Cequa: Cost, Alternatives, Side Effects, Uses, Dosage, And More

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What is Cequa?

Cequa is a brand-name prescription medication. The Food and Drug Administration (FDA) has approved it to help adults with dry eye produce more tears. The medical name for dry eye is keratoconjunctivitis sicca.

Dry eye can affect one or both eyes. If you have this condition, you may experience other symptoms besides dry eyes. They include burning, redness, or itching of the eyes, and sensitivity to light.

The active ingredient in Cequa is cyclosporine, which belongs to a group of medications called calcineurin inhibitor immunosuppressants.

Cequa comes in eyedrop form as a liquid solution in single-use vials. Cequa is available in one strength of 0.09%, and you’ll likely use the medication twice per day.

Effectiveness

For information about the effectiveness of Cequa, see the “Cequa for dry eye” section.

Cequa generic

Cequa is available only as a brand-name medication. It’s not currently available in generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Generics usually cost less than brand-name drugs.

Cequa contains the active ingredient cyclosporine in a strength of 0.09%. (An active ingredient is what makes a drug work.) Generic cyclosporine eye drops are available in other strengths. However, there isn’t a generic cyclosporine eye drop that’s an exact copy of Cequa.

In addition, cyclosporine comes in oral and injectable forms, but the FDA has not approved them to treat dry eye.

Cequa vs. Restasis

You may wonder how Cequa compares with other medications that are prescribed for similar uses. The following table looks at how Cequa and Restasis are alike and different.

Cequa	Restasis
Active ingredient	cyclosporine	cyclosporine
Use	chronic dry eye in adults	chronic dry eye in adults and children ages 16 years and older
Form	eye drops in a single-use vial	eye drops in a:• single-use vial• multi-use vial (Restasis MultiDose)
Strength	0.09%	0.05%
Dosage	twice per day	twice per day

»Get a more detailed comparison of Cequa vs. Restasis, including details about their side effects and cost.

Cequa side effects

Cequa can cause mild or serious side effects. The following lists contain some of the key side effects that may occur while taking Cequa. These lists don’t include all possible side effects.

For more information about the possible side effects of Cequa, talk with your doctor or pharmacist. They can give you tips on how to manage any side effects that may bother you.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Sharing your experience helps make medications safer for everyone by giving doctors and researchers more information about how the drug works in real life. If you develop a side effect while using Cequa and want to tell the FDA about it, visit MedWatch or call 800-FDA-1088.

Mild side effects

Mild side effects of Cequa can include:

burning feeling in the eye
eye irritation
headache
inflammation of the eyelid
conjunctival hyperemia (eye redness caused by inflamed blood vessels in the eye)

Most of these side effects may go away within a few days or a couple of weeks. But if they become more severe or don’t go away, talk with your doctor or pharmacist.

For more information about some of these side effects, see the “Side effect details” section.

Serious side effects

Serious side effects from Cequa aren’t common, but they can occur. Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency.

Serious side effects can include a urinary tract infection (see “Side effect details” for more information).

Allergic reaction

For some people, Cequa can cause an allergic reaction. But this side effect wasn’t reported in the drug’s studies.

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

Ways to manage

For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know whether you should keep using the medication.

For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to Cequa, your doctor may recommend a different medication instead.

Side effect details

You may wonder how often certain side effects occur with this drug. Here’s some detail on certain side effects this drug may cause.

Burning

Burning in the eye, especially when putting in Cequa eye drops, is the most common side effect that occurred with the drug. The medical term is instillation site pain.

In clinical studies of Cequa, 22% of people who used the drug experienced burning in the eye. The studies did not compare Cequa with a different medication or a placebo (treatment with no active ingredient).

If you experience a burning feeling in your eye when using Cequa, talk with your doctor. They may be able to suggest ways to help ease this side effect or recommend a different medication for dry eye.

Eyelid inflammation

Blepharitis (eyelid inflammation) may occur with Cequa use. Inflammation refers to swelling and skin discoloration. Your eyelids may also be itchy when you have eyelid inflammation.

In clinical trials of Cequa, between 1% and 5% of people who used the drug experienced eye inflammation. The studies did not compare Cequa with a different medication or a placebo.

If your eyelid becomes swollen or uncomfortable while using Cequa, talk with your doctor. They may be able to suggest ways to help ease this side effect or recommend a different medication for dry eye.

Urinary tract infection

Some people using Cequa eye drops developed urinary tract infections (UTIs) in clinical trials of the drug. Between 1% and 5% of people who used Cequa reported UTIs. The studies did not compare Cequa with a different medication or a placebo.

UTIs may cause burning while urinating or an urge to urinate more often than usual. You may also have blood in your urine if you have a UTI.

