Tyrvaya®
varenicline solution nasal spray 0.03 mg
Clinical Snapshot
Tyrvaya is the first intranasal therapy for dry eye disease. It stimulates the trigeminal parasympathetic pathway to increase basal tear production through a neural mechanism — a fundamentally different approach from topical therapies.
Mechanism of Action
Varenicline is a nicotinic acetylcholine receptor (nAChR) agonist delivered intranasally. It activates the trigeminal parasympathetic pathway via nAChR stimulation in the nasal mucosa, increasing basal tear production through the lacrimal functional unit.
Common Clinical Applications
- Signs and symptoms of dry eye disease
Typical Dosing Principles
One spray in each nostril twice daily (approximately 12 hours apart).
Dosing information is provided for educational purposes. Always consult current prescribing information for specific dosing protocols.
Important Precautions
- Not recommended in patients with uncontrolled or unstable cardiovascular disease.
- Sneezing and coughing are common; patients should be counseled before initiation.
Clinical Pearls
- The intranasal route is a meaningful differentiator for patients who struggle with eye drop instillation or compliance.
- Sneezing is the most commonly reported adverse effect and typically diminishes with continued use.
- Mechanism is complementary to topical anti-inflammatory therapies — combination use is clinically reasonable.
- Useful in patients with needle phobia or significant drop instillation difficulty.
Commonly Associated Disease States
Select any disease state to explore its full entry in the Disease State Library.
Dry Eye Disease
One of the most prevalent conditions in optometric practice; a leading cause of patient dissatisfaction and reduced quality of life, with significant implications for contact lens wear, surgical candidacy, and systemic disease management.
Neurotrophic Keratopathy
A sight-threatening condition that requires early recognition; reduced corneal sensation is the hallmark finding, and management requires a stepwise approach including neurotrophic-specific therapies such as cenegermin (Oxervate®) and autologous serum tears.
This entry is an educational reference designed to support clinical reasoning and therapeutic awareness. It does not constitute medical advice, establish a standard of care, or replace individualized patient assessment. Clinicians should consult current prescribing information before initiating any therapy.