Xiidra® Dry Eye Drops | Side Effects, Cost, Coupon, Dosage, & Reviews

What Is Xiidra®, aka Lifitegrast?

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 Dosage

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

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. But 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

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.

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 an Omega-3 supplement (such as the Heyedrate Omega-3 for Eye Health).
  • 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 a hypochlorous acid eyelid cleanser twice per day. Our Heyedrate Lid and Lash Cleanser is a great option, and all you have to do is close your eyes, spray it on, rub it in, and let it dry!  

Xiidra Reviews

Now that we’ve gone through some of the things you can do to treat your dry eyes besides using Xiidra and other pharmaceuticals, let’s dive into whether or not Xiidra actually does what it says it does. Does it work?

Well, in clinical studies over a 12 week period, Xiidra was shown to reduce dry eye symptoms in as little as two weeks (some patients took longer than others, but most noticed improvement within 12 weeks). Now, this is data from the makers of Xiidra, so we also looked outside.

According to Everyday Health, Xiidra worked well for many people and we read tons of reviews from patients who were very satisfied with the relief they found. Actually, the majority of bad reviews came down to expectations. Nearly all of these bad reviews mentioned side effects that are known to occur with Xiidra, but their doctors likely neglected to warm them about.

Complaints regarding burning and stinging and blurred vision were prevalent, and some complaints of headaches and a metallic taste were noted as well. So, we take this with a grain of salt. If you’ve got the right expectations for any treatment, and the right mindset going into it, you’re likely to be more successful than someone who expects the worst and thinks nothing will ever work for them.

Xiidra vs Restasis

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.

Xiidra is a wonderful new prescription medication that is available from your eye doctor. If you’ve truly tried all of our alternative treatment options and are still struggling with dry eyes, it might be a great option for you!

One Love,

Dr. Travis Zigler

Dr. Travis Zigler
SeeEO of Eye Love
Director of the Dry Eye Syndrome Support Community 

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nicole on April 16 2018 at 01:13PM

hi I’ve been using xiidra for two weeks because I have dry I since getting the PRK treatment – my vision is worse then before PRK and they say its from dryeye now.. I feel like it is even worse now after using xiidra for two weeks… will it get worse before better? help
thank you

ashley venable- Operations Manager at Eye Love on November 28 2017 at 04:05PM

Hey Sheila – The Xiidra company says that it can work in as little as 2 weeks, but everyone is different and I encourage you to contact your doctor or Xiidra.
One Love, ashley

Sheila on November 27 2017 at 04:30PM

After cataract and lasik surgery, I was diagnosed with dry eye, my only symptom being blurriness. Been on Xiidra for 5 months and no improvement. At what point do I can I conclude that Xiidra isn’t working?

Selena on November 01 2017 at 08:04PM

Okay hi there so my mom got dry eyes, and like she was told to use Xiidra and she used it for 3 days and the effect were horrible and she got eye plugs permanent ones but her eyes look swollen as if there still infected and with pain , she is taking two medications that were doing great but she stopped Xiidra for sure does anyone know when the bluriness goes away?

Clare on October 21 2017 at 04:18PM

I felt lots of burning in the first 3 days of using it. I was quite frustrated, but it started working on the 4th day. And my eyes felt better on and off for the following week. Some days, I still experience the burning sensation, but some days, my eyes feel much better. So, I will keep using it probably for a full month.

Marcia Mason on October 10 2017 at 03:36PM

GREAT NEWS! I just enrolled in Medicare Part D and for 2018 (NOT 2017) there are several insurance carriers that are allowing Xiidra coverage as a tier 3 drug in their formulary. This means a higher co-pay, and likely the “donut hole” will show up in mid-year, but after that the 50% coverage will kick in and I can still get Xiidra but at half price! Yipee! The companies I found are ENVISIONRxPlus, Humana Preferred Rx Plan, Symphonix Value Rx, Humana Walmart Rx Plan, Humana Enhanced, and both AARP MedicareRx Saver Plus and Preferred. There may be other carriers in other zip codes than mine. I am so glad I don’t have to quit taking it because of cost.

