Restasis was the first prescription dry eye drug to be FDA approved and remains the only prescription drop on the market though there are several others currently in development (see Drug Pipeline).
The active ingredient of Restasis is cyclosporine (0.05%). The vehicle for Restasis is actually marketed separately as an over-the-counter artificial tear product, Refresh Endura. Because early clinical trials reportedly did not show a very clear superiority of the drug over the vehicle, some doctors continue to recommend that patients first try Refresh Endura before trying Restasis.
Cyclosporine has a considerable history of use in treatment of extreme dry eye and has long been veterinarians' preferred treatment for canine dry eye. Since the approval of Restasis, its conspicuous position as the only prescription dry eye drug has probably contributed much to its growing popularity in the treatment of more moderate dry eye symptoms. Indeed, the current trend in dry eye treatment in general is heavily emphasizing treatment of the inflammatory component.
A common complaint with Restasis is a sensation of burning. Data from the clinical trials indicate that 17% of patients experienced this and along with the high cost this remains a key reason for patient dropout. Some physicians prescribe Restasis along with a topical steroid or NSAID or precede Restasis with a short course of one. Many patients taking Restasis continue to need supplementation with artificial tears.
Patients being prescribed Restasis are usually directed to take it for a minimum of 6 weeks to 3 months in order to determine whether it will benefit them.