If you develop symptoms of a UTI during your Cequa treatment, tell your doctor. UTIs require treatment with antibiotics so they don’t spread to your kidneys. The doctor will see if Cequa or a different condition is causing your symptoms. If the UTI is due to Cequa, they may recommend a different medication for dry eye.

Cequa for dry eye

The Food and Drug Administration (FDA) approves prescription drugs such as Cequa to treat certain conditions.

Cequa is FDA approved to help adults with dry eye produce more tears. The medical name for dry eye is keratoconjunctivitis sicca.

Dry eye can affect one or both eyes. If you have this condition, you may experience other symptoms besides dry eyes. They include burning, redness, or itching of the eyes, and sensitivity to light.

Dry eye can occur if your eyes don’t produce enough tears. The condition can also occur if your eye makes tears, but they don’t work properly.

Tears comprise many parts, such as water, oil, and mucus. If your tears don’t have the correct levels of any of these parts, your tears may not keep your eye lubricated. This means that you may produce the proper amount of tears, but they don’t work well enough to keep your eye moist. This can be what causes symptoms of dry eye.

Dry eye can be a chronic (long-term) condition, which means you may need to keep treating it over a long period.

This helps prevent your eye from becoming dry and decreases the frequency and severity of dry eye symptoms.

In clinical trials, Cequa was an effective treatment to ease the symptoms of dry eye. To see if the drug was working, researchers measured how many tears the eye produced.

The results showed that over a 3-month period, there was a significant increase in tear production in between:

16.6% and 16.8% of people who used Cequa
8.6% and 9.2% of people who used a placebo, which was an eye drop with no active drug in it

Cequa dosage

The Cequa dosage your doctor prescribes will depend on several factors. These may include:

the type and severity of the condition you’re using Cequa to treat
other medical conditions you may have

The following information describes dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you. Your doctor will determine the best dosage to fit your needs.

Drug forms and strengths

Cequa comes in eyedrop form as a liquid solution in single-use vials. Cequa is available in one strength: 0.09%.

Dosage for dry eye

The usual dosage of Cequa to treat dry eye is one drop into each affected eye twice per day. It’s best to separate the doses by 12 hours.

Be sure to discard your used Cequa vial after taking your dose. You shouldn’t reuse a Cequa vial, even if there’s some medication left. This is because the drug does not contain any preservatives to help keep Cequa fresh.

If you reuse a vial, it could become contaminated with bacteria, causing an infection in your eye.

How to use Cequa

You should use Cequa according to your doctor’s or healthcare professional’s instructions.

Cequa comes as an eye drop in single-dose vials. You’ll use one vial for each dose.

When administering a dose of Cequa, ensure that the tip of the vial doesn’t touch your eye or any other surfaces. The tip can become contaminated if it comes into contact with your eye or other surfaces. This makes it easier for bacteria to enter your eye. You can also injure your eye if you touch it with the vial tip.

Be sure to discard your used Cequa vial after giving your dose. You shouldn’t reuse a Cequa vial, even if there’s some medication left. This is because the drug does not contain any preservatives to help keep Cequa fresh. If you reuse a vial, it could become contaminated with bacteria, causing an infection in your eye.

Dosage questions

Here are some questions you may have about taking Cequa.

What if I miss a dose?

If you miss a dose of Cequa, talk with your doctor or pharmacist about when to take your next dose. Depending on how long it’s been since your missed dose, they may recommend:

taking your dose of Cequa as soon as possible
skipping your missed dose and administering your next dose as scheduled

To help make sure that you don’t miss a dose, try using a medication reminder. This can include setting an alarm on your phone or downloading a reminder app. A kitchen timer can work, too.

Will I need to use this drug long term?

Cequa is meant to be used as a long-term treatment. If you and your doctor determine that Cequa is safe and effective for you, you’ll likely take it long term.

Cequa price and coupons

As with all medications, the cost of Cequa can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Drug coupons: You can visit Optum Perks for price estimates of Cequa. These estimates are based on the use of Optum Perks coupons. Note: Optum Perks coupons cannot be used with insurance copays or benefits.

Financial and insurance assistance: If you need financial support to pay for Cequa or help understanding your insurance coverage, help is available.A program called PhilRx is available for Cequa. PhilRx can help you get the lowest price for Cequa based on your insurance coverage. With a qualifying insurance plan, you may also be eligible for a Cequa Copay Card. For more information and to find out if you’re eligible for support, call 855-268-1426 or visit the program website.

Generic version: Cequa is not available in a generic form. A generic drug is an exact copy of the active ingredient in a brand-name medication. Generics tend to cost less than brand-name drugs. Generic cyclosporine eye drops are available in other strengths. However, no generic eye drop is an exact copy of Cequa.

»Learn more about saving on your prescriptions.

