Cequa is an immunosuppressant. Cequa can increase tear production that has been reduced by inflammation in the eye(s). Cequa is used to treat chronic dry eye that may be caused by inflammation.

Cequa eye drops are packaged in sterile, preservative-free, single-use vials.

Warnings

Follow all directions on your medicine label and package. Tell each of your healthcare providers about all your medical conditions, allergies, and all medicines you use.

Before taking this medicine

You should not use Cequa if you are allergic to cyclosporine.

Tell your doctor if you are pregnant or breastfeeding.

Cequa is not approved for use by anyone younger than 16 years old.

How should I use Cequa?

Use Cequa eye drops exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Use the medicine about every 12 hours. Remove contact lenses first.

Wash your hands before using eye medication.

To apply the eye drops: Tilt your head back slightly and pull down your lower eyelid to create a small pocket. Hold the dropper above the eye and squeeze a drop into this pocket. Close your eyes for 1 or 2 minutes.

Use only the number of drops your doctor has prescribed.

Wait at least 15 minutes before inserting contact lenses or using artificial tears.

Do not touch the tip of the eye dropper or place it directly on your eye. A contaminated dropper can infect your eye, which could lead to serious vision problems.

Cequa eye drops should be clear and colorless.

Each single-use bottle is for one use only (in both eyes). Throw the bottle away after one use, even if there is still medicine left inside.

Store at room temperature. Store Cequa single-use vials in their original foil pouch.

Dosing information

Usual Adult Dose for Keratoconjunctivitis Sicca:

1 drop 2 times a day in each eye approximately 12 hours apart

Comments:
– This drug can be used concomitantly with artificial tears, allowing a 15 minute interval between products.

Use: To increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca

What happens if I miss a dose?

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

An overdose of Cequa is not expected to be dangerous. Seek emergency medical attention or call the Poison Help line at 1-800-222-1222 if anyone has accidentally swallowed the medication.

What should I avoid while using Cequa eye drops?

It may be best not to wear contact lenses if you have dry eyes. Talk with your doctor about your own risk.

Cequa side effects

Get emergency medical help if you have signs of an allergic reaction to Cequa: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using Cequa and call your doctor at once if you have:

• severe eye pain, burning, or stinging after putting in the drops;
• swollen eyelids; or
• signs of eye infection – swelling, redness, severe discomfort, crusting or drainage.

Common Cequa side effects may include:

• mild eye pain, redness, or other irritation;
• watery eyes;
• blurred vision; or
• feeling like something is in your eye.

What is pegcetacoplan?

Intravitreal pegcetacoplan (Syfovre) is used to treat geographic atrophy (GA), the dry, advanced form of age-related macular degeneration (AMD). It is given as an injection into each affected eye by a qualified healthcare provider every 25 to 60 days.

Pegcetacoplan for injection into the eye gained FDA approval on February 17, 2023, under the brand name Syfovre. It is manufactured by Apellis Pharmaceuticals Inc. There is no generic.

• A formulation of pegcetacoplan given by infusion (Empaveli) is used to treat paroxysmal nocturnal hemoglobinuria (PNH).

How does intravitreal pegcetacoplan work?

Pegcetacoplan works by targeting an overactive immune response that can harm cells in the retina. It focuses on a protein called C3 which is part of the complement system – an immune system component that, when too active, can damage retinal cells and accelerate GA progression.

By inhibiting the C3 protein, intravitreal pegcetacoplan helps:

• Protect retinal cells from further immune system damage
• Reduce the expansion of GA lesions in the eye
• Help preserve vision for a longer period by slowing disease progression.

Pegcetacoplan belongs to the drug class called complement inhibitors.

How effective is intravitreal pegcetacoplan?

