Pregnant & off Restasis

[Niteyorkie]

I am 4 months pregnant and my OB recommended stopping the Restasis. I have dry eye which I think is caused by my rosacea x 4 yrs. I always thought I would continue Restasis during pregnancy since it is not absorbed, but I started to feel guilty so I stopped it. I thought I would try it for at least the first trimester.
Now that I am in the second trimester I feel that my eyes are getting worse. I biggest fear is that these red veins that I have will become permanent if my eyes keep staying dry. I already had several red veins before, but I felt Restasis stopped them from becoming so dilated.
What has been the experience with others that have had dry eyes prior to pregnancy and how do you find pregnancy effected them. I know that someone people develop dry eyes while pregnant. I'm hoping that things will get better in the third trimester.
Any advice would be greatly appreciated.

[Lucy]

Calling Dianat

Diana is the Pregnancy Queen of Dry Eye
or the Go To Person............
Dianaaaaaaaa.......

Congratulations, Niteyorkie!

[nahzee]

I am 4 months pregnant and my OB recommended stopping the Restasis. I have dry eye which I think is caused by my rosacea x 4 yrs. I always thought I would continue Restasis during pregnancy since it is not absorbed, but I started to feel guilty so I stopped it. I thought I would try it for at least the first trimester.
Now that I am in the second trimester I feel that my eyes are getting worse. I biggest fear is that these red veins that I have will become permanent if my eyes keep staying dry. I already had several red veins before, but I felt Restasis stopped them from becoming so dilated.
What has been the experience with others that have had dry eyes prior to pregnancy and how do you find pregnancy effected them. I know that someone people develop dry eyes while pregnant. I'm hoping that things will get better in the third trimester.
Any advice would be greatly appreciated.

To be absolutely honest, I don't see why she asked you to stop the restasis. Looking at what restasis is, I personally cannot see any great risks- the cyclosporin is very low dose, and the castor oil vehicle is only a true risk if you are overcome with the urge to swallow at least 30 vials worth of restasis at once, and even then, you'll only end up with the urge to.. visit the toilet. :P

To be certain, I checked the specific prescribing information:

Teratogenic effects: No evidence of teratogenicity was observed in rats or rabbits receiving oral doses of cyclosporine up to 300 mg/kg/day during organogenesis. These doses in rats and rabbits
are approximately 300,000 times greater than the daily human dose of one drop (28 μL) 0.05%
RESTASIS® BID into each eye of a 60 kg person (0.001mg/kg/day), assuming that the entire
dose is absorbed.

Non-Teratogenic effects: Adverse effects were seen in reproduction studies in rats and rabbits
only at dose levels toxic to dams. At toxic doses (rats at 30 mg/kg/day and rabbits at 100
mg/kg/day), cyclosporine oral solution, USP, was embryo- and fetotoxic as indicated by
increased pre- and postnatal mortality and reduced fetal weight together with related skeletal
retardations. These doses are 30,000 and 100,000 times greater, respectively than the daily
human dose of one-drop (28 μL) of 0.05% RESTASIS® BID into each eye of a 60 kg person
(0.001 mg/kg/day), assuming that the entire dose is absorbed. No evidence of embryofetal
toxicity was observed in rats or rabbits receiving cyclosporine at oral doses up to 17 mg/kg/day or 30 mg/kg/day, respectively, during organogenesis. These doses in rats and rabbits are
approximately 17,000 and 30,000 times greater, respectively, than the daily human dose.
Offspring of rats receiving a 45 mg/kg/day oral dose of cyclosporine from Day 15 of
pregnancy until Day 21 post partum, a maternally toxic level, exhibited an increase in
postnatal mortality; this dose is 45,000 times greater than the daily human topical dose,
0.001 mg/kg/day, assuming that the entire dose is absorbed. No adverse events were
observed at oral doses up to 15 mg/kg/day (15,000 times greater than the daily human
dose).


So, yes, the drop DOES pose a risk to your fetus if you are taking absolutely extreme doses, which is why it has earned itself a pregnancy cat C. However, at normal human doses, there is no proof of any risk whatsoever. I would seriously discuss that fact with all your doctors- both eye and ob and see if you cannot come to the conclusion I'm seeing: the benefits for you clearly outweigh the risks that only exist in extreme overuse. And while the prescribing information covers it's bum with recommending restasis in pregnant women only when there is a clear need, the fact that it ended up a cat C is clear: there is no proof it is dangerous to human fetuses, and as such, there are instances where it's use is warranted.

[dianat]

Niteyorkie,

Hi, and congratulations on your pregnancy! That's great news. I know it's a bit daunting when you have DES on top of all the other discomforts, but it is worth it and always goes better for me than I expect.

I think stopping Restasis is a wise one. I am generally a minimalist when it comes to any drug during pregnancy, and absolutely consider Restasis, while used in small doses, still significant. It's category C rating is such because there's been no real testing done on humans. That's why your OB cannot recommend it. It's a very new drug, and is certainly not "tried and true".

Have you considered trying Refresh Endura in the interim? It's actually made with castor oil, I believe. It's the same vehicle less the cyclosporin. It certainly won't work the same, but could offer you some of the relief you were appreciating while on Restasis. I'm sorry your eye comfort is declining.

For what it's worth, my eye comfort did not change in pregnancy. In fact, I started blood serum drops during my third pregnancy and actually got better. It was my first post-LASIK pregnancy and I really was afraid of what was ahead. I had voiced my concerns to my eye doc who asked me if I noticed increased discomfort with the changing of my menstrual cycle.

I had previously plotted for months how my eyes felt daily and had actually never made a correlation between hormone fluxuation and eye comfort. My doc went on to tell me that since I wasn't sensitive to hormonal changes, I wouldn't likely feel any difference in pregnancy either. I believed him and he was correct. (Newborn feeding schedule? Now that's another story!)

I hope that piece of advice helps. I cannot speak to your vein situation and how they will behave. Manage your comfort as best you can. Everything will work out okay.

When are you due?

Diana