Ross is a writer for Verywell with years of experience practicing pharmacy in various settings. She is also a board-certified clinical pharmacist and the founder of Off Script Consults.
Mary Choy, PharmD, is board-certified in geriatric pharmacotherapy. She currently serves as the director of pharmacy practice of the New York State Council of Health-System Pharmacists.
Cequa (cyclosporine 0.09%) is a treatment option for keratoconjunctivitis sicca (dry eyes).
As a calcineurin inhibitor, cyclosporine is thought to work by suppressing the immune system (the body's defense system) to relieve eye inflammation (swelling). Eye inflammation is thought to block tear production in people with dry eyes.
As an eye medication for dry eyes, cyclosporine is available by prescription as a Cequa (cyclosporine 0.09%) solution and Restasis (0.05%) emulsion. Cyclosporine is also available by prescription as a Verkazia (cyclosporine 0.1%) emulsion for another eye condition called vernal keratoconjunctivitis, a chronic (long-term) severe eye allergy.
Dosage Form: Ophthalmic (eye) solution
Cequa (cyclosporine 0.09%) is used as a treatment option for dry eyes, which is a common medical condition. While anyone can get dry eyes, you might have a higher likelihood of having dry eyes if you:
If you have dry eyes, you may experience some of the following symptoms:
Since directions may vary for different eye medications, carefully read the directions and packaging label on your container.
In general, however, squeeze one drop from the Cequa vial into each eye twice daily. Also, keep the following in mind about Cequa:
The following are also some general steps on how to use eye drops:
Since Cequa is a non-controlled medication, your healthcare provider may authorize refills for up to one year from the original date on the prescription.
When you receive your Cequa prescription from the pharmacy, store the eye medication at room temperature, which is between 68 degrees to 77 degrees Fahrenheit (F). Do not store Cequa in the bathroom.
If you're going to travel with Cequa, become familiar with your final destination's regulations. In general, however, make a copy of your Cequa prescription. You may also want to keep the original container or packaging from the pharmacy, with your name on it.
The Food and Drug Administration only approved Cequa for dry eyes.
Cyclosporine, however, is also available as another prescription eye medication called Verkazia (cyclosporine 0.1%). Instead of dry eyes, the Verkazia emulsion is used for a different eye condition called vernal keratoconjunctivitis. Vernal keratoconjunctivitis is a chronic severe eye allergy.
You might notice some improvement in your dry eye symptoms with 28 days.
Side effects are possible with Cequa.
This is not a complete list of side effects, and others may occur. A medical professional can advise you on side effects. If you experience other effects, contact your pharmacist or a medical professional. You may report side effects to the FDA at www.fda.gov/medwatch or 1-800-FDA-1088.
Common side effects for Cequa include mild eye pain and red eyes, or other irritation.
Eye injury and eye infection are possible with Cequa. To limit these serious side effects, avoid touching the vial tip to your eye or any other surface.
If you suspect that you're experiencing an eye injury or infection, get medical help right away.
Cyclosporine is typically a safe long-term treatment option for dry eyes.
Cequa may cause other side effects. Call your healthcare provider if you have any unusual problems while using this medication.
If you experience a serious side effect, you or your provider may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting Program or call the FDA by phone (800-332-1088).
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
Your healthcare provider might slightly modify (change) your Cequa treatment under the following situations:
Pregnancy: There are limited safety and effectiveness data about Cequa in pregnant people. Talk with your healthcare provider to weigh the benefits and risks of using Cequa during pregnancy.
Nursing: It's unlikely that large amounts of cyclosporine would be absorbed through your eye. So, negative effects on your nursing baby are also unlikely. You can, however, further lower the risk of cyclosporine reaching the breastmilk. After placing a cyclosporine drop in your eye, press down for one minute on your tear duct, which is the corner of your eye that's closest to your nose. Then, use a tissue to remove any excess solution.
People who use contact lenses: Remove your contact lenses before using Cequa. After using Cequa, wait 15 minutes before wearing contact lenses again.
People who use other eye medications: If you have multiple eye medications, don't immediately use one after another. You should usually wait five minutes between different eye medications. For Cequa, however, separate it from other eye medications by at least 15 minutes.
