Cyclosporine 

Cyclosporine

Cyclosporine, sold under the brand Restasis, is an FDA-approved eye drop prescribed for treating chronic dry eye. This liquid emulsion is recommended for patients aged 16 years and older. It is not approved for use in children below 16 years of age as the safety and effectiveness of this product have not been found yet in the mentioned age group. Generally, patients are advised to use one drop in the affected eye twice daily, but if your doctor tells you something else, follow their guidelines. Like every other medication, this drug may also have some side effects, like eye swelling or itching. Beware of such effects and consult your doctor right away. 

Product Overview

Restasis is a prescription drug primarily used to treat chronic conditions like dry eye. It may also be used off-label for other conditions. It is an immunosuppressant medication containing Cyclosporine as its active ingredient. With conditions like dry eye, patients can have inflammation in their eyes, causing dryness. As a result, the body finds it difficult to make enough of its own tears. 

Cyclosporine is available in one strength, 0.5 mg. It is usually taken orally, with or without food, and the dosage is determined by the patient’s medical condition and response to treatment. Only adults and children prescribed by their healthcare provider should take this medication. It works by managing the inflammation in the eyes and tear ducts. Thus improving the body’s natural ability to produce tears. This way, Restasis moistens the patient’s eyes and lowers dry eye symptoms.  

Some common side effects of these eye drops are blurry vision, watery eyes, and eye infections. Specific populations like pregnant and lactating women should remain cautious when using this medication or consult with their doctors for expert guidance. If a dose is missed, it should be taken as soon as remembered unless it is close to the time for the next dose. In case of an overdose, seek immediate medical attention. Store Restasis (Cyclosporine) at room temperature, away from moisture and heat, and keep it out of reach of children and pets. Always follow your healthcare provider’s instructions and guidance when using this medication.

Uses of Cyclosporine

The medication helps in:

• Treating vernal keratoconjunctivitis
• Treating dry eye diseases
• Increasing tear production in patients.

How to Use Cyclosporine

Dosage

Strengths and Forms

Cyclosporine ophthalmic solution comes in one strength, i.e., 0.5mg/mL. The medication is available in two forms:

• Single-Use Vials: These Restasis vials contain a single dose of the drug, 0.4 mL.
• Restasis Multidose: These bottles contain multiple doses of the drug, each containing 5.5 mL of Restasis.

Recommended Dosage for Different Patients

For Chronic Dry Eye

The usual dose of Restasis in patients aged 16 and above is one drop in each eye twice daily. There should be a 12-hour gap between each dose. It is important to note that this medication is not approved for use in children under 16.

[Note: These recommendations may vary from person to person. Discuss them with your doctor, and they’ll customize your dosage accordingly.]

How to Take It?

• Pull straight up to remove the clear shipping cover. Do not use the bottle if the shipping cover or pull tab is missing or damaged.
• Remove the pull tab by winding it counterclockwise.
• Unlock the bottle by removing the olive green colored protective cap, but do not throw it.
• Prime the bottle by squeezing 2-3 drops on a tissue. Do not let the bottle tip touch the tissue.
• Shake the bottle well before using it to mix the medicine well.
• If you are wearing any contact lenses, remove them before applying your eye drops, as these products contain preservatives that the contact lenses may absorb. Wait at least 15 minutes before putting the lenses back in your eyes.
• Tilt your head, look upward, and pull down the lower eyelid. Hold the bottle’s dropper over the affected eye and instill a drop in the eye. Immediately close your eyes and wait for 1 to 2 minutes. 
• Do not rub or blink your eyes for some time. This will prevent the medication from coming out. 
• Do not wash the dropper.
• Place the protective cap after using the medication.
• Make sure your hands are thoroughly washed before using your eye drops.
• Avoid touching the tip of the bottle to the eye or any surface, as this may contaminate the medication.
• If you are applying other eye medications like ointments, wait for 15 minutes before you use your other eye products. 
• Use it regularly to get the maximum benefit out of it.
• Use the drops at the same time each day. 

