Tyrvaya

Tyrvaya is a prescription nasal spray that treats the signs and symptoms of dry eye disease. It contains varenicline solution 0.03% and works by stimulating nerves inside the nose that signal your tear glands to make more of your own natural tears. This is different from drops that you put directly on the eye. The most common side effect is brief, mild sneezing after each spray. 1

Large clinical trials (ONSET-1 and ONSET-2) showed that varenicline nasal spray increased tear production and improved dryness symptoms in many adults with dry eye compared with placebo. 2

How it works: You spray Tyrvaya once in each nostril, twice a day (usually morning and evening). The medicine activates nicotinic receptors on branches of the trigeminal nerve inside the nose. That nerve connects to the tear-producing pathway, which tells the lacrimal gland to release basal tears. You are not putting medicine in the eye itself. 3

Where it fits with other choices: Dry eye care is a ladder. Steps can include:

• Artificial tears
• Eyelid hygiene
• Omega-3s
• Prescription drops (cyclosporine, lifitegrast)
• Heat or in-office gland treatments
• Punctal plugs
• Moisture goggles

Tyrvaya is another option that can be used alone or with these treatments when a doctor believes increasing natural tear production would help. 4

Good candidates: Adults diagnosed with dry eye disease who have symptoms like burning, grittiness, or fluctuating vision and would benefit from more natural tear production. It may be especially helpful if eye drops are hard to use, sting, or do not give enough relief. 5

Who may not be a fit: People with active nasal inflammation, a recent nasal surgery, or severe chronic nose problems may not tolerate a nasal spray well. Tyrvaya has not been established in children, and the most common reactions are sneezing, cough, and mild throat or nose irritation. Your eye specialist will also review pregnancy/breastfeeding plans and other medical conditions before prescribing. 6

Tyrvaya is a branded prescription supplied as a carton with two glass nasal-spray bottles (a 30-day supply at the usual dose). Pricing can vary by pharmacy, region, and insurance tier. Your out-of-pocket cost depends on your plan’s deductible, copay, and whether prior authorization is required. 7

What you can do:

• Call your insurer about Tyrvaya’s tier, prior authorization needs, and quantity limits.
• Ask your eye specialist about samples while coverage is arranged.
• Use FSA/HSA dollars when allowed and consider 90-day fills if approved.
• If costs are high, discuss alternative or companion therapies (drops, plugs, gland therapy).

Effective therapy may also reduce indirect costs like lost productivity. 8

Benefits: Many patients see increased tear production on testing and report less dryness after several weeks of regular use. Because it is a nasal spray, it avoids the burning or blur of drops and can be paired with other treatments. 9

Limitations & side effects: Not everyone responds. Common effects include brief sneezing, cough, and mild throat/nose irritation. Rarely, people stop due to discomfort. As with any medicine, treatment should be guided and monitored by your eye care professional. 10

There is no downtime. Use one spray in each nostril twice daily as directed.

Technique tips:

• Sit or stand upright
• Insert the nozzle just inside the nostril
• Angle slightly outward
• Spray while gently breathing in
• Avoid hard sniffing for a few seconds

Most people continue everyday dry eye care like artificial tears, warm compresses, screen breaks, and humidifiers. Tyrvaya may be combined with other treatments if needed. 11

Phase 3 trials (ONSET-1, ONSET-2) and the 12-week MYSTIC study showed improvements in tear production and symptoms versus placebo, supporting its role as a neural pathway therapy that uses your own tears. 13

Reviews continue to explore where Tyrvaya fits among therapies and how neuro-stimulation strategies may help different dry eye subtypes. 14

If your eyes feel dry, gritty, or your vision fluctuates, start with a complete eye exam. Ask whether Tyrvaya could complement your current plan. 15

Best specialists: Cornea/External Disease Ophthalmologists or optometrists with ocular surface expertise. Kerbside can connect you with a specialist for education (not a physician-patient relationship). 16