Clinical trials, including two Phase 3 clinical trials, OAKS and DERBY, which followed 1,258 patients over 24 months reported:

• Slowing of GA lesions by 18 to 22% (-0.72 mm² to -0.87 mm²/24 months) with monthly pegcetacoplan injections
• Slowing of GA lesions by 17 to 18% (-0.70 mm² to -0.72 mm²/24 months) with pegcetacoplan injections every 2 months.

Pegcetacoplan side effects

The most common side effects of pegcetacoplan injections into the eye are:

• Eye discomfort, such as pain, irritation, or a feeling that something is in your eye
• Development of wet macular degeneration 
• Seeing flashes of light or “floaters” in vision (vitreous floaters)
• Minor eye bleeding (conjunctival bleeding)
• Inflammation of the cornea (clear outer layer at the front of the eye) and other parts of the eye
• Vitreous detachment (when a gel-like substance within the eye separates from the retina)
• Retinal bleeding
• Clouding of the eye’s lens capsule (posterior capsule opacification)
• Increased eye pressure.

Serious pegcetacoplan injection side effects

Intravitreal pegcetacoplan can cause the following serious side effects.

Eye infection (endophthalmitis) or separation of layers of the retina (retinal detachment). Call your healthcare provider right away if you have eye redness, light sensitivity, eye pain, or any change in vision including blurred, wavy/distorted vision, small specks floating in your vision, or flashing lights.

Severe inflammation of the vessels in the retina that may result in severe vision loss. Call your healthcare provider right away if you have eye redness, light sensitivity, eye pain, or any change in vision including blurred, wavy/distorted vision, or flashing lights

Risk of developing wet AMD. You should be monitored for signs of wet AMD and you should report if you have any change in vision including blurred, wavy/distorted vision, black spots, or loss of central vision to your healthcare provider.

Episodes of eye inflammation. You should report any symptoms including eye redness, light sensitivity, eye pain, specks floating in your vision, or any changes in vision to your healthcare provider.

Increase in eye pressure within minutes of the injection. Your healthcare provider will monitor this after each injection.

Allergic reactions: Get emergency medical help if you have signs of an allergic reaction with symptoms of hives, difficulty breathing, or swelling of your face, lips, tongue, or throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Before receiving

Do NOT receive a pegcetacoplan injection if you:

• have an infection in or around your eye
• have any active swelling around or in your eye that may include pain and redness
• are allergic to the active ingredient or inactive ingredients.

Before receiving this medicine, tell your healthcare provider about all your medical conditions, including if you:

• Have a history of seeing flashes of light or specks floating in your vision and notice a sudden increase in the size and number of these specks
• Have high pressure in the eye or glaucoma
• Are pregnant or planning to become pregnant
• Are breastfeeding or planning to breastfeed.

Pregnancy

Females who can become pregnant should use effective contraception methods to prevent pregnancy during treatment with this medicine and for 40 days after the last dose. The use of this medicine may be considered following an assessment of the risks and benefits.

Breastfeeding

Ask your doctor for advice before taking this medicine. If you are breastfeeding or planning to breastfeed, your doctor will talk to you about the best way to feed your baby.

How is pegcetacoplan administered?

Pegcetacoplan is given as an injection into the soft gel (vitreous) in the middle of your eye by a qualified healthcare provider. This is called an intravitreal injection.

• The injection is given into each affected eye 1 time every 25 to 60 days.
• Your healthcare provider will decide how often you receive your injections.

You will need frequent eye examinations before and after receiving this injection.

Pegcetacoplan dosing information

Before giving you the eye injection, your healthcare provider will numb (anesthetize) your eye and use a broad-spectrum antibiotic eye drop to disinfect the periocular skin, eyelid, and ocular surface prior to the injection.

Adult Dose for GA caused by AMD: Pegcetacoplan 15 mg (0.1 mL of a 150 mg/mL solution).

• Administer a single dose into each affected eye.
• Dispose of any excess volume.

After the eye injection

• Your healthcare provider will monitor you for any increase in eye pressure.

What should I avoid while receiving this medicine?