Cequa vs. Xiidra

The drug Xiidra (lifitegrast) has uses similar to those of Cequa. Here’s a comparison of how Cequa and Xiidra are alike and different.

Ingredients

The active ingredient in Cequa is cyclosporine, which belongs to a class of drugs called calcineurin inhibitor immunosuppressants. (A class of drugs is a group of medications that work in a similar way.)

The active ingredient in Xiidra is lifitegrast, which belongs to a class of drugs called lymphocyte function-associated antigen-1 antagonists.

Uses

The Food and Drug Administration (FDA) has approved both Cequa and Xiidra to help people with dry eye produce more tears. The medical name for dry eye is keratoconjunctivitis sicca.

Cequa is approved for use in adults, while Xiidra is approved for use in adults and children ages 17 years and older.

Drug forms and administration

Both Cequa and Xiidra are given as eye drops and come in single-use vials. Both drugs are typically administered twice per day.

Side effects and risks

Cequa and Xiidra both treat dry eye. Therefore, these medications can cause very similar side effects but some different ones as well. The following list highlights some of these side effects.

Mild side effects

These lists contain some of the most common mild side effects that can occur with each drug, as well as mild side effects that both drugs may share.

Can occur with Cequa:
- inflammation of the eyelid
Can occur with Xiidra:
- blurry vision
- eye discharge
- eye discomfort or itching
- sinusitis (sinus inflammation), which can lead to infection
Can occur with both Cequa and Xiidra:
- burning feeling in the eye
- conjunctival hyperemia (eye redness caused by inflamed blood vessels in the eye)
- eye irritation
- headache

Serious side effects

These lists contain examples of serious side effects that can occur with Cequa or Xiidra, as well as serious side effects that both drugs may share.

Can occur with Cequa:
- urinary tract infection
Can occur with Xiidra:
- change in your sense of taste
- worsening vision
Can occur with both Cequa and Xiidra:
- allergic reaction

Effectiveness

The only condition both Cequa and Xiidra are used to treat is dry eye.

Although clinical studies have not directly compared these drugs, studies have found both Cequa and Xiidra to be effective for treating dry eye.

Costs

Cequa generally costs less than Xiidra. The actual price you’ll pay for either drug depends on your insurance plan, your location, and the pharmacy you use.

Cequa and Xiidra are both brand-name drugs. There are currently no generic forms of either drug. Brand-name medications usually cost more than generics.

»MORE: Get the facts on Xiidra's cost, including coupons and ways to save.

Alternatives to Cequa

Other drugs are available that can treat your condition. Some may be a better fit for you than others. If you’re interested in finding an alternative to Cequa, talk with your doctor. They can tell you about other medications that may work well for you.

Alternatives for dry eye

Examples of other drugs that may be used to treat dry eye include:

cyclosporine 0.05% (Restasis)
lifitegrast (Xiidra)
artificial tears (Systane, Refresh, TheraTears)
hydroxypropyl cellulose (Lacrisert)

How Cequa works

The Food and Drug Administration (FDA) has approved Cequa to help adults with dry eye produce more tears.

Cequa increases the amount of tears that your eye produces. This helps prevent your eye from becoming dry. It also helps decrease the frequency and severity of dry eye symptoms.

It’s unknown exactly how Cequa works to treat dry eye. But it’s thought that the drug decreases the activity of the immune system.

With dry eye, the swelling in your eye may be due to an overactive immune system. When your immune system is less active, there may be less swelling. As a result, your eye may be able to produce more tears, decreasing the symptoms of dry eye.

»MORE: Learn more about how Cequa works, including how long it takes to work.

Cequa and alcohol

There are no known interactions between Cequa and alcohol.

Cequa interactions

Cequa is not known to interact with other medications, herbs, supplements, or foods.

However, before starting Cequa treatment, be sure to tell your doctor about any other medications you are taking. Tell them about all prescription, over-the-counter, and other drugs you take. Also, tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Cequa and pregnancy and breastfeeding

If you can become pregnant, are breastfeeding, or are using birth control, it’s important to consider whether Cequa is a safe choice for you.

You can refer to this Cequa reproductive health article for more information. If you have additional questions, talk with your doctor.

Common questions about Cequa

Here are answers to some frequently asked questions about Cequa.

Can I wear contacts while using Cequa?

You shouldn’t use Cequa eye drops when you have contact lenses in your eyes because the lenses can absorb the medication. Be sure to take out your contact lenses before using Cequa. Then wait at least 15 minutes before putting your contact lenses back in.

If you have any questions about using Cequa, talk with your doctor or pharmacist.

Will I be able to use other eye drops during my Cequa treatment?

If you’re using any eye drops or eye medications, talk with your doctor before you start taking Cequa. You may have to space the timing of your doses so that all the medications work effectively. If you don’t space out your doses, one medication may wash out the other, and neither eye medication may work.

