Recently, Cequa (cyclosporine ophthalmic solution 0.09%) became only the third dry eye medication to be approved by the FDA in the past 19 years. This is exciting for those of us suffering from dry eyes, as well as for those who treat it.
FDA approved to treat dry eye disease by enhancing tear production, it works as an immunomodulator in a similar fashion to its earlier competitor. Like the Restasis that we know all too well, Cequa uses cyclosporine but in a much higher concentration. This higher concentration is also part of a formula that includes nanomicelles. Micelles are gelatinous congregates of hydrophilic and hydrophobic molecules that can help with absorption of a substance. Sun Pharma (the manufacturer of Cequa) says these will help increase the ability of Cequa to penetrate the ocular tissues and overcome any solubility changes.
For the patient, this means a more effective medication, because penetration into the cells of the cornea and conjunctiva will be enhanced. Hopefully, this also means the medication will work more quickly, since it is well known that Restasis can sometimes take six months for the patient to notice changes in their dry eye symptoms.
Cequa was evaluated in two randomized studies with over 1000 patients suffering from dry eye disease. Compared to control at day 84, use of Cequa for 12 weeks showed a statistically significant increase in tear production (measured by Schirmer Score). Corneal and conjunctival staining was evaluated earlier, and positive changes were noted as early as four weeks.
As of October 2019, Cequa is now available from Sun Ophthalmics in the US. Cequa is dosed just like Restasis and Xiidra twice per day, 12 hours apart, morning and evening. The new medication comes in single-use vials that should be discarded immediately after each use. Each box contains six pouches with 10 vials each, for a one month supply.
Cequa should never be used while wearing contact lenses, and the company advises that dry eye patients should likely not be wearing extended wear contact lenses anyway. If contact lenses are worn, they may be inserted 15 minutes after instillation of the medication.
Cequa Cost/Price | Cequa Coupon Information
Since Cequa is such a new medication, information regarding cost and savings will begin to roll out. Currently, many patients with commercial insurance are able to get Cequa for as low as $5 for a 1-month supply and as low as $10 for a 3-month supply through their savings program. Of course, this varies by insurance and you may be asked to pay up to $90 for 1 month and $180 for 3 months. These savings do exclude Medicare and Medicaid plans.
We will continue to update this blog as more information comes available but, without insurance, you are looking at about $500 per month.
Cequa Side Effects and Contraindications
As with any medication, Cequa has a few common side effects. 22% of those studied experienced a burning or pain sensation upon instillation. 6% of those people noticed redness of the eyes, but both of these should subside within a few moments of using the medication. Typically, burning and redness are very common side effects for any eye drop, especially when inflammation is present. With dry eyes, inflammation is going to make burning and redness much more likely side effects no matter what is instilled into the eyes.
Other reactions noted were blepharitis, eye irritation, headache, and urinary tract infection, which is interesting. There are no adequate studies to show that Cequa is safe for pregnant and nursing mothers, so this should be either avoided or discussed with your doctor, weighing the benefits of the medication versus the risk to the unborn child or infant.
Cequa Generic and Alternatives
If you're suffering from debilitating dry eye disease but don't have the money to afford Cequa or you're tired of prescription medications, we have a few alternatives for you.
First of all, make sure you're drinking at least half your body weight in ounces of water per day (for a 150 pound person, that's 75 ounces). This will profoundly affect how your eyes feel.
Next, look at your diet. Are you eating tons of processed foods? Do you love cookies and cake as a snack? You need to get rid of these foods and switch to a plant based diet rich in healthy fats such as avocados, coconut oil, flaxseed, and other omega-3 fatty acids. You can even take a supplementto ensure you're getting the omega-3s you need.
Since there is no generic Cequa, we'll recommend other ways to control your dry eyes. First, ensure that your eyelids are kept clean. An eyelid hygiene regimen is so important to your dry eye relief success.
Heyedrate Lid and Lash Cleanser is a great place to begin. Used twice daily, this hypochlorous acid cleanser rivals prescription cleansers out there and effectively cleans bacteria from the skin of the eyelids, allowing you to feel relief of your dry eye symptoms. When used routinely, this spray can be a game changer.
A great routine we suggest making a part of your day includes washing your face with a tea tree oil soap to remove bacteria and any demodex that may be present, using a warm compress eye mask to loosen the stagnant oils that may be present in your meibomian glands, and then following this up with the Heyedrate Lid and Lash Cleanser. Although we do not usually recommend artificial tears, now would be the time to use them before going about your day (or heading to bed).
As you can see, there are many great natural ways to treat dry eye disease aside from the use of expensive pharmaceutical medications. Cequa absolutely shows promise for dry eye sufferers, but it's up to you to also make lifestyle changes that can ultimately heal your dry eyes.