials have shown that this first-of-its-kind nasal spray reduces symptoms of dry eye disease. It’s a great option if you don’t want to or can’t administer eye drops. 

• Eysuvis (loteprednol etabonate). This ocular steroid is the first to be FDA-approved for treating the eye. Since it’s a corticosteroid, it works quickly. However, due to the side effects of excessive steroid use, you should only use it for a maximum of two weeks at a time. 

• Xdemvy (lotilaner 0.25% ophthalmic solution). This medication directly treats demodex blepharitis, which causes dry eyes due to a buildup of Demodex mites on eyelids.

Procedures

Severe dry eye may not respond to any prescription medications. If so, your eye doctor might suggest a surgical procedure to help the condition. The two most common treatments for dry eye are punctal plugs and thermal pulsation. 

Punctal plugs insert tiny devices into the tear ducts to block drainage and moisten the eye’s surface. Meanwhile, thermal pulsation helps unclog oil glands in the eyelids, improving tear stability, particularly in cases of meibomian gland dysfunction and dry eye. 

At-home, natural remedies

If you’re looking for non-prescription treatments for dry eye, these lifestyle changes are great complements to Restasis, Xiidra, and other prescription eye drops. Always talk to your eye care provider before making any significant changes. 

• Purchasing a humidifier

• Reducing screen time

• Applying warm compresses or cloths to the eyes

• Practicing good eye hygiene

• Trying acupuncture

• Avoiding dust, smoke, or other eye irritants

• Blinking frequently

Contrary to popular belief, the American Academy of Ophthalmology (AAO) says there’s no concrete evidence that omega-3 supplements can improve your eye health. 

Restasis & Xiidra FAQs

Can you use Restasis & Xiidra at the same time?

No. It’s not recommended to use both medications simultaneously, as there is no clinical evidence to support using both of these eye drops together. Using Xiidra and Restasis together can worsen side effects with little to no significant relief. You should talk to your doctor if you are considering using both of them together. 

Can you switch between Restasis & Xiidra?

Yes, you can switch from one medication to the other if you're not seeing improvement or are experiencing uncomfortable side effects. Always consult your eye care provider before switching to a new eye drop to ensure a safe transition and proper usage.

What happens if I stop using Restasis or Xiidra suddenly?

Stopping either eye drop medication suddenly might cause dry eye symptoms to return. These drops work by managing inflammation over time, and discontinuing them could reverse the progress. Consult your healthcare provider before making any changes or discontinuing your medication. 

How do I use Restasis & Xiidra if I wear contact lenses? 

Always remove your contact lenses before using Restasis or Xiidra. After applying the medication, wait at least 15 minutes before reinserting your lenses. This helps avoid irritation and ensures the medication has time to absorb properly.

Do Restasis and Xiidra interact with other medications?

Not really. These eye drops typically have low systemic (all over the body) absorption, so interactions with other oral or topical medications are rare. That said, if you are using other types of eye drops, you should wait at least 5 minutes in between. Talk to your doctor if you have additional questions on how to safely use your eye drops.  

Can I use Xiidra or Restasis while pregnant?

Using Xiidra or Restasis while pregnant is considered generally safe. Since the medication is applied to the eyes, it is not absorbed into the bloodstream in large amounts. Thus, the risk of any significant problems is low. However, if you’re pregnant or breastfeeding, speak with a doctor before starting any new medications, including eye drops.