Xiidra® (lifitegrast ophthalmic solution 5%) became FDA approved in mid-July 2016 and has been widely successful since its release. However, this is still considered a new medication that’s still finding its way into the pharmaceutical marketplace. Some things have yet to be determined, but sharing what is known is important for the millions of people who could benefit from this medication.
During FDA trials, Xiidra was found to start working in test subjects as early as two weeks after the beginning of the application and most felt a positive difference in their dry eyes within 12 weeks. The efficacy and safety of this medication was studied in four well-controlled trials over a period of 12 weeks, and over 2100 patients were studied. Improved symptom relief was noted in two of the four studies at two, six, and 12 weeks.
Also at 12 weeks, Xiidra was shown to improve the signs of dry eyes, measured by inferior corneal staining. This is a huge jump forward from Restasis (cyclosporine ophthalmic emulsion 0.05%), which typically takes about six months before a real difference is felt by users or seen by your eye doctor. We’ll go into a bit more about Restasis vs. Xiidra later in the article.
How Does Xiidra Work? Xiidra Mechanism of Action
Xiidra is FDA approved to treat the signs and symptoms of dry eye disease, or keratoconjunctivitis sicca, as we discussed above. We know this can get a little confusing, but it basically works by inhibiting the binding of inflammatory cells.
This mechanism decreases inflammation mediated by T lymphocytes (a type of white blood cell that plays a critical role in your body’s immunity), therefore improving dry eye signs and symptoms. More specifically, Xiidra blocks the interaction of ICAM-1 and LFA-1, which are key players of the inflammation behind dry eye. Although we know all of this, the exact mechanism of action is still unknown.
Xiidra comes in a preservative-free solution in eye drop form and is dispensed in small, single-use vials as a 30-day supply. It is prescribed as one drop in each eye, twice per day, morning and evening. If you cannot take the medication in the morning and evening, it is important to still make sure that your doses are 12 hours apart. Each vial should be discarded after one single use, as there are no preservatives in the solution to prevent contamination should the vial be left out and open.
Although some may be concerned about systemic absorption, this risk was shown to be very low. If you’re concerned, make sure to use the eye drops and then apply pressure to the inside corners of your eyes (where your punta drain), as this may prevent even more systemic absorption.
Xiidra Side Effects and Contraindications
Keep in mind, the FDA trials tested only a few thousand subjects, so further side effects could be found as the drops hit the market and are used more comprehensively for dry eye patients.
It is important to note that, if your eyes are inflamed (as most are with dry eye disease), anything you put into your eyes has the potential to sting or burn. Xiidra is no different, and it is very common for the medication to burn for a few seconds to minutes after instillation. This side effect, although very common, is harmless and will subside as your eyes heal.
The side effects determined by the trial are noted to be the following:
Between 5-25% of those using the drops felt burning in their eyes when they first put them in.
Blurry vision immediately after insertion
A strange or bad taste in the mouth (dysgeusia) immediately after application
Between 1-5% reported a headache, redness of the eyes, watering eyes, discharge from the eyes, and runny nose, to name a few relatively insignificant others
Allergic reactions to Xiidra are more serious than the side effects, but they are few. They include breaking out in hives, difficulty breathing, and swelling of the face, lips, tongue, and/or throat. Any such reaction should be reported to emergency medical personnel and to the company. If persistent vision problems or severe redness or irritation occur, a person is advised to discontinue use of Xiidra and call their doctor to discuss what to do next.
Though Xiidra’s trials used 76% women, none of them were pregnant or breastfeeding mothers so it may be included amongst contraindications. There is no evidence to support or deny that it may be harmful to pregnant women, so those who are pregnant or plan to become pregnant should consult with their doctor. It is also unknown if Xiidra can harm a baby through breast milk. Breastfeeding mothers should talk to their doctors as well.
People who wear contact lenses can use Xiidra, with a few caveats. They should take the lenses out before use and should also wait 15 minutes before putting their lenses back in. The same sanitary measures that apply to wearing contacts, like having clean hands and not contaminating anything that will touch the eye, applies to the use of Xiidra.
Xiidra Cost and Coupon Information
According to GoodRx, Xiidra is going to cost you over $500 without insurance or coupons. Of course, even if you do have an insurance plan, everyone’s insurance is different. We know that many will cover some of the cost of Xiidra, which is a huge help for the millions of Americans that need it. It’s estimated that about 30% of Medicare plans will cover this medication, so you’ll be left with a small copay. Even better, if you’re eligible, you can use a coupon through Xiidra’s website to get your first month free and only pay $10 per month after that.Make sure to check that out here.
