Xiidra (Lifitegrast)

Xiidra (lifitegrast ophthalmic solution 5%) is a prescription eye drop for treating signs and symptoms of dry eye disease. It works differently from cyclosporine drops by blocking a specific inflammatory pathway involved in dry eye.

How It Works

Xiidra is an LFA-1 antagonist that:

• Blocks LFA-1 protein on white blood cells
• Prevents inflammatory cells from binding to eye surface
• Reduces inflammation that contributes to dry eye
• Different mechanism than cyclosporine-based drops

Common Uses

• Dry eye disease—signs and symptoms
• When artificial tears alone aren't sufficient
• May be used when cyclosporine isn't tolerated or effective
• Can be combined with other dry eye treatments

How to Use

• Dosing: One drop in each eye twice daily, approximately 12 hours apart
• Single-use vials: Each vial is for one-time use (preservative-free)
• Instillation: Wash hands, tilt head back, pull down lower eyelid, apply drop
• After instillation: Close eyes gently; some drainage into throat is normal
• Contact lenses: Remove before use; wait 15 minutes before reinserting
• Other drops: Wait 5 minutes between different eye medications

What to Expect

Timeline

• First 2 weeks: Some patients notice improvement relatively quickly
• 6-12 weeks: Continued improvement expected
• Ongoing: Continue treatment for maintained benefit

Unique Feature

Xiidra may work faster than cyclosporine drops for some patients, though individual response varies.

Side Effects

Common

• Dysgeusia (altered taste)—most distinctive side effect
  • Unusual, often bitter or metallic taste
  • Occurs when drop drains into throat
  • Temporary after each dose
• Eye irritation
• Blurred vision
• Eye discomfort

Less Common

• Headache
• Sinusitis
• Eye redness
• Eye itching

Managing Taste Side Effect

• Close tear drainage by pressing corner of eye after instillation
• Taste typically diminishes quickly
• Most patients adapt over time

Precautions

• Contact lenses: Remove before use; wait 15 minutes to reinsert
• Pregnancy/breastfeeding: Limited data; discuss with doctor
• Eye infections: Don't use during active eye infection
• Keep tip sterile: Don't touch dropper tip to eye or other surfaces

Cost and Insurance

• Brand-name medication
• Insurance coverage varies widely
• Check manufacturer savings programs
• May have prior authorization requirements

Comparing to Other Dry Eye Medications

Feature	Xiidra	Restasis	Cequa
Active ingredient	Lifitegrast	Cyclosporine 0.05%	Cyclosporine 0.09%
Mechanism	LFA-1 antagonist	Immunomodulator	Immunomodulator
Potential onset	May be faster	Slower	Slower
Distinctive side effect	Taste changes	Burning	Burning
Dosing	Twice daily	Twice daily	Twice daily

Frequently Asked Questions

Why do I taste something weird after using Xiidra?

Eye drops can drain through the tear ducts into the nose and throat. Lifitegrast has a distinctive taste that many patients notice. Pressing the corner of your eye for a minute after instillation can reduce this.

Is Xiidra better than Restasis?

Neither is universally "better"—they work differently and individual responses vary. Some patients respond better to one than the other. If one doesn't work, the other might. Some patients use both.

How long until Xiidra works?

Some patients notice improvement within 2 weeks, though others take longer. Clinical trials showed benefit as early as 2 weeks for symptoms and 12 weeks for signs of dry eye.

Can I use Xiidra with artificial tears?

Yes, artificial tears can be used alongside Xiidra for comfort. Wait at least 5 minutes between different eye drops.

Will the taste side effect go away?

The taste occurs with each dose but diminishes quickly after instillation. Most patients find it becomes less bothersome with continued use, though it doesn't completely disappear.

How long do I need to use Xiidra?

Dry eye is typically a chronic condition requiring ongoing treatment. If you stop Xiidra, symptoms usually return. Discuss your long-term treatment plan with your doctor.