Marcia Mason on October 09 2017 at 05:09PM

This stuff is awesome, but my understanding is that it is an ongoing lifelong treatment not a cure. I’ll be going on Medicare next month and it isn’t covered. At around $500 a month, I can’t afford it on a retirement income, and I’ll be so sad to stop taking it. I haven’t been able to see this well in years, so I guess I’ll have to go back to blurry vision again. As a career engineer, this is devastating to me.

gail on September 28 2017 at 09:53AM

I used Xiidra for a few days but found the weird taste upset my stomach and caused a headache. The side effects are worse than my dry eye symptoms and I plan to stop using.

Penny Froh on September 15 2017 at 02:47AM

I used Xiidra for 12 days and stopped. While using it, I because so “aware” of my eyes and it was very uncomfortable. Also, after about a week, the headaches started behind my eyes, and then became migraine headaches. I have had migraines in the past, so know what they are. I stopped using the drops two days ago, and my headaches are better. Also when using it, I had blurred vision, and my eyes were itchy, and I started getting hives and swelling on my lids. The vile used for the product is ridiculous. It is stiff plastic and when you remove the top, there is flash around the hole that can easily scratch the eye. Also, the drops want to stay in the tube and not drop down. Xiirda could take a lesson from OTC eye drops that cost less than $20. The engineer who designed this vile should be fired. Not sure what the next move is, but with debilitating headaches, this product is not the answer!

Jenna Zigler on August 10 2017 at 11:51AM

Hey Jason – No, it will not cause harm to you…any pharmaceutical eye medication that caused harm like that would never be approved. The eyes, nose, throat are all connected which is why you taste the drop. Some notice that it goes away within a few weeks. – One Love, Dr. Jenna Zigler

Jason on August 10 2017 at 11:11AM

Is there any concern with the bad taste in the back of the throat? It lasts for over an hour. I have been on Restasis for a few years and it was not helping my eyes produce adequate tears. My Optometrist stated my eyes lose the natural tears after a second, when normally it should remain there much longer. I have only taken it for a day. I am hopeful it will help, but I can’t stand the bad taste afterwards. Does it go away? Am I swallowing the chemicals that could cause further damage to my internal organs? I take an Omega 3, 6, and 9 as well, usually in the form of liquid Hemp Oil or Flaxseed oil.

Rene' McDowell on July 14 2017 at 09:33AM

Been on xiidra for a little over a week now. Right eye constantly waters and hurts near my tear ducts along with discharge from the eye, mainly in the morning! Left eye seems to be doing better with it. However, I feel like my vision is getting worse and I have tear duct plugs. I had lasik over a year ago and my Dr. is trying to get my eyes back to normal tear levels since my eyes have been dry every since the surgery. Should I be using these drops with plugs?

Travis on June 28 2017 at 10:50AM

Virginia – If you wanted to try a more natural approach, we would recommend using our Lid and Lash Cleansing Spray. Check it out here – https://eyelovethesun.com/collections/dry-eye-syndrome/products/heyedrate-for-blepharitis
One Love,
Dr. Travis Zigler

virginia on June 28 2017 at 07:19AM

Started using Xiidra five days ago. After third day noticed itching of right eye. Continued using and
itching became more intense, along with swelling and tenderness. Will stop using, do not want to test that I will “adjust” to chemicals in drop.

Jenna Zigler on June 19 2017 at 01:38PM

Hey Karen – We are not the makers of Xiidra, you need to contact them.

Karen Lohse on June 17 2017 at 10:24PM

I am informing Xlidra was taken for two weeks. On week one icaused my mouth odd taste to food and week 2 swelling, excessive amount of pain, and swelling. Then doctor told me take with artifial tears then swelling got worse. After I stopped taking the drop there is still burning, light sensetivity and loss of vision. I have one seeing eye.
Medicaid will not provide no eye drop stop the symptom I experiencing. Only onioment which blurrs my vision at night.
I thought it would be confort and smoothing eye instead coausing anguish from vision loss. I am having eye gland isues in my eye. Over counter drops 2 hous a day is my relief with duppliement. What is the minerals in the caused this reaction?