Their website also includes savings such as $20 for a 90-day supply, so if you don’t qualify for one deal, you might just qualify for another. Either way, there are ways to save despite the large chunk of change they demand for self-pay patients.
Xiidra Generic and Alternatives
Xiidra is so new that there is no generic for this medication. However, there are loads of alternative ways to treat your dry eyes. Let’s start simple, and we’ll build from there (make sure to ask yourself if you’re doing all of these...and if you’re not...get to it!)
Hydration: You may think this is ridiculous to mention, but 80% of people are dehydrated and symptoms of disease can mimic dehydration. So many people do not drink enough pure, filtered water. You should be drinking at least half your body weight in ounces of water per day (ask your primary care doctor about this if you’re unsure that it’s right for you). Get a large, reusable water bottle and fill that baby up multiple times per day! And, once again, this is water only...not coffee, tea, or juice.
Diet: Are you still eating things that contain so many ingredients you can’t pronounce? Have you ever read the labels of some of the things you’re eating? Replace all of that junk (think boxed, processed foods and sugary items like cakes, cookies, and chips) with REAL, anti-inflammatory food. Real food means eating fruits (apples, oranges, mango…), vegetables (spinach, carrots, celery…), beans (all kinds!), gluten free whole grains (oatmeal, quinoa, rice), and other things like those. Did you notice that all of those foods have only one ingredient?
Omega-3s and Healthy Fats: Without healthy fats and a proper ratio of Omega-3 to Omega-6 fatty acids, your cells cannot turn over and become new, healthier cells. Start replacing nasty fats like vegetable oils with things such as avocados, coconut oil, avocado oil, walnuts, chia seeds, flaxseed, or even take anOmega-3 supplement(make sure it's triglyceride based).
Eyelid Hygiene: This is the most important recommendation of all and it applies to everyone, from birth to 100 years+. Clean eyelids that are free of debris, dead skin cells, eyelash mites (demodex), and an overgrowth of bacteria mean healthy eyes for a lifetime. It’s as simple as using ahypochlorous acid eyelid cleanser twice per day. All you have to do is close your eyes, spray it on, rub it in, and let it dry!
Now onto this important distinction and one of the main questions we are asked when discussing either of these medications. Which is better? Well, one main difference between Restasis, a decade-old medication used to treat dry eye, and Xiidra, is that Xiidra is approved to treat not just dry eye signs but its symptoms as well. That distinction is because of the nature of the product.
Xiidra stops a chemical chain reaction in the cells. When the drop hits the eye, the drop binds with proteins in the cells that stop the signals that would otherwise create many of the problems and symptoms of dry eye including itching, burning, pain, and redness. This effect can be noticed quite quickly!
Restasis, on the other hand, is a slower process. Although the exact mechanism of action is also unknown, we do know that it contains a topical immunomodulator with anti-inflammatory effects. Over time, this medication helps the eyes produce more of their own high quality tears which, in turn, helps the patient feel relief.
The important thing to note with both of these medications is that they are not artificial tears. They’re not designed to give you immediate relief because they’re healing your eyes from the inside out, not simply putting a bandaid on the problem. Healing takes time.
FAQs about Xiidra
What is the difference between Xiidra and Restasis?
Made up of Lifitegrast 5%, Xiidra is a new class of medication that is the first to be a lymphocyte function associated antigen-1 (LFA-1) antagonist. The exact mechanism of action is unknown for Restasis (Cyclosporine Ophthalmic Emulsion) 0.05%, but we do know that it belongs to a class of medications called calcineurin inhibitor immunosuppressants. Xiidra and Restasis are both available by prescription only.
Is Xiidra a better option than Restasis?
Restasis was the only dry eye medication available for 12 years for a reason. It work for many people! The downfall of Restasis is that it can take up to 6 months to fully kick in. You might not feel anything for months, and the side effects are stinging, burning, and dryness. Xiidra tends to work a little faster. You might feel the benefits in as little as 2 weeks and full benefits in 2 to 4 months. Is it better? This is patient dependent, since one person may react more favorably to Xiidra yet another patient may prefer Restasis.