These highlights do not include all the information needed to use RESTASISMULTIDOSE safely and effectively. See full prescribing information for RESTASISMULTIDOSE.
RESTASISMULTIDOSE®(cyclosporine ophthalmic emulsion) 0.05%,for topical ophthalmic use
Initial U.S. Approval: 1983
RESTASISMULTIDOSEis a calcineurin inhibitor immunosuppressantindicated to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca. Increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs. (1)
- Prime by squeezing two drops onto a tissue before initial use. (2.1)
- Instill one drop of RESTASISMULTIDOSE ophthalmic emulsion twice a day in each eye approximately 12 hours apart. (2.2)
Cyclosporine ophthalmic emulsion 0.05% (0.5 mg/mL)(3)
- Hypersensitivity(4)
- To avoid the potential for eye injury and contamination, be careful not to touch the bottletip to your eye or other surfaces. (5.1)
The most common adverse reaction following the use of cyclosporine ophthalmic emulsion 0.05% was ocular burning (17%).(6.1)
To report SUSPECTED ADVERSE REACTIONS, contact AbbVie at 1-800-678-1605 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch.
See 17 for PATIENT COUNSELING INFORMATION and FDA-approved patient labeling.
Revised: 3/2025
2.1Preparation for First-Time Use
2.2Preparation for Use
5.1Potential for Eye Injury and Contamination
5.2Use with Contact Lenses
6.1Clinical Trials Experience
6.2Post-marketing Experience
8.1Pregnancy
8.2Lactation
8.4Pediatric Use
8.5Geriatric Use
12.1Mechanism of Action
12.3Pharmacokinetics
13.1Carcinogenesis, Mutagenesis, Impairment of Fertility
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- Sections or subsections omitted from the full prescribing information are not listed.
RESTASISMULTIDOSE®ophthalmic emulsion is indicated to increase tear production in patients whose tear production is presumed to be suppressed due to ocular inflammation associated with keratoconjunctivitis sicca. Increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs.
Instill one drop of RESTASISMULTIDOSE ophthalmic emulsion twice a day in each eye approximately 12 hours apart. RESTASISMULTIDOSE can be used concomitantly with lubricant eye drops, allowing a 15-minute interval between products.
2.1Preparation for First-Time Use
Step 1: Pull off the clear shipping cover by pulling straight up. Throw the shipping cover away. Do not use RESTASIS MULTIDOSE if shipping cover or pull tab are damaged or missing.
Step 2: Remove the pull tab on the olive green colored protective cap by pulling the end of the pull tab away from the bottle then winding it counterclockwise. Throw away the pull tab.
Step 3: Remove the olive green colored protective cap by pulling it straight up. Keep the colored protective cap.
Step 4: Prime the bottle forfirst-time use by squeezing two drops onto a tissue. Do not let the bottle tip touch the tissue.
Step 5: The bottle is now ready for use. After use, recap the bottle with the olive green colored protective cap by pushing it straight down onto the bottle.
2.2Preparation for Use
Step 6: Turn the bottle upside down a few times before giving your dose to make sure the medicine is mixed well.
Step 7: Instill one drop in the affected eye. Replace the olive green colored protective cap.
Ophthalmic emulsion containing cyclosporine0.05% (0.5 mg/mL)
RESTASISMULTIDOSE is contraindicated in patients with known or suspected hypersensitivity to any of the ingredients in the formulation[see Adverse Reactions (6.2)].
5.1Potential for Eye Injury and Contamination
Be careful not to touch the bottle tip to your eye or other surfaces to avoid potential for eye injury and contamination.
5.2Use with Contact Lenses
RESTASIS MULTIDOSE should not be administered while wearing contact lenses. Patients with decreased tear production typically should not wear contact lenses. If contact lenses are worn, they should be removed prior to the administration of the emulsion. Lenses may be reinserted 15 minutes following administration of RESTASIS MULTIDOSE ophthalmic emulsion.
The following serious adverse reactions are described elsewhere in the labeling:
- Potential for Eye Injury and Contamination [see Warnings and Precautions (5.1)]
6.1Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in theclinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may notreflect the rates observed in practice.
