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Imiquimod (Topical route)

Pronunciation:

im-I-kwi-mod

Brand Names:

  • Aldara
  • Zyclara

Dosage Forms:

  • Cream
  • Kit

Classifications:

Therapeutic—

Immune Modulator

Uses of This Medicine:

Imiquimod topical is used to treat external warts around the genital and rectal areas called condyloma acuminatum. It is not used on warts inside the vagina, penis, or rectum. Imiquimod is also used to treat a skin condition of the face and scalp called actinic keratosis (AK), which is caused by too much sun exposure. Imiquimod may be used to treat certain types of skin cancer called superficial basal cell carcinoma (sBCC).

Imiquimod works on the immune system to help the body fight viruses that cause warts. It does not destroy the viruses directly. It is not known how imiquimod works for actinic keratosis or skin cancer.

This medicine is available only with your doctor's prescription.

Before Using This Medicine:

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies—

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Children—

Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of imiquimod topical for external warts in children older than 12 years of age. However, safety and efficacy have not been established in children younger than