Tyrvaya (Varenicline Nasal Spray)

Tyrvaya (varenicline solution) is a prescription nasal spray for treating signs and symptoms of dry eye disease. Unlike eye drops, it's sprayed into the nose and works by stimulating a nerve pathway that increases natural tear production.

How It Works

Tyrvaya takes a novel approach:

• Activates the trigeminal nerve in the nose
• This nerve connects to tear-producing glands
• Stimulates the body's natural tear production
• Results in increased natural tears (not just lubrication)

This is fundamentally different from anti-inflammatory drops (Restasis, Xiidra) or lubricating drops.

Common Uses

• Dry eye disease
• When eye drops alone aren't sufficient
• For patients who prefer not to use eye drops
• Can be combined with other dry eye treatments

How to Use

• Dosing: One spray in each nostril twice daily (approximately 12 hours apart)
• Prime the pump: Before first use, prime by pumping until spray appears
• Technique: Insert nozzle into nostril, aim away from septum, press pump firmly
• After spraying: Don't blow your nose immediately
• Storage: Room temperature

What to Expect

Timeline

• Some patients notice improved tear production within the first week
• May work faster than anti-inflammatory drops
• Continue as directed even when feeling better

Common Experience

• Expect sneezing after use (very common)
• Temporary sensation in nose
• Gradual improvement in dry eye symptoms

Side Effects

Very Common

• Sneezing—occurs in about 80% of patients
• Usually brief (within minutes of use)
• Typically becomes less bothersome with continued use

Common

• Cough
• Throat irritation
• Nose irritation

Less Common

• Runny nose
• Nasal discomfort
• Changes in taste

About the Sneezing

• Most patients sneeze after using Tyrvaya
• Usually subsides within minutes
• Often decreases over time with continued use
• Not harmful, but plan accordingly

Precautions

• Not for nasal use if severe nasal conditions (discuss with doctor)
• Pregnancy/breastfeeding: Limited data; discuss with doctor
• Not related to smoking cessation varenicline (Chantix)—much lower dose

Tyrvaya vs. Eye Drops

Feature	Tyrvaya	Anti-inflammatory Drops
Delivery	Nasal spray	Eye drops
Mechanism	Stimulates tear production	Reduces inflammation
Onset	Potentially faster	Weeks to months
Main side effect	Sneezing	Burning/stinging
Contact lens compatible	N/A (not eye drop)	Need to remove

Using Tyrvaya with Other Treatments

Tyrvaya can be combined with:

• Artificial tears
• Anti-inflammatory drops (Restasis, Cequa, Xiidra)
• Miebo (different mechanism)
• Warm compresses and lid hygiene

The different mechanism allows complementary use.

Cost and Insurance

• Brand-name medication
• Insurance coverage varies
• Check manufacturer savings programs
• Specialty pharmacy may be required

Frequently Asked Questions

Why a nasal spray instead of eye drops?

The nerve pathway that Tyrvaya activates runs through the nose. Stimulating this pathway triggers the tear glands in a natural reflex. It's a completely different approach than applying drops directly to the eye.

Will I sneeze every time I use it?

Most patients sneeze, especially when starting. Many find the sneezing decreases or becomes less bothersome over time. It's a brief side effect that resolves within minutes.

Is this the same as Chantix (smoking cessation)?

No. While both contain varenicline, Tyrvaya is a nasal spray with a much lower dose that acts locally. It doesn't have the systemic effects associated with the smoking cessation medication.

Can I use Tyrvaya with eye drops?

Yes, Tyrvaya can be used alongside artificial tears and prescription dry eye drops. The different mechanism makes combination therapy sensible for some patients.

How fast does Tyrvaya work?

Some patients notice improved tear production within the first week. This may be faster than anti-inflammatory drops, which often take months for full effect.

Can I use Tyrvaya if I have a cold or stuffy nose?

Discuss with your doctor. Nasal congestion may affect delivery of the medication.