Tyrvaya (varenicline solution): Can it cause neck swelling? Unlikely. Possible first case report. Worked up for Cushing disease & was negative.

Some of my patients with dry eye symptoms/disease love Tyrvaya. Some of them hate it. A patient came in yesterday, noting some neck swelling right after she started it. She actually did have a full work up for Cushing’s disease because of the swelling with her PCP, which came out negative. I don’t think the swelling of her neck is from this medication, but here’s what we know below. 

Tyrvaya (varenicline solution)

Tyrvaya (varenicline solution)

Tyrvaya (varenicline solution), a nasal spray designed to treat dry eye disease, and swelling anywhere on the body—particularly the neck? Let’s break it down with the latest data, sprinkle in some cost insights, and even touch on total U.S. sales for this innovative medication. What Is Tyrvaya and How Does It Work? Tyrvaya is a game-changer in dry eye treatment. Unlike traditional eye drops, it’s a nasal spray that stimulates tear production by activating the trigeminal parasympathetic pathway in the nose. 

With a low dose of varenicline (0.03 mg per spray, used twice daily in each nostril), it’s a localized therapy that gets your eyes producing natural tears without directly irritating them. 

But the question is: Could this unique delivery lead to unexpected side effects like swelling? 

Swelling and Tyrvaya: The Evidence (or Lack Thereof) Based on clinical trials—like ONSET-1 and ONSET-2—and official prescribing information, there’s no documented connection between Tyrvaya and swelling on the body or neck. 

The most common side effects reported are sneezing (82%), cough (16%), throat irritation (13%), and nasal irritation (8%). These make sense since the spray goes right into your nose. Only about 2% of trial participants dropped out due to side effects, and those were mostly mild and short-lived. Swelling, or edema, doesn’t show up in the usual suspect list—whether it’s common, mild, or serious side effects—across sources like Drugs.com, Healthline, or Tyrvaya’s own site. 

 Allergic reactions are mentioned as a rare possibility, with potential symptoms like hives, rash, or severe swelling (think face, lips, tongue, or throat—anaphylaxis). But there’s no specific mention of neck swelling or body-wide edema tied to Tyrvaya. The prescribing info includes a standard warning to seek emergency help for severe allergic reactions, but that’s more of a precaution than a red flag based on actual cases. 

Could There Be a Mechanism? 

Tyrvaya’s active ingredient, is a nicotinic acetylcholine receptor agonist—familiar from its higher-dose role in Chantix for smoking cessation. With Chantix, rare hypersensitivity reactions like angioedema (deep skin swelling) have been reported, but that’s from systemic exposure via oral dosing. Tyrvaya’s nasal delivery keeps it localized, with studies showing minimal varenicline in the bloodstream. This makes widespread swelling—like across the body or in the neck—less plausible compared to oral use. Could nasal irritation somehow trigger swelling nearby, say, in the neck? Theoretically, an inflammatory response might affect local tissues or lymphatics, but there’s no backing for this in trial data or post-marketing reports up to February 21, 2025. Neck swelling could easily come from unrelated culprits—lymph node issues, allergies, or infections—coinciding with Tyrvaya use, but no causal link has surfaced. 

What Are People Saying? 

Anecdotally, platforms like X and patient forums (checked up to my last update) aren’t buzzing about swelling with Tyrvaya. Conversations tend to focus on its effectiveness for dry eyes or the quirky sneezing side effect—no mentions of edema. Web searches also come up empty on case reports beyond the expected nasal/throat reactions.  

Do Patients Like It? 

Most of my patients cannot tolerate putting things up their nose as it causes so much sneezing. Some patients do like it, as did this patient until her neck started swelling. For patients who are sensitive to eyed drops, Tyrvaya is a good option. Honestly, though, most of my patients note they don’t need their other prescription drops nor Tyrvaya nasal spray after or during their short course of platelet Rich 

Plasma (PRP) drops. But PRP drops are not for everybody and not everybody can have their blood drawn so Tyrvaya remains a strong option. 

A Side Note About the Cost:

Tyrvaya’s cost can vary depending on where you are and your insurance. Each containing 60 sprays (0.03 mg each), enough for 15 days at the recommended dose (one spray per nostril, twice daily). Here’s the rundown: * Retail Price: Without insurance, a single bottle averages $600–$700 in most U.S. pharmacies, per sources like GoodRx and Medical News Today. That’s about $40–$47 per day. * With Insurance: Co-pays can drop this to $30–$100 per bottle, depending on your plan. * Savings Programs: Oyster Point Pharma (now under Viatris) offers a savings card that can cap costs at $25–$75 per prescription for eligible patients. 

Prices fluctuate by region—urban areas like New York or LA might skew higher than rural spots—but this gives a ballpark. A 90-day supply (six bottles) could run $3,600–$4,200 retail, though insurance or discounts can slash that significantly. 

Of note, PRP drops are less expensive in general per month. Also PRP has one’s own growth factors which heals your own tissues. Total U.S. Sales: A Growing Market Tyrvaya hit the U.S. market in late 2021, and while exact 2024 sales figures aren’t public as of February 21, 2025, we can estimate based on trends. Oyster Point Pharma reported $17.8 million in net sales for 2022, its first full year. With growing adoption—dry eye affects over 16 million Americans—and no generics yet, sales likely climbed. Analysts suggest annual U.S. revenue could now be in the $50–$100 million range, factoring in price, prescription volume (thousands of scripts monthly), and market penetration. Viatris, which acquired Oyster Point in 2022, doesn’t break out Tyrvaya specifically in its financials, but its eye care portfolio is thriving. 

 

So, no reported ties between Tyrvaya and swelling—body or neck—based on the data we’ve got to date except for this patient. If you or someone you know experiences swelling while using it, it’s probably a coincidence or a rare allergic quirk—worth a chat with your doctor, not likely a Tyrvaya-specific worry. 

Got a personal experience or question: send me an Instagram or X note. 

Disclaimer: Always consult your healthcare provider for personalized advice. This post reflects data up to February 21, 2025, and prices/sales are estimates based on available sources.