Cequa (Cyclosporine 0.09%) - Ophthalmic

Warning:

What Is Cequa?

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.

Drug Facts

Generic Name: Cyclosporine 0.09%

Brand Name: Cequa

Drug Availability: Prescription

Therapeutic Classification: Calcineurin inhibitor

Available Generically: No

Controlled Substance: N/A

Administration Route: Ophthalmic (eyes)

Active Ingredient: Cyclosporine 0.09%

Dosage Form: Ophthalmic (eye) solution

What Is Cequa Used For?

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:

  • Blurry vision
  • Burning sensation in your eyes
  • Eye sensitivity to light
  • Gritty or scratchy sensation in your eyes
  • Itchy eyes
  • Red eyes
Cequa (Cyclosporine) Drug Information - Illustration by Dennis Madamba

Verywell / Dennis Madamba

How to Use Cequa

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:

  • Don't touch the tip of the Cequa vial to your eye or any surface. This is to prevent injuring your eye or contaminating (dirtying) the solution.
  • Don't use Cequa with contact lenses. Remove contact lenses from your eyes before using Cequa. After using Cequa, wait 15 minutes before wearing contact lenses again.
  • Cequa is available in single-use vials. So, don't open a vial until you're ready to use it right away. Immediately throw away the opened vial after each scheduled dosing time. Don't save an opened vial to use later in the day or on a future date.
  • Wait between different eye products. You can typically wait five minutes between each eye medication. For Cequa, however, separate it from other eye products (like artificial tears) by 15 minutes.

The following are also some general steps on how to use eye drops:

  1. Wash your hands before using your eye drops.
  2. Tilt your head back to look up.
  3. Pull down your lower eyelid to form a small cup or pocket.
  4. Place one eye drop into this pocket.
  5. Close your eyes and press down on your tear duct, which is the corner of your eye that's closest to your nose. Do this for at least one minute.
  6. Repeat steps two through five for the other eye.
  7. Wash your hands after using your eye drops.

Storage

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.

Off-Label Uses

The Food and Drug Administration (FDA) 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.

How Long Does Cequa Take to Work?

You might notice some improvement in your dry eye symptoms within 28 days.

What Are the Side Effects of Cequa?

Side effects are possible with Cequa.

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or a healthcare provider. You may report side effects to the FDA at fda.gov/medwatch or 1-800-FDA-1088

Common Side Effects

Common side effects of Cequa include mild eye pain and red eyes or other irritation.

Severe Side Effects

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.

Long-Term Side Effects

Cyclosporine is typically a safe long-term treatment option for dry eyes.

Report Side Effects

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 FDA's MedWatch Adverse Event Reporting Program or call the FDA by phone (800-332-1088).

Dosage: How Much Cequa Should I Use?

Drug Content Provided and Reviewed by IBM Micromedex®

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.

  • To increase tear production:
    • For ophthalmic emulsion dosage form (eye drops):
      • Adults and children 16 years of age and older—One drop in the affected eye(s) 2 times a day (every 12 hours).
      • Children younger than 16 years of age—Use and dose must be determined by your doctor.
    • For ophthalmic solution dosage form (eye drops):
      • Adults—One drop in the affected eye(s) 2 times a day (every 12 hours).
      • Children—Use and dose must be determined by your doctor.
  • To treat vernal keratoconjunctivitis:
    • For ophthalmic emulsion dosage form (eye drops):
      • Adults and children 4 years of age and older—One drop in the affected eye(s) 4 times a day (morning, noon, afternoon, and evening).
      • Children younger than 4 years of age—Use and dose must be determined by your doctor.

Modifications

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, adverse 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.

Missed Dose

If you accidentally forgot your Cequa dose, place a Cequa drop in your eyes as soon as you remember. However, if it's already close to your next scheduled dose, 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.

Overdose: What Happens If I Use Too Much Cequa?

It's unlikely that you would overdose from Cequa. However, if you suspect that you're experiencing life-threatening side effects, seek immediate medical attention.

What Happens If I Overdose on Cequa?

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.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

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.

What Are Reasons I Shouldn't Use Cequa?

Talk with your healthcare provider before using Cequa if any of the following apply to you:

  • Severe allergic reaction: If you've had a severe allergic reaction to Cequa or any of its components (ingredients), then Cequa isn't an ideal option for you.
  • Pregnancy: There is no safety and effectiveness data for Cequa on pregnant people. Reach out to your healthcare provider to weigh the benefits and risks of using Cequa during pregnancy.
  • Nursing: It's unlikely for large amounts of cyclosporine to be absorbed through the eye. So, adverse effects on the nursing baby are also unlikely. However, there are ways to further lower the risk of cyclosporine reaching your breast milk. 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. If there is any excess solution, remove it with a piece of tissue.
  • Children: There is no safety or effectiveness information for Cequa in children under 18.
  • Older adults: There are no safety or effectiveness differences between older adults—people over 65—and younger adults.
  • People who use contact lenses: Remove contact lenses before using Cequa. After using Cequa, wait 15 minutes before wearing contact lenses again.

What Other Medications Interact With Cequa?

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.

What Medications Are Similar?

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.

Frequently Asked Questions

  • Where is Cequa available?

    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.

  • How much does Cequa cost?

    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.

  • Will I need other medications in addition to Cequa?

    In addition to Cequa, some people might also use ariticial tears to relieve dry eye symptoms.

How Can I Stay Healthy While Using Cequa?

Dry eye symptoms can be irritating. Thankfully, there are ways to prevent worsening dry eye symptoms. Refer to the following general tips:

  • Use your dry eye medications according to your healthcare provider's recommendations.
  • Drink plenty of water.
  • Consider using a humidifier in your home, office, and/or bedroom.
  • Limit your screen time.
  • Blink more often if you can't limit your screen time.
  • Wear sunglasses and/or a sunhat to protect your eyes from sunny, windy, or dry environments.
  • Limit contact lens use—especially when your eyes are irritated.
  • Get adequate amounts of sleep.
  • Use a warm compress or have eye massages to lessen eye inflammation.

Medical Disclaimer

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 provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

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14 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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