If you accidentally forgot your Cequa dose, place a Cequa drop in each of your eyes as soon as you remember. If it's already close to your next scheduled dose, however, then skip the missed dose and use Cequa again at your next scheduled time. Don't try to double up to make up for the missed dose.
It's unlikely that you would overdose from Cequa. If you suspect that you're experiencing life-threatening side effects, however, seek immediate medical attention.
If you think you or someone else may have overdosed on Cequa, call a healthcare provider or the Poison Control Center (800-222-1222).
If someone collapses or isn't breathing after taking Cequa, call 911 immediately.
It is very important that your eye doctor check your or your child's eyes at regular visits to make sure this medicine is working properly and to check for unwanted effects.
If your or your child's symptoms do not improve or if they become worse, check with your doctor.
This medicine may cause blurred vision or other vision problems. If any of these occur, do not drive or do anything else that could be dangerous until you know how this medicine affects you.
While applying this medicine, your eyes will probably sting or burn for a short time. This is to be expected.
Talk with your healthcare provider before using Cequa if any of the following apply to you:
If you have multiple eye medications, don't immediately use one after another. Separate Cequa from other eye medications by at least 15 minutes.
If you have any questions or concerns about medication interactions with Cequa, talk with your pharmacist or healthcare provider.
There are a number of eye medications used for dry eyes. Some are over-the-counter (OTC) artificial tear products, and others are prescription eye drops.
For the prescription products, there are steroid eye drops, such as Eysuvis (loteprednol). Steroid eye drops, however, tend to have a higher risk of side effects.
As a result, some healthcare providers might prefer non-steroid eye medications for long-term use. Examples of non-steroid eye medications include Xiidra (lifitegrast) and cyclosporine products. Xiidra works differently than cyclosporine eye medications. It might also work a little faster. Some people using Xiidra may notice some improvement in dry eye symptoms as soon as two weeks.
As for the different cyclosporine products, cyclosporine is available as Cequa and Restasis for dry eyes. Compared to Restasis, studies suggest that Cequa might be more effective—with fewer side effects.
Cequa is available with a prescription from your healthcare provider. Local retail pharmacies typically carry Cequa. If necessary, the pharmacy staff may order the medication for you.
Since Cequa isn't available as a generic product yet, it's typically costly without insurance coverage. If cost is a concern, the manufacturer does offer a copay card for people with commercial or no insurance. For eligibility questions, visit the Sun Pharmaceutical website or call 1-855-268-1426. Another potential cost-savings option is to discuss with your pharmacist or healthcare provider about switching to Restasis or a generic version.
In addition to Cequa, some people might also use ariticial tears to relieve dry eye symptoms.
Dry eye symptoms can be irritating. Thankfully, there are ways to prevent worsening dry eye symptoms. Refer to the following general tips:
Verywell Health's drug information is meant for educational purposes only and not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare professional. Consult your doctor before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.
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Food and Drug Administration. Cequa label.
Food and Drug Administration. Restasis label.
Genetic and Rare Diseases Information Center. Vernal Keratoconjunctivitis.
Food and Drug Administration. Verkazia label.
Akpek EK, Amescua G, Farid M, et al. Dry eye syndrome preferred practice pattern. 2019;126(1):PP286-P334.
National Eye Institute. Dry eye.
National Eye Institute. How to put in eye drops.
Goldberg DF, Malhotra RP, Schechter BA, et al. A phase 3, randomized, double-masked study of OTX-101 opthalmic solution 009% in the treatment of dry eye disease. Ophthalmology. 2019;126(9): P1230-1237.
Carlos de Oliveira R, Wilson SE. Practical guidance for the use of cyclosporine ophthalmic solutions in the management of dry eye disease. Clinical Ophthalmology. 2019;13:1115-1122. doi: 10.2147/OPTH.S184412
Haber SL, Benson V, Buckway CJ, et al. Lifitegrast: a novel drug for patients with dry eye disease. Therapeutic Advnces in Ophthalmology. 2019;11:1-8 doi: 10.1177/2515841419870366
Food and Drug Administration. Orange book: approved drug products with therapeutic equivalence evaluations.
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