In clinical trials,the most common adverse reaction following the use of cyclosporine ophthalmic emulsion, 0.05% was ocular burning(17%).
Other reactions reported in 1% to 5% of patients included conjunctival hyperemia, discharge, epiphora, eye pain, foreign body sensation, pruritus, stinging, and visual disturbance (most often blurring).
6.2Post-marketing Experience
The following adverse reactions have been identified during post approval use ofcyclosporine ophthalmic emulsion, 0.05%. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Reported reactions have included: hypersensitivity (including eye swelling, urticaria,rare cases of severe angioedema, face swelling, tongue swelling, pharyngeal edema, and dyspnea); and superficial injury of the eye (from the bottletip touching the eye during administration).
8.1Pregnancy
Risk Summary
Clinical administration of cyclosporine ophthalmic emulsion 0.05% is not detected systemically following topical ocular administration[see Clinical Pharmacology (12.3)], and maternal use is not expected to result in fetal exposure to the drug. Oral administration of cyclosporine to pregnant rats or rabbits did not produce teratogenicity at clinically relevant doses [see Data].
Data
Animal Data
At maternally toxic doses (30 mg/kg/day in rats and 100 mg/kg/day in rabbits), cyclosporine oral solution(USP) was teratogenic as indicated by increased pre- and postnatal mortality,reduced fetal weight and skeletal retardations. These doses (normalized to body surface area) are 5,000 and 32,000 times greater, respectively, than the daily recommended human dose of one drop (approximately 28 mcL) of cyclosporine ophthalmic emulsion0.05% twice daily 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 during organogenesis at oral doses up to 17 mg/kg/day or 30 mg/kg/day, respectively. These doses in rats and rabbits are approximately 3,000 and 10,000 times greater, respectively, than the daily recommended human dose.
An oral dose of 45 mg/kg/day cyclosporine administered to rats from Day 15 ofpregnancy until Day 21 postpartum produced maternal toxicityand an increase inpostnatal mortality in offspring.This dose is 7,000 times greater than the daily recommended human dose.No adverse effects in dams or offspringwereobserved at oral doses up to 15 mg/kg/day (2,000 times greater than the daily recommended humandose).
8.2Lactation
Risk Summary
Cyclosporine is known to appear in human milk following systemic administration, butits presencein human milk followingtopical treatment has not been investigated. Although bloodconcentrations are undetectable followingtopical administration of cyclosporine ophthalmicemulsion 0.05%[see Clinical Pharmacology (12.3)], caution should be exercised when RESTASISMULTIDOSEis administered to a nursingwoman. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for RESTASISMULTIDOSE and any potential adverse effects on the breast-fed child from cyclosporine.
8.4Pediatric Use
Safety and efficacy have not been established in pediatric patients below the age of 16.
8.5Geriatric Use
No overall difference in safety or effectiveness has been observed between elderly and younger patients.
RESTASIS MULTIDOSE (cyclosporine ophthalmic emulsion) 0.05% contains a calcineurin inhibitor immunosuppressant with anti-inflammatory effects. Cyclosporine’s chemical name is Cyclo[[(E)-(2S,3R,4R)-3-hydroxy-4-methyl-2-(methylamino)-6-octenoyl]-L-2-aminobutyryl-N-methylglycyl-N-methyl-L-leucyl-L-valyl-N-methyl-L-leucyl-L-alanyl-D-alanyl-N-methyl-L-leucyl-N-methyl-L-leucyl-N-methyl-L-valyl] and it has the following structure:
Structural Formula
Formula: C62H111N11O12 Mol. Wt.:1202.6
Cyclosporine is a fine white powder. RESTASISMULTIDOSE appears as a white opaque to slightly translucent homogeneous emulsion. It has an osmolality of 230 to 320 mOsmol/kg and a pH of 6.5-8.0. Each mL of RESTASISMULTIDOSE ophthalmic emulsion contains: Active: cyclosporine 0.05%. Inactives: glycerin; castor oil; polysorbate 80; carbomer copolymer type A; purified water; and sodium hydroxide to adjust pH.