Dr. Jenna Zigler on April 10 2017 at 11:00AM

Hey Mary – yes, you sure can!

Mary on April 10 2017 at 10:56AM

This eye got is fantastic. Tried re stasis in the past but always had burning and film in my eyes. Since using Xiidra
It’s the first time for over 15 years my eyes have not felt dry. I also have Sjogren syndrome. With the allergy season approaching can I also use Patanol?

Cheryl on April 02 2017 at 02:27AM

I started Xiidra a few weeks ago. When I put the drops in they feel soothing and nice.occasionally a few seconds of a burn but managable. Once I spoke with pharmacist she gave me i fo on plugging ductsin corner of eyes for about 30-45 seconds after applyi g drops to avoid bad taste. Perfect it works. However i am being plagued with headaches they start out achy behind eyes then thru eyes then migrai e leveli tensity. I end up witj Imitrex i jections daily. I get them day after start drops and have every day. Will tje headaches stop or do I stop taking.

Liz on March 24 2017 at 02:01PM

I am having the same reactions as Lynda, GigGi and Darlene. I have been using Xiidra for 4 weeks and my eyes look more red, are extremely itchy, sometime stiff and the skin around my eyes are crepey. I have a call into my doctor’s office since my follow up isn’t until 2 more weeks. I also have a rheumotology appointment because I think I do have arthritis and perhaps Sjogren’s syndrome. I am so disappointed, I thought this was the answer for my dry eyes. So far I:
use Omega 3 and 6 pills daily
hot compresses daily
lid scrubs
erythromycin ointment at night
doxcycycline pills daily
and had Mibo flow treatments

No relief yet

Laura on March 14 2017 at 12:06AM

Darlene – If you see this note, can you please send me an email at lauralily0721@gmail.com? I would love to hear your insights and experience with Xiidra. I’ve only heard positive, but would be very interested in knowing challenges people have experienced.

Dr. Jenna Zigler on February 15 2017 at 11:58AM

Great question Jennifer! This is a common symptom we’ve heard and I actually experienced it for about a week while using Xiidra (it eventually stopped happening). I would give it another 2 weeks or so and see if it begins to clear up. If not, definitely speak with your doctor about trying another route.

Jennifer on February 14 2017 at 12:22AM

Hi, I saw another comment that mentioned extreme itching from the xiidra. I’ve been having that too, mostly at the inner corners but also along the upper eyelid margins. It’s miserable when it starts. Also, ironically enough my eyes sometimes feel like they’re even MORE dry and burning, not getting less dry. I’ve only been on the medication about ten days, so I’ve really been trying to give it a chance. When I looked online all these symptoms I’m currently having are listed as less common side effects, but they’re listed. But….is this normal? Should I try to stick it out a little longer or maybe ask the dr for something else? We’re getting to a point where we’ve tried EVERYTHING for my eyes. I just want it all to stop. It’s been going on for years.

Sandy on February 06 2017 at 07:46PM

Do note that Shire has a program to help: “Shire Cares is dedicated to assisting patients with limited financial resources. If you don’t have prescription insurance or are having trouble affording your medicines, Shire Cares may be able to help.”
Per the app, income caps are:
1 person $35,640
2 people $48,060
3 people $60,480
4 people $72,900
5 people $85,320


Dr. Jenna Zigler on February 04 2017 at 12:18PM

Hey Darlene,
We can’t really comment on if you should stop or not, because you are not one of our patients. If you were one of our patients and you were in a lot of discomfort from the drops, we would tell them to discontinue it. Always talk to your doctor about it.
One Love,

Dr. Jenna Zigler
SeeEO of Eye Love

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