[Note: Your doctor will decide the right amount for you based on your condition, following guidelines and studies on the drug. They’ll adjust it as needed over time.]

How Does Cyclosporine Work?

Restasis contains Cyclosporine as its main ingredient, which belongs to a class of drugs known as calcineurin inhibitor immunosuppressants. In patients whose tear formation is reduced due to ocular inflammation caused by keratoconjunctivitis sicca, cyclosporine emulsion helps by partially modifying the immune response. While the exact mechanism of action is still unknown, Cyclosporine has provided relief to many patients from conditions such as chronic dry eye. 

Important Safety Information

Side Effects

Common side effects of Cyclosporine may include:

• Burning sensation in the eyes
• Eye pain
• Itching in the eye
• Stinging in the eye
• Watery eyes
• Sensitivity to light
• Feeling something in the eye
• Headache
• Runny nose
• Ear pain

Serious side effects of Cyclosporine may include:

• Eye redness 
• Irritation in the eye
• Troubled vision
• Subconjunctival hemorrhage (red spot in the eye)
• Thick discharge from eyes
• Eye swelling
• Skin itchiness
• Flushing
• Swelling under the skin, like in the eyelids, hands, or feet
• Swelling in mouth, throat, or tongue
• Trouble in breathing

[Note: This list may not cover all possible side effects. Always consult with your healthcare provider for medical advice about side effects.]

Warnings

• Contact Lenses: Doctors generally do not recommend wearing contact lenses if you have chronic dry eyes. Contact lenses need moisture to work properly, and they may not work well for people with this condition. If you wear contact lenses, it is essential to take them out before instilling Restasis eye drops in your eyes. It is also recommended to wait at least 15 minutes before putting them on. 
• Hypersensitivity: If you have had any allergic reactions or are allergic to any ingredients of Restasis, your doctors will not prescribe these eye drops to you as the medication may contain certain inactive ingredients that can cause adverse reactions like face swelling, tongue swelling, pharyngeal edema, dyspnea, and urticaria. Therefore, consult with your healthcare provider about any alternate options that might be better.
• Driving & Operating Machinery: Restasis multidose emulsion formulation may cause blurred vision in patients. If you are experiencing such a problem, do not drive or operate machinery that requires alertness until the vision is cleared.
• Ophthalmologic: Restasis multidose has not been tested in patients with certain eye conditions. These include a history of herpes keratitis, advanced lacrimal gland disease, or keratoconjunctivitis sicca (KCS) caused by damage to the conjunctival goblet cells. These conditions can happen due to Vitamin A deficiency, scarring from conditions like cicatricial pemphigoid, alkali burns, Stevens-Johnson syndrome, trachoma, or radiation exposure. If you have one of these problems, consult with your medical professional.
• Pregnant Women: When Restasis is used as per the doctor’s instructions, the drug is not found in the bloodstream, making it very unlikely that the developing fetus would get harmed by the drug. However, the medication contains the active drug cyclosporine, which also comes in a pill form that is used to treat other conditions. This pill has shown reduced fetal birth weights and slowed skeletal growth when given to the mother during animal studies. But remember, Restasis is an eye drop and not a pill. It is better to have an expert opinion when taking Cyclosporine eye drops or pills.
• Breastfeeding: When Restasis is used as per the doctor’s instructions, the drug is not found in the bloodstream, making it very unlikely that the developing fetus would get harmed by the drug while breastfeeding. However, the medication contains the active drug cyclosporine, which also comes in a pill form that is used to treat other conditions. This pill has been shown to pass into the breast milk of mothers using this drug. But remember, Restasis is an eye drop and not a pill. It is better to have an expert opinion when taking Cyclosporine eye drops or pills.

Precautions

• Visit your eye doctor frequently and closely monitor your eyes to check for any unwanted eye infections and to determine whether the medication is working properly.
• While applying the eye drops, your eye may sting or burn a little. If the stingness does not go away, check with your doctor.
• Before using this medication, tell your healthcare professional about any medical history, especially of current or recent eye infections, cancer, or precancerous conditions in or around your eye.
• Before undergoing any medical surgery or procedure, inform your doctor or dentist about the products you are using, including prescription or nonprescription drugs and herbal products.
• Do not use the product when it is past its expiration date.

