Xiidra dosage, forms, and strengths

Xiidra twice-daily eye drops are a brand-name prescription drug for relieving dry eye disease symptoms. While occasional bouts of dry eye can have many different causes, the immune system’s response is one of the key components of persistent dry eye problems. This response also plays a significant role in the damage done to the eye’s surface caused by prolonged bouts of dry eye. To relieve symptoms of dry eye disease, lifitegrast, the active ingredient in Xiidra, adjusts the immune response in the outer eye tissues. 

Xiidra forms and strengths

Xiidra is an ophthalmic solution (eye drops) that comes in only one dosage form and strength: 

• Ophthalmic solution (eye drops): 5% (50 mg/mL)

Xiidra dosage for adults

Xiidra is approved by the U.S. Food and Drug Administration (FDA) for relieving the symptoms of dry eye disease (DED) such as eye pain, eye discomfort, and visual problems in people 17 years of age and older. It is most effective when inflammation is causing or contributing to the condition. 

Xiidra dosage for dry eye disease 

Dry eye disease, also known as keratoconjunctivitis sicca, is a chronic and sometimes progressive medical condition. Keratoconjunctivitis sicca happens when the mechanisms for keeping the eye lubricated fail over and over again. There are many ways the process of lubricating the eyes can go wrong. The immune system is one possible cause. When the eyes are dry long enough, the immune system plays a key role in keeping the dry eye cycle going. Xiidra’s active ingredient, lifitegrast, blocks the interaction of certain white blood cells with tissue cells on the eye’s surface, preventing those tissues from activating the immune system. In this way, the twice-daily application of Xiidra eye drops is meant to reduce one part of the dry eye cycle. Doses are applied to each eye twice daily—once in the morning and once in the evening—using single-use eye drop containers.

• Standard Xiidra dosage for dry eye disease: 1 drop in each eye every 12 hours (twice per day)

Xiidra dosage for children

The FDA has not approved using Xiidra in adolescents or children 16 years of age or younger. Teens who are 17 years of age and older take adult doses. 

Xiidra dosage restrictions

As a topical medication, not much of the active drug in Xiidra gets into the bloodstream. It’s mostly absorbed by tissue at the front of the eye, as reported by animal and human studies. For this reason, no dosage restrictions or adjustments are recommended for people with kidney disease, liver disease, or old age.

Xiidra dosage for pets 

Dogs and cats can have dry eye disease, too. Topical immunosuppressants like ophthalmic cyclosporine or ophthalmic tacrolimus are among the treatment options veterinary professionals choose. Remember that veterinarians have some latitude in prescribing human medications like Xiidra to treat dry eye, but cost and lack of veterinary studies may be an issue.

How to take Xiidra

Xiidra eye drops are only for use in the eyes. One drop is applied to each eye twice per day. The applications are spaced twelve hours apart, so people will time the first dose for some time in the morning and the second in the evening. 

Unlike other eye drops that people are familiar with, Xiidra comes only in single-use containers. That adds some work to the process, but using single-use containers reduces the risk of contamination or infection. 

To use Xiidra correctly, here are some pointers:

• Take this medicine exactly as the doctor instructed.

• Instructions For Use and Patient Information are included in the Xiidra package. Please read both these inserts thoroughly.

• Wash your hands with soap and water before applying a dose.

• People who wear contact lenses will need to remove them first.

• Do not allow the container tip to touch the eye or any other surface including your fingers or skin.

• Store Xiidra containers in their original foil pouch at room temperature. The foil pouch will protect the medicine from light.

How to apply a dose

• To start, open the foil pouch containing Xiidra containers. Do not open a pouch until you’re ready to use the medicine.

• The pouch contains five connected single-use containers.

• Detach one container.

• Return the remaining containers to the original foil pouch. You will use those containers for later doses.

• Hold the container upright and tap the top of the container with your finger to get all the solution to the bottom.

• Twist off the tab to open the container. 

• Use the container as soon as it’s been opened. Do not store the opened medicine.

• Tilt your head back or lie down.

• With your index finger, pull down the lower lid of your eye to form a pocket and look up.

• Hold the container close to your eye with the other hand.

• Drop a single Xiidra drop into the pocket between your lower lid and eyeball. 

• If you miss, squeeze another drop into the pocket. There is enough medicine in the container if you have problems like missing the eye.

• Do the same for the other eye. There is enough medicine in one single-use container for both eyes.

• Throw away each single-use container after using it, even if there is solution remaining.

• Wait at least 15 minutes before you put your contact lenses back in.

Xiidra dosage FAQs

How long does it take Xiidra to work?