You can use Cequa along with artificial tears for dry eye. If this applies to you, be sure to separate the timing of Cequa and artificial tear doses by at least 15 minutes.

If you have any questions about the timing of any eye medications, including Cequa, talk with your doctor or pharmacist.

Why does Cequa come in single-use vials instead of a larger bottle?

Cequa comes in single-use vials instead of a larger multiuse bottle because the drug does not contain any preservatives.

Preservatives help keep bacteria from growing in the bottle. If the bacteria enter your eye through an eye drop, they could cause an infection. Larger bottles that contain more than one dose typically have preservatives in them.

Because Cequa doesn’t contain any preservatives, it comes in a single-use vial. Be sure to discard your used Cequa vial after taking your dose. You shouldn’t reuse a Cequa vial, even if there’s some medication left in the vial. Bacteria could form in or on the vial after the first use.

Cequa precautions

This drug comes with several precautions. Before taking Cequa, talk with your doctor about your health history. Cequa may not be right for you if you have certain medical conditions or other factors affecting your health. These include:

Contact lenses: If you wear contact lenses, be sure to take them out before using Cequa. Then wait at least 15 minutes before putting your contact lenses back in. This is to help prevent the lenses from absorbing the medication.
Allergic reaction: If you’ve had an allergic reaction to Cequa or any of its ingredients, you shouldn’t take Cequa. Ask your doctor what other medications are better options for you.
Pregnancy: It is unknown if Cequa is safe to use during pregnancy. For more information, see the “Cequa and pregnancy” section.
Breastfeeding: It is unknown if Cequa is safe to use while you’re breastfeeding. For more information, see the “Cequa and breastfeeding” section.

Note: For more information about the potential negative effects of Cequa, see the “Cequa side effects” section.

Cequa expiration, storage, and disposal

When you get Cequa from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically 1 year from the date they dispensed the medication.

The expiration date helps guarantee that the medication is effective during this time. The current stance of the Food and Drug Administration (FDA) is to avoid using expired medications. If you have unused medication that has gone past the expiration date, talk with your pharmacist about whether you might still be able to use it.

Storage

How long a medication remains good can depend on many factors, including how and where you store the medication.

You should store Cequa eye drops at room temperature (68 to 77°F/20 to 25°C). Be sure to keep the single-use vials in the foil pouch until you’re ready to use them. Avoid storing this medication in areas where it could get damp or wet, such as bathrooms.

Disposal

If you no longer need to take Cequa and have leftover medication, it’s essential to dispose of it safely. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

This article provides several useful tips on medication disposal. You can also ask your pharmacist for information about how to dispose of your medication.

After applying your dose of Cequa, dispose of the empty individual-use vial immediately.

Disclaimer: Medical News Today 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 other 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.

Dry Eye
Eye Health / Blindness
Pharmacy / Pharmacist
Drugs

How we reviewed this article:

SourcesMedical News Today has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical journals and associations. We only use quality, credible sources to ensure content accuracy and integrity. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

Cequa (cyclosporine ophthalmic solution) 0.09%, for topical ophthalmic use. (2022).https://cequapro.com/pdf/CequaPI.pdf
de Oliveira, R. C., & Wilson, S. E. (2019). Practical guidance for the use of cyclosporine ophthalmic solutions in the management of dry eye disease.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6612764/
Xiidra (lifitegrast ophthalmic solution), for topical ophthalmic use. (2020).https://www.accessdata.fda.gov/drugsatfda_docs/label/2020/208073s005lbl.pdf

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Medically reviewed by Alyssa Walton, PharmD — Written by Jennifer Mitri Williamson, PharmD — Updated on May 27, 2025

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What is Cequa?

Effectiveness

Cequa generic

Cequa vs. Restasis

Cequa side effects

Mild side effects

Serious side effects

Allergic reaction

Ways to manage

Side effect details

Burning

Eyelid inflammation

Urinary tract infection

Cequa for dry eye

Cequa dosage

Drug forms and strengths

Dosage for dry eye

How to use Cequa

Dosage questions

What if I miss a dose?

Will I need to use this drug long term?

Cequa price and coupons

Cequa vs. Xiidra

Ingredients

Uses

Drug forms and administration

Side effects and risks

Mild side effects

Serious side effects

Effectiveness

Costs

Alternatives to Cequa

Alternatives for dry eye

How Cequa works

Cequa and alcohol

Cequa interactions

Cequa and pregnancy and breastfeeding

Common questions about Cequa

Can I wear contacts while using Cequa?

Will I be able to use other eye drops during my Cequa treatment?

Why does Cequa come in single-use vials instead of a larger bottle?

Cequa precautions

Cequa expiration, storage, and disposal

Storage

Disposal

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