Azasite and Cyclosporine (Restasis)

[lizlou29]

I've been prescribed Azasite to use once a day for a month. I'm also meant to be using Cyclosporine at night (I can't use it in the morning as well as it is 2% and stings like mad). Has anyone used these at the same time and if so, how long should I leave between the applying them? When I take the Cyclosporine I have to go straight to bed as I can't keep my eyes open due to the intense burning so I'm hoping the Azasite won't be as bad.... I pick the prescription up next week.

[Faith1989]

Hey there!

i have never used Azasite, but have a sort of canadian version of it. It does help kind of, its not a steroid but will help get rid of the bacteria! Have you not gotten the script for the lower cyclosporine? I have had 1 percent before and couldnt handle it..

P.S. the antibiotic ointment i have doesnt really burn to bad..hopefully azasite wont either? Sometimes when the eye is extra sensitive (there is a medical term for this, i dont remember it though!) it is hard to put anything prescription in it

[lizlou29]

I've got to wait a while for the lower strength cyclosporine as it is not commonly prescribed so has to be ordered into my eye clinic. In the meantime he wants me to keep using the 2% at night. I'd stopped it but going to try again.

My eyes are painful from the drops used during the eye examination earlier so yes, they are sensitive to everything it seems!

[rppnj]

Azasite never really helped. Restasis is helping. It doesn't burn my eyes unless my eyes are irritates already when it's time for my Restasis. My esyes have been much better since using Restasis for the last several konths. Sorry I can't correct my typos biut if I backspace my reply 'locks up'.

[NotADryEye]

I don't recall using Cyclosporine (Restasis) and Azasite at the same time but I'm not able to tolerate either one. I was better able to tolerate non-Restasis cyclosporine that was preservative free. Azasite burns terribly. When I use it now I apply only the tiniest amount to my eye lashes. But I rarely ever use it.

You might try the following:
Irrigate with a few squirts of pf saline, maybe 4 squirts, or fewer. Don't use Unisol that has boric acid and sodium borate. Just use simple pf saline, .9%. Then instill the drop. Close your eyes immediately. Keep them closed for a minimum of 5 minutes. Maybe more. Do not open even for a split second. This can help with the stinging/burning. I used to do this after surgery when I had to use drops. It helped tremendously.

[lizlou29]

Thanks NotADryEye. I'm going wait for the weaker formulation of cyclosporine as I tried the 2% last night and my eyes are burning badly today. I only have Unisol so will look for the saline you suggest.

Rppnj I'm glad restasis is working for you. Hopefully when I get a formulation I can tolerate it will do the same for me!

[littlemermaid]

Just use simple pf saline, .9%

That would be Bausch & Lomb Minims sodium chloride 0.9%, preservative free, individual vials. We just get a box easily from normal pharmacy, Boots, Lloyds etc. GP will also supply it NHS, although they tried to fob us off with a cheaper generic in a bottle. Individual vials are more hygienic, last us longer, easily carried around. Osmolarity of saline is unhelpful for longer-term frequent use, ie not a substitute for a lubricant - still searching for the ref.

[NotADryEye]

Osmolarity of saline is unhelpful for longer-term frequent use, ie not a substitute for a lubricant - still searching for the ref.

I recall seeing something like that, but do not recall where. I agree with littlemermaid and can say from experience that saline alone should not be used as a substitute for a lubricant. I used to irrigate daily to clear my eyes of irritants, debris, pollen, etc., because the tear ducts are still partially closed. Over time irrigating became irritating, a drippy, annoying feeling that just wasn't very good and exacerbated the sensation of saponification. Since I stopped irrigating things have seemed to calm down quite a bit and the soapy feeling is much less prominent. Still, irrigating with pure sterile saline can help if you need to instill some other drop but are sensitive to it. Remember to close your eyes and not open them even for a single blink as soon as you get the drop in. Let us know if this helps, lizlou29.

