Cequa (cyclosporine) is a prescription eye drop used to increase tear production in adults with chronic (long-term) dry eye.

The active ingredient in Cequa is cyclosporine. A generic form of cyclosporine eye drops is not currently available.

Cyclosporine belongs to a group of immunosuppressant drugs called calcineurin inhibitors. Keep reading to learn more about Cequa, including its cost, side effects, and more.

Cequa and Restasis are eye drops prescribed for increasing tear production in people with chronic (long-term) dry eye. The active ingredient in both is cyclosporine. You use each eye drop twice per day, about 12 hours apart. Cequa comes in a higher strength than Restasis.

Prices of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers and which pharmacy you use.

Here are a few things to consider regarding cost:

  • Cost information and savings coupons: You can visit Optum Perks to get price estimates of what you’d pay for Cequa when using coupons from the site. See the coupon options below. (Note: Optum Perks coupons cannot be used with any insurance copays or benefits.)
  • Savings options: Cequa’s manufacturer provides some savings options, including a copay card and a mail-order service. If you have questions about how to pay for your prescription, talk with your doctor or pharmacist.

Like most drugs, Cequa may cause mild or serious side effects. The lists below describe some of the more common side effects that Cequa may cause. These lists don’t include all possible side effects.

Keep in mind that side effects of a drug can depend on:

  • your age
  • other health conditions you have
  • other medications you take

Your doctor or pharmacist can tell you more about the potential side effects of Cequa. They can also suggest ways to help reduce side effects.

Mild side effects

Here’s a short list of some of the mild side effects that Cequa can cause. To learn about other mild side effects, talk with your doctor or pharmacist, or read Cequa’s prescribing information.

Mild side effects of Cequa that have been reported include:

See “Side effect focus” for more information about some of these side effects.

Mild side effects may go away within a few days to a couple of weeks. But if they become bothersome, talk with your doctor or pharmacist.

Serious side effects

Serious side effects from Cequa are possible, but none were reported in the drug’s studies.

If you think you’re having any serious side effects from Cequa, call your doctor right away. If it might be a medical emergency, call 911 or your local emergency number.

Side effect focus

Learn more about some of the side effects Cequa may cause.

Burning of the eyes

Burning of the eyes is the most common side effect reported by people who used Cequa in studies.

This burning sensation can happen when you’re putting Cequa drops in your eyes. It should go away within a few minutes.

What might help

Talk with your doctor if you experience burning of the eyes that bothers you or doesn’t go away. It’s possible that your doctor might recommend ways to treat this side effect. But they may also suggest stopping Cequa and trying a different treatment for dry eye.

Eye inflammation

Inflammation of the eyes is a possible side effect of Cequa. This refers to irritation, redness, and possibly swelling of the eyes. This wasn’t common in studies.

Inflammation caused by Cequa may affect the eyelid or the conjunctiva. (The conjunctiva is a clear, thin tissue that covers your eye.)

What might help

If you have inflammation of your eyes while using Cequa, talk with your doctor. They might recommend ways to treat this side effect. For example, if you mainly have eye redness, they may suggest an eye drop that can help treat this symptom. They may also suggest stopping Cequa and trying a different dry eye treatment.

Headache

It’s possible to have a headache as a side effect of Cequa eye drops. This side effect wasn’t common in studies.

What might help

Talk with your doctor if you’re having headaches after using Cequa drops. Depending on your overall health and other medications you take, they may suggest an over-the-counter treatment for your headache. Examples include ibuprofen (Advil, Motrin) or acetaminophen (Tylenol).

Your doctor may also suggest stopping Cequa, especially if your headaches don’t go away or bother you. In this case, they can tell you more about other treatments for dry eye.

ALLERGIC REACTION

For some people, Cequa can cause an allergic reaction. While allergic reaction wasn’t reported in studies of Cequa, it can still happen.

In general, symptoms of allergic reaction can be mild or serious.

What might help

If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest a treatment to manage your symptoms and can determine whether you should keep taking Cequa.

If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.

If your doctor confirms you’ve had a serious allergic reaction to Cequa, they may have you switch to a different treatment.

Your doctor will recommend the dosage of Cequa that’s right for you. Below are commonly used dosages, but always take the dosage your doctor prescribes.

Form and strength

Cequa comes as a liquid solution in eye drop form.

Cequa eye drops come in one strength: 0.9 milligrams per milliliter of solution (mg/mL). This strength may also be written as 0.09%.

Recommended dosage

You’ll likely place one drop of Cequa solution in each eye, twice per day. You should administer each dose 12 hours apart. Be sure to follow your doctor’s dosing instructions.

Questions about Cequa’s dosage

Below are some commonly asked questions about Cequa’s dosage.

  • What if I miss a dose of Cequa? If you miss a dose of Cequa drops, administer the missed dose as soon as you remember. But if it’s almost time for your next scheduled dose, skip the missed dose, and apply your next dose of eye drops at your usual time. Do not use more than one dose of Cequa at a time to make up for a missed dose. This could raise your risk of side effects, including eye burning or inflammation (redness and irritation).
  • Will I need to use Cequa long term? If you and your doctor agree that Cequa is working well for you, you’ll likely use the medication long term if needed.
  • How long does Cequa take to work? In studies, certain dry eye symptoms reduced 1 month after starting to use Cequa. It took an average of about 3 months for tear production to improve. Keep in mind that your results from using Cequa may differ from those in studies.

Cequa is used to increase tear production in adults with chronic (long-term) dry eye. The medical term for chronic dry eye is keratoconjunctivitis sicca.