Pegcetacoplan injection may cause blurred vision and may impair your reactions. Avoid driving or hazardous activity until you know how this medicine will affect you.

Storage

Your healthcare provider will store pegcetacoplan in the refrigerator between 2°C to 8°C (36°F to 46°F) in the original carton to protect from light.

• The vial should not be shaken or used beyond the expiration date on the carton.

What is Restasis?

Restasis eye drops contain cyclosporine which is an immunosuppressant. Cyclosporine can increase tear production that has been reduced by inflammation in the eye(s).

Restasis eye drops are used to treat chronic dry eye that may be caused by inflammation.

Restasis ophthalmic emulsion may also be used for treating eye disease not listed in this medication guide.

Warnings

Do not touch the Restasis dropper on to any surface, including the eyes or hands. The dropper is sterile. If it becomes contaminated (dirty), it could cause an infection in the eye(s).

Do not use this medicine while wearing contact lenses. Contact lenses may be reinserted 15 minutes following the administration of Restasis eye drops, unless otherwise directed by your doctor.

Before taking this medicine

You should not use Restasis if you are allergic to cyclosporine.

Restasis is likely safe in pregnancy. Tell your doctor if you are pregnant or plan to become pregnant.

It is not known whether Restasis passes into breast milk or if it could harm a nursing baby, although it is likely safe. Tell your doctor if you are breast-feeding a baby.

This medicine is not approved for use by anyone younger than 16 years old.

How should I use Restasis?

Use Restasis eye drops exactly as directed by your doctor. Follow all directions on your prescription label. Do not use the eye drops in larger or smaller amounts or for longer than recommended.

The usual dose is 1 drop in each eye twice daily. Use Restasis eye drops every 12 hours (approximately).

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

Wash your hands before using the eye drops.

To apply the eye drops:

• Turn the bottle upside down a few times to gently mix the medicine. Restasis eye drops should appear white in color.
• Tilt your head back slightly and pull down your lower eyelid to create a small pocket. Hold the dropper above the eye with the tip down. Look up and away from the dropper and squeeze out a drop.
• Close your eyes for 2 or 3 minutes with your head tipped down, without blinking or squinting. Gently press your finger to the inside corner of the eye for about 1 minute, to keep the liquid from draining into your tear duct.
• Wait at least 15 minutes before using artificial tears, or any other eye drops your doctor has prescribed.

Do not touch the tip of the eye dropper or place it directly on your eye. A contaminated (dirty) dropper can infect your eye, which could lead to serious vision problems.

Do not use the drops if the liquid has changed colors or has particles in it. Call your pharmacist for new medicine.

Each single-use bottle of Restasis is for one use only (in one or both eyes). Throw away the bottle after one use, even if there is still some medicine left in it.

Store at room temperature away from moisture and heat. Do not freeze. Keep the bottle tightly closed when not in use.

Dosing information

1 drop 2 times a day in each eye approximately 12 hours apart

Restasis can be used concomitantly with artificial tears, allowing a 15 minute interval between products.

What happens if I miss a dose?

Apply the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

An overdose of Restasis is not expected to be dangerous. Seek emergency medical attention or call the Poison Help line if anyone has accidentally swallowed the medication.

What should I avoid while using Restasis?

You should not put Restasis in your eyes while wearing contact lenses. Wait at least 15 minutes after using this medicine before putting in your contact lenses. It may be best not to wear contact lenses if you have dry eyes. Talk with your doctor about your own risk.

Restasis side effects

Get emergency medical help if you have signs of an allergic reaction to Restasis: hives; difficult breathing; swelling of your face, lips, tongue, or throat.

Stop using this medicine and call your doctor at once if you have:

• eye pain; or
• eye swelling, redness, severe discomfort, crusting or drainage (may be signs of infection).

Common Restasis side effects may include:

• mild burning or stinging in the eyes;
• mild redness or itching;
• blurred vision; or
• feeling like something is in your eye.