[littlemermaid]

Curr Eye Res. 2013 Jul;38(7):722-8. Evaluation of the frequency of ophthalmic solution application: washout effects of topical saline application on tear components. Shigeyasu C, Hirano S, Akune Y, Mochizuki H, Yamada M. - Rebecca's blog 'Dry Eye Digest', 18 June 2013.

'Even a single application of saline solution resulted in significant changes in major tear protein and sialic acid concentration in the tears of normal subjects. Differences in the recovery of tear protein concentration may be related to the process of protein production and secretion. A balance between normal tear function and the therapeutic effects of ophthalmic solutions should be considered when deciding the frequency of application, particularly in patients with dry eye.' Just had inspiration where this was while washing the car

[LaDiva]

I have taken both together. The Azasite, I cannot tolerate, and recently became unable to tolerate Restasis. I remember reading where someone said to apply the Azasite only to the outer edge of the lids, but I was told to drop it in my eye. As NADE said, keep your eyes closed after instilling the Azasite, and I would buffer it with something. There were no problems using Azasite and Restasis together. I think that I used the Restasis about 30 minutes before the Azasite. Once you have used the Azasite, it is time for bed, and you are finished for the day. At least that was my experience. Best of luck. I hope you find one of these drugs will help you.

[NotADryEye]

I checked in my diary. When I was using Azasite in the eye, about 20 minutes after application I would use a lubricating drop. Of course that was back when I could use lubricating drops, and you might be too sensitive for that too. But for now, while you are on it, you could try a drop of saline 20 or 30 minutes after to remove any excess. The Azasite should still work since it absorbs.

[lizlou29]

Hmm. Well it doesn't burn too badly on installation but it burns nearly all the following day. Not quite so bad after a few days use but it's definitely not improving symptoms. Not sure whether to carry on or not. My eyes got so dry yesterday and I had a Salagen tablet in my bag so used that and it took the edge off. Bit concerned that the Azasite is causing more dryness

[Faith1989]

I am now used to most prescription drops causing some stinging. I think continuing is important because maybe your eyes will get used to treatment and eventually start healing? Persistence is key with dry eye treatment. But if it is really bothering you contacting your doctor may be a good idea.

[NotADryEye]

But if it is really bothering you contacting your doctor may be a good idea.

I agree. It's important to keep your doctor informed about how you are feeling. The doctor needs to know and the only one who can tell him is you. Things change all the time and we (I) respond differently to different treatments depending on many factors that also change over time.

I suspect one of the reasons that dry eye care given by professionals is generally poor is because when they get patients like us, difficult cases, they tell us to try the typical drops, compresses, Restasis and lid wipes. But we don't respond to the treatments or already know we won't. Then we don't communicate about the ineffectiveness of the treatments with the provider and we don't schedule follow-up appointments. So the doctor isn't faced with the problem and assumes that the treatment has worked. Then, when another difficult case walks in the door, they offer the same solutions because there is no reason in their mind, and experience, to do anything differently. That's just a theory, but one that might merit further research and investigation.

[Dog2012]

I think if doctor him/her self would be having dry eyes and tremendously suffering because of that the way we do ..they would take different approach..



I agree. It's important to keep your doctor informed about how you are feeling. The doctor needs to know and the only one who can tell him is you. Things change all the time and we (I) respond differently to different treatments


depending on many factors that also change over time.

I suspect one of the reasons that dry eye care given by professionals is generally poor is because when they get patients like us, difficult cases, they tell us to try the typical drops, compresses, Restasis and lid wipes. But we don't respond to the treatments or already know we won't. Then we don't communicate about the ineffectiveness of the treatments with the provider and we don't schedule follow-up appointments. So the doctor isn't faced with the problem and assumes that the treatment has worked. Then, when another difficult case walks in the door, they offer the same solutions because there is no reason in their mind, and experience, to do anything differently. That's just a theory, but one that might merit further research and investigation.