Dry eye happens when your eyes don’t make enough tears, or your tears don’t maintain enough moisture in your eye. This might be related to swelling and damage in your eye that affects how well your eyes make tears.

Dry eye can cause symptoms such as pain, redness, burning, and blurry vision. And with chronic dry eye, these symptoms last for a long time.

Cequa may work to treat chronic dry eye by reducing inflammation, which can help your eyes produce and maintain tears.

Find answers to some commonly asked questions about Cequa.

Is Cequa a steroid?

No, Cequa is not a steroid. It belongs to a group of immunosuppressant drugs called calcineurin inhibitors. Immunosuppressant drugs work to lower inflammation by reducing the activity of the immune system.

How does Cequa work? How long does it take for Cequa eye drops to work?

It’s not fully understood how Cequa works to treat dry eye. It’s thought that the drug reduces swelling and damage in your eyes, which helps your eyes produce and maintain tears.

In clinical trials, it took about 2 weeks of Cequa treatment for doctors to see signs of improvement in people’s eye exams. After 1 month, some people reported a reduction in their dry eye symptoms, such as dryness and irritation. After 2 months, some people reported improved visual clarity (how sharp vision is at a distance). And it took about 3 months for Cequa to increase tear production. Keep in mind that everyone’s experience with a drug can be different.

If you have questions about how Cequa works to treat dry eye, talk with your doctor or pharmacist.

Can I use Cequa if I wear contact lenses?

You can use Cequa if you wear contact lenses, but do not put Cequa drops in your eyes while you’re wearing contact lenses. It’s very important to remove contacts before putting in Cequa drops.

After putting Cequa drops in your eyes, wait at least 15 minutes before putting contact lenses in.

In general, contact lenses aren’t recommended for people with problems producing tears. If you have questions about using Cequa if you wear contacts, talk with your doctor.

Like Cequa, Xiidra is used to treat dry eye. To see a side-by-side comparison of these drugs, refer to the “Cequa vs. Xiidra” section of this Cequa overview.

If you’d like to learn more about these drugs, talk with your doctor.

Your doctor will explain how you should use Cequa. They’ll also explain how much to use and how often. Be sure to follow their instructions.

Using Cequa

Cequa eye drops come in single-use vials. After putting a drop in each eye, you’ll throw away the vial and use a new one next time.

You should administer Cequa doses about 12 hours apart. And be sure to avoid wearing contact lenses while you’re putting Cequa drops in your eye and for 15 minutes after using the drops.

Cequa’s manufacturer provides tips and instructions for how to use Cequa. You can also check out these general pointers for how to use eye drops.

Using Cequa with other drugs

As long as your doctor approves, it’s safe to use artificial tears with Cequa. But you should wait at least 15 minutes after putting Cequa drops in your eye before using artificial tears or other eye drops.

Be sure to talk with your doctor before using any new over-the-counter or prescription eye drops or medications with Cequa. They can tell you more about whether other medications are safe to use with Cequa.

There are important considerations to discuss with your doctor before using Cequa. It’s important that you tell your doctor about your overall health and any medical conditions you may have.

Interactions

There are no known interactions between Cequa and other medications. (Interactions are things that can affect how a medication works, such as certain vaccines, foods, and other drugs.)

Before taking Cequa, it’s important to tell your doctor about all medications you take, including prescription and over-the-counter types. Also, tell them about any vitamins, herbs, or supplements you use.

Warnings

Cequa may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Cequa. Factors to consider include those in the list below.

  • Contact lens use. If you wear contacts, it’s important to take them out before putting Cequa drops in your eyes. You’ll also need to wait at least 15 minutes after using Cequa drops before putting contact lenses in. In general, wearing contact lenses may not be recommended if you have chronic (long-term) dry eye.
  • Allergic reaction. If you’ve had an allergic reaction to Cequa or any of its ingredients, your doctor will likely not prescribe Cequa. Ask your doctor what other medications are better options for you.

Cequa and alcohol

It should be safe to drink alcohol during Cequa treatment. Your doctor can give you more information if you have questions about alcohol use during your treatment.

Pregnancy and breastfeeding

It isn’t known if it’s safe to use Cequa while pregnant or breastfeeding. Talk with your doctor about Cequa’s safety if you’re pregnant, breastfeeding, or planning either.

Do not use more Cequa than your doctor prescribes. Using more than this can lead to serious side effects.

What to do in case you use too much Cequa

Call your doctor if you think you’ve used too much Cequa. You can also call 800-222-1222 to reach America’s Poison Centers or use its online resource. However, if you have severe symptoms, immediately call 911 or your local emergency number. Or go to the nearest emergency room.

Q:

I’ve heard that cyclosporine (Cequa’s active ingredient) can harm my immune system. Is this true? Should I be worried about getting sick if I take Cequa?

Anonymous

A:

No, this isn’t likely. Cyclosporine is a type of immunosuppressant drug, meaning it works to reduce the activity of the immune system. But cyclosporine isn’t known to cause harm to the immune system.

When cyclosporine is used as an eye drop, as with Cequa, it works locally (only in the area where it’s applied). It treats dry eye by reducing swelling and damage in your eyes. This helps your eyes produce and maintain tears.

Cequa drops can cause side effects, such as a urinary tract infection (UTI), but the drug isn’t known to increase your overall risk of getting sick.

If you have more questions about how Cequa affects the immune system, talk with your doctor or pharmacist.

The Healthline Pharmacist TeamAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

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