In clinical trials, some people using Xiidra experienced relief from dry eye symptoms in at least two weeks. These studies showed even more people experiencing symptom relief after six and twelve weeks of continued twice-daily dosing. 

How long does Xiidra stay in your system?

Xiidra is a topical prescription drug. When put on the eyes, very little of the drug gets into the bloodstream. In clinical studies, only around 1 in 5 people had detectable amounts of lifitegrast in their blood after 180 days or 360 days of twice-daily dosing. The majority of those people had amounts that were just barely detectable. 

What happens if I miss a dose of Xiidra?

Ask the prescribing healthcare professional what to do if a dose of Xiidra is missed. The manufacturer’s drug information sheet does not specify what to do about a missed dose. Most importantly, if a dose is missed, do not take the next dose as a double dose.

For Xiidra to work, doses must be taken twice daily, 12 hours apart. If forgotten doses are a problem, talk to a pharmacist about possible solutions, including alarms and apps that can help ensure doses are taken on time.

How long can you take Xiidra?

Xiidra is intended for long-term use. Dry eye disease is a chronic and sometimes lifelong condition. A clinical study that tracked Xiidra patients for one year showed no unique side effects or complications due to extended use of the drug.

How do I stop taking Xiidra?

Xiidra can be discontinued at any time without causing withdrawal symptoms.

What is the maximum dosage for Xiidra?

The recommended dosage, one drop in each eye twice daily, is the highest amount you should take. 

Can you overdose on Xiidra?

Overdosing on Xiidra is unlikely. The medicine is applied to the eyes, and very little gets into the bloodstream. When someone swallows the medicine, it’s a different matter, so avoid contact with your skin and never put it in your mouth. If Xiidra is swallowed, call a poison helpline or go to an emergency room.

What interacts with Xiidra?

Xiidra has no known drug interactions because so little of its active ingredient gets into the bloodstream. Still, to be safe, make sure the prescribing ophthalmologist knows about all prescription drugs, over-the-counter medications, and supplements being used. Although artificial tears are okay to use, always check with the eye doctor before using any type of medicated or OTC eye drops.

What happens when you mix Xiidra and alcohol?

Nothing is known to happen if you drink alcohol while using Xiidra eye drops. For most people, the amount of Xiidra’s active ingredient that gets into the bloodstream is undetectable and won’t interact with alcohol. However, alcohol may worsen the symptoms of dry eye disease, particularly in women.

Is it safe to take Xiidra during pregnancy?

Healthcare providers consider Xiidra safe to use as eye drops during pregnancy, even though its effects on pregnant women have not been studied. For most people, undetectable amounts of lifitegrast enter the bloodstream when Xiidra is applied to the eye. The manufacturer and the FDA do not consider the amount high enough to determine if there is any impact on an unborn baby. Even so, always tell the prescriber if you are pregnant or planning to get pregnant.

Is it safe to take Xiidra while breastfeeding?

Used as instructed, Xiidra is safe to take while breastfeeding because so little of the medicine gets into the blood. However, no one knows if lifitegrast is present in human breast milk or affects a nursing infant. Women should ask the eye doctor for medical advice about taking Xiidra if they are breastfeeding or plan to breastfeed.

What should I know about the possible side effects of Xiidra?

Xiidra has only a few side effects, but there’s a chance a person taking Xiidra will have one or more mild problems. In five clinical studies, about 5% to 25% of the patients reported having adverse effects, including instillation site discomfort, bad taste in the mouth (dysgeusia), and a reduction in visual acuity. Other less common reactions include blurred vision, eye irritation, eye discharge, headache, and sinusitis.

What should I know about the serious side effects of Xiidra?

Serious side effects of Xiidra are rare and usually limited to allergic reactions, but these reactions can sometimes be severe. Hypersensitivity reactions can happen with nearly every drug. When they do, it’s time to stop the drug, call a healthcare provider, or get immediate medical help. Ask the eye doctor what symptoms to watch for.

Sources

• Dry eye syndrome, StatPearls

• Keratoconjunctivitis sicca (KCS) or dry eye in cats, VCA Animal Hospitals

• Keratoconjunctivitis sicca (KCS) or dry eye in dogs, VCA Animal Hospitals

• Ocular distribution and pharmacokinetics of lifitegrast following repeat ocular dose administration in rabbits, Investigative Ophthalmology & Visual Science

• Safety of Lifitegrast Ophthalmic Solution 5.0% in Patients With Dry Eye Disease: A 1-Year, Multicenter, Randomized, Placebo-Controlled Study, Cornea

• The relationship between alcohol consumption and dry eye, The Ocular Surface

• Xiidra, Novartis

• Xiidra lifitegrast solution/drops prescribing information, NIH National Library of Medicine

• Xiidra HCP, Novartis