Refresh PM has been on backorder with Allergan for several months.
I call them at least weekly, and spoke with them last today (Feb 20). The latest word is:
- No firm availability date yet.
- They have been told they will know more on March 1.
Navigating alternative products
What can you use in the meantime? That's the question that's plaguing people who cannot quite stomach Ebay and Amazon scarce-product-scalper-pricing levels. Rather than continue to write the same things over and over in response to individual emails, it finally occurred to me to just post this somewhere and then send people links. So here is all my limited stock of wisdom about replacements:
1. Must it be ointment? If so, here are your need-to-knows:
There are many lubricant eye ointments. The main differences between them are as follows:
Is it preserved? The vast majority are not. An exception is Refresh Lacrilube ("coincidentally" also on backorder), which contains chlorobutanol.
What is the ratio of petrolatum to mineral oil? This is the real crux of it... well, mostly... for ointments. A distinguishing feature of Refresh PM is the relative balance between petrolatum and mineral oil - it's nearly half and half. In contrast, all other name brand ointments are four to one (petrolatum to mineral oil) at best. If you are one of those who have tried other ointments and none worked as well for you as Refresh PM, it may be because of that ingredient ratio difference.
How do other ointments compare, in terms of that ratio? As I said, the other name brands have much more petrolatum:
- Refresh PM: 57.3% white petrolatum, 42.5% mineral oil
- Systane PM: 94% white petrolatum, 3% mineral oil
- Genteal PM: 93% white petrolatum, 4% mineral oil
- Soothe (B&L): 80% white petrolatum, 20% mineral oil
On the other hand, the generics tend to echo Refresh PM:
- Walmart [Equate Restore PM Nighttime Lubricant Eye Ointment]: 57.3% white petrolatum, 42.5% mineral oil (same as Refresh PM)
- Walgreens [Walgreens Sterile Lubricant Eye Ointment]: 57.3% white petrolatum, 42.5% mineral oil (ditto)
- CVS [CVS Health Lubricant Eye Ointment Nighttime Relief]: 57.3% white petrolatum, 42.5% mineral oil
I have kept my ear to the ground on the question of whether those generics perform the same as Refresh PM.
Sidebar... when I first started The Dry Eye Shop I had to deal a lot with issues about drops and such, FDA labeling requirements and what those labels say and what they conceal. There is a great deal of information you cannot get form a label. An ingredient might go under the same name but be ever so different - even a relatively slight difference in grade or sourcing of an ingredient might make all the difference in the world to the user, and they'll never know why... great source of frustration to me.
Anyway, the scuttle-but on Equate, Walgreens and CVS ointments is mixed. It might, or it might not, do as well. It might even irritate. Your mileage may vary. It is remarkable to me though that some people see such a marked difference between the name brand and others. It's a pretty simple product, according to the label, so one can really only speculate about differences in the sourcing and grades of the ingredients - all those details that don't find their way on to the label. I don't doubt they ARE different, based on the experiences I've been hearing from patients who are highly motivated to make it work!
My take? If you have tried the other name brand ointments and already know you do not tolerate them well, you have little to lose by trying Equate or Walgreens generics. I mean, they're cheap. If you have NOT tried the others, perhaps try one of the 80/20 types first.
2. Could a different type of lubricant suffice?
What about a gel?
I know many people who cannot tolerate ointments. They use polymer gels instead. A polymer gel is made of the same stuff as many of the popular drops, but in a higher concentration and in a tube rather than a vial or bottle. Genteal Gel is far and away the most popular of these. What you must be aware of about gels is that they usually contain a "dissipating preservative", one of those preservatives that supposedly dissipates on contact. Talk with your doctor and use only what they approve, of course. I know a great many severe dry eye patients that have used Genteal Gel for years, and while it's not a personal favorite, I have a lot of respect for it because of the people I know who use it. Systane makes a lookalike, and no doubt there are generics available as well.
What about a drop, that's just, well, better?
Personally, when I was at my very worst phase of dry eye... 2002, one year post LASIK, pregnant, eyes dry as a bone.... At night, I was using LacriLube and cling film. There really wasn't anything else. I was living in London at the time. What saved me in those days was Dr. Holly's Drops which were being compounded in a pharmacy in Dallas TX at the time. It's a drop that has sadly been long off the market - Dakrina. It was the first thing to get me actually sleeping through an entire night without waking up and putting more goop in my eyes.
What Dakrina helped me understand was that the conventional wisdom of thicker = longer lasting might not be universally true. Dr. Holly's drops (Dwelle, Dakrina, and NutraTear back in the day) were formulated with a very different type of science in mind. In my simple-minded explanation to myself, I think of it as employing physics more than chemistry, though surely that's a gross oversimplification. Dr. Frank Holly really understands what it means to "wet" a surface, including a cornea. But I digress.
There is but one drop left in that family, called FreshKote. I'm in better shape these days, but if/when I need strong overnight protection, FreshKote is what I'd use. This may seem counterintuitive, as I am an absolute preservative hater, and this is a preserved drop. My very unscientific position on that is: I understand it to be about the lowest toxicity preservative around, and you can use a lot less of this drop than other products. Preservative-free, after all, is not a virtue - it's the absence of a vice. A ton of preservative free lubricants are, in fact, lousy lubricants, but hey, they're preservative free (like fat free).
3. Is it time to revisit your overnight strategy?
There are three different aspects of dry eye night care, in my opinion:
- Preparation: Warm compress, for those who need them or are so inclined.
- Lubrication: Drops, gel, or ointment. You find what works for you.
- Physical barrier protection: This is especially critical for those whose lids do not fully seal overnight, but anecdotally, it seems to help most people regardless. For examples, check out our Night Protection products collection.
My point here is that it is not just all about the goop. Set your eyes up for a really good overnight experience across the board. For some, though certainly not all, this will help reduce your dependence on the availability of any one lubricant product.
p.s. A propos of ointments, I had a customer comment recently about Retaine PM, that the 5g tube worked better for her than the 3g tube. I have not seen the 5g tube myself, but apparently one is plastic and the other is metal, so they conduct heat differently, which may have something to do with it. So many nitpickety details about these things that can make a difference!