12.1Mechanism of Action
Cyclosporine is an immunosuppressive agent when administered systemically.
In patients whose tear production is presumed to be suppressed due to ocular inflammationassociated with keratoconjunctivitis sicca, cyclosporine emulsion is thought to act as a partialimmunomodulator. The exact mechanism of action is not known.
12.3Pharmacokinetics
Blood cyclosporine A concentrations were measured using a specific high pressure liquidchromatography-mass spectrometry assay. Blood concentrations of cyclosporine, in all the samples collected, after topicaladministration of cyclosporine ophthalmic emulsion,0.05%, twice daily, in humans for up to 12 months, were below the quantitation limit of 0.1 ng/mL. There was no detectable drug accumulation in blood during 12 months of treatment with cyclosporine ophthalmic emulsion, 0.05%.
13.1Carcinogenesis, Mutagenesis, Impairment of Fertility
Carcinogenesis
Systemic carcinogenicity studies were conducted in male and female mice and rats. In the 78-week oral (diet) mouse study, at doses of 1, 4, and 16 mg/kg/day, evidence of a statistically significant trend was found for lymphocytic lymphomas in females, and the incidence of hepatocellular carcinomas in mid-dose males significantly exceeded the control value.
In the 24-month oral (diet) rat study, conducted at 0.5, 2, and 8 mg/kg/day, pancreatic islet celladenomas significantly exceeded the control rate in the low dose level. The hepatocellularcarcinomas and pancreatic islet cell adenomas were not dose related. The low doses in mice andrats are approximately 80 times greater (normalized to body surface area) than the daily recommended human dose ofone drop (approximately 28 mcL) of cyclosporine ophthalmic emulsion, 0.05%twice daily into each eye of a 60 kg person (0.001 mg/kg/day), assuming that the entire dose is absorbed.
Mutagenesis
Cyclosporine has not been found to be mutagenic/genotoxic in the Ames Test, the V79-HGPRT Test, the micronucleus test in mice and Chinese hamsters, the chromosome-aberration tests in Chinese hamster bone-marrow, the mouse dominant lethal assay, and the DNA-repair test in sperm fromtreated mice. A study analyzing sister chromatid exchange (SCE) induction by cyclosporine using human lymphocytes in vitro gave indication of a positive effect (i.e., induction of SCE).
Impairment of Fertility
No impairment in fertility was demonstrated in studies in male and female rats receiving oral doses of cyclosporine up to 15 mg/kg/day (approximately 2,000 times the human daily dose of 0.001 mg/kg/day normalized to body surface area)for 9 weeks (male) and 2 weeks (female) prior to mating.
Four multicenter, randomized, adequate and well-controlled clinical studies were performed inapproximately 1,200 patients with moderate to severe keratoconjunctivitis sicca. Cyclosporine ophthalmic emulsion, 0.05% demonstrated statistically significant increases in Schirmer wetting of 10 mm versus vehicle atsix months in patients whose tear production was presumed to be suppressed due to ocularinflammation. This effect was seen in approximately 15% of cyclosporine ophthalmic emulsion,0.05%-treated patients versus approximately 5% of vehicle-treated patients. Increased tear production was not seen in patients currently taking topical anti-inflammatory drugs or using punctal plugs.
No increase in bacterial or fungal ocular infections was reported following administration of cyclosporine ophthalmic emulsion, 0.05%.
RESTASISMULTIDOSE ophthalmic emulsion is packaged in a sterile, multi-dosebottle. Each bottle consists of a white opaque LDPE bottle, a white opaque polypropylene top with unidirectional valve and air filter, a protective olive green polypropylene cap, and a clear disposable shipping cover over the colored cap. RESTASIS MULTIDOSE contains no preservatives.
5.5 mL in 10-mL bottle - NDC 0023-5301-05
Storage:Store at 15°C to 25°C (59°F to77°F). After opening, RESTASIS MULTIDOSE can be used until the expiration date on the bottle.
Advise the patient to read the FDA-approved patient labeling (Instructions for Use).