Missed Dose

• If you missed a dose of your Restasis eye drops, take the skipped dose as soon as possible. 
• If it is almost time for your next dose, do not take the medication that you have missed.
• Apply the next dose at the scheduled time.
• Do not overuse the medication to make up for the missed one.
• Utilize reminders or apps to avoid further missing your doses.
• Apply your doses at the same time each day for effective results.

[Note: If you have missed a medication dose and are unsure when to take the next one, consult your doctor or pharmacist immediately.]

Overdose

Taking an overdose of Restasis eye drops may have severe side effects in patients, including increased eye irritation, burning, and redness. If you notice such side effects, immediately contact your healthcare provider or 911.

[Note: If you consumed more than the recommended dose, get medical help immediately or call the Poison Help line at 1-800-222-1222.]

Storage

• Store your Restasis eye drop bottle at 15 – 25° C.
• Do not freeze the medication
• If you are not using the eye drops, throw it 30 days after opening the bottle.
• Keep the medication out of reach and sight of children and pets.
• Do not store it in moist areas like the bathroom or near the sinks.
• Do not flush the medication down the toilet
• Discard the product when not in use.
• Keep the bottle away from direct heat or sunlight.
• Consult your healthcare provider/pharmacist on properly disposing of the product.
• Read the product label for detailed storage instructions.

[Note: Discuss with your healthcare professional the proper disposal of unused medicine and any questions you may have regarding its storage.]

Cyclosporine Interactions

• Betaxolol 
• Carteolol 
• Dexamethasone 
• Difluprednate 
• Fluocinolone 
• Fluorometholone 
• Levobetaxolol 
• Levobunolol 
• Loteprednol 
• Medrysone 
• Metipranolol 
• Prednisolone 
• Rimexolone 
• Timolol 
• Triamcinolone

[Note: This isn’t a complete list, and there could be other drugs that interact with Cyclosporine. Make sure to tell your doctor about any prescription, over-the-counter medicines, and herbal products you’re taking.]

Cyclosporine Alternatives

• Tyrvaya (varenicline)
• Varenicline
• Eysuvis
• Loteprednol ophthalmic
• Xiidra
• Systane
• Cequa
• Refresh
• TheraTears
• Hydroxypropyl cellulose (Lacrisert)

[Note: Your doctor will choose what’s best for you. Don’t use any of these alternative medications without consulting your healthcare provider. Taking them by yourself may cause serious side effects.] 

Frequently Asked Questions

Is Cyclosporine (Restasis) a steroid?

No, Cyclosporine (Restasis) is not a steroid. It is an immunosuppressant medication used to increase tear production in patients with conditions like dry eye caused by inflammation. Unlike steroids, which broadly reduce inflammation, Cyclosporine specifically targets and balances the immune response in the eyes to improve tear production and reduce inflammation. Restasis is often used for long-term treatment to manage chronic dry eye conditions.

Can I use Cyclosporine for the long term?

The FDA recommends that Cyclosporine be used for no more than one year. However, there are no specific guidelines for how long you should use this drug. Some doctors may even prescribe these eye drops for more than one year. In the end, the duration of the usage will depend on the patient’s needs and infection. 

What happens if I suddenly stop taking Cyclosporine? 

It is not recommended to discontinue your medication suddenly. However, if you stop taking your Cyclosporine eye drops, there are no such serious withdrawal symptoms. However, as per the clinical studies, persistent dry eye symptoms may return if you stop your treatment. Therefore, you are advised to consult with your medical professional before taking any action.

How do I get to know if Cyclosporing is working?

To know if Cyclosporine is working, look for improvements in your dry eye symptoms. These improvements can include increased tear production, reduced eye discomfort, less redness, and fewer episodes of eye irritation. Remember that these improvements may take time to notice. Regular follow-ups with your eye doctor are essential to monitor progress. Your doctor may perform tests to measure tear production and evaluate the overall health of your eyes to determine the effectiveness of the treatment.

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