Handling the Container
Advise patients to not allow the tip of the bottleto touch the eye or any surface, as this may contaminate the emulsion. Advise patients to not touch the bottletip to their eye to avoid the potential for injury to the eye [see Warnings and Precautions (5.1)].
Use with Contact Lenses
RESTASIS MULTIDOSE should not be administered while wearing contact lenses. Patients with decreased tear production typically should not wear contact lenses. Advise patients that if contact lenses are worn, they should be removed prior to the administration of the emulsion. Lenses may be reinserted 15 minutes following administration of RESTASIS MULTIDOSE ophthalmic emulsion [see Warnings and Precautions(5.2)].
Administration
Advise patients to read the “Instructions for Use” for detailed first-time use instructions.
Distributed by:
AbbVie Inc.
North Chicago, IL 60064
© 2025 AbbVie. All rights reserved.
RESTASIS MULTIDOSE and its design are trademarks of Allergan, Inc., an AbbVie company.
v2.0USPI5301
INSTRUCTIONS FOR USE
RESTASIS MULTIDOSE® (Re stay’ sis Mul tee dōs)
(cyclosporine ophthalmic emulsion) 0.05%
Read this Instructions for Use before you start using RESTASIS MULTIDOSE and each time you get a refill. There may be new information. This leaflet does not take the place of talking to your healthcare provider about your medical condition or treatment.
Important:
- RESTASIS MULTIDOSE is for use in the eye
- Wash your hands before using RESTASIS MULTIDOSE.
- Do not let the bottle tip touch the eye or any other surfaces to avoid contamination or injury to your eye.
- Use 1 drop of RESTASIS MULTIDOSE in each eye, 2 times each day, about 12 hours apart.
- If you wear contact lenses, remove them before using RESTASIS MULTIDOSE. Wait for at least 15 minutes before placing them back in your eyes.
- RESTASIS MULTIDOSE can be used with lubricant eye drops, but you should wait at least 15 minutes between using each product.
PREPARING THE BOTTLE FOR FIRST-TIME USE:
| Step 1: Pull off shipping cover by pulling straight up. Throw the shipping cover away. Do not use RESTASIS MULTIDOSE if shipping cover or pull tab are damaged or missing. |  |
| Step 2: Remove the pull tab on the olive green colored protective cap by pulling the end of the pull tab away from the bottle then winding it counterclockwise. Throw away the pull tab. |  |
| Step 3:Remove the olive green colored protective cap by pulling it straight up. Keep the colored protectivecap. |  |
| Step 4:Prime the bottle for first time usebysqueezing 2 drops onto a tissue. Do not let the bottle tip touch the tissue. |  |
| Step 5:The bottleis now readyfor use.After use, recap the bottle with the olive green colored protective cap by pushing straight down onto the bottle. |  |
GIVING YOUR DOSE:
| Step 6: Turn the bottle upside down a few times before giving your dose to make sure the medicine is mixed well. |  |
| Step 7: Instill one drop in the affected eye. Replace the olive green colored protective cap. |
How do I store RESTASIS MULTIDOSE?
- Store RESTASIS MULTIDOSE between 15°C to 25°C (59°F to 77°F).
- After opening, RESTASIS MULTIDOSE can be used until the expiration date (EXP) on the bottle.
KeepRESTASIS MULTIDOSE and all medicines out of the reach of children.
This Instructions for Use has been approved by the Food and Drug Administration.
Distributed by:
AbbVie Inc.
North Chicago, IL 60064
© 2025 AbbVie. All rights reserved.
RESTASIS MULTIDOSE and its design are trademarks of Allergan, Inc., an AbbVie company.
Approved: 3/2025
v2.0IFU5301
PRINCIPAL DISPLAY PANEL – Restasis Multidose Carton Label
NDC 0023-5301-05
abbvie
Restasis
MultiDose™
(Cyclosporine Ophthalmic Emulsion) 0.05%
For Topical Application
In the Eye
PRIOR TO FIRST USE, PLEASE READ
BOTTLE PREPARATION INSTRUCTIONS
Sterile, 5.5 mL
Preservative-FreeRx Only
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Labeler -Allergan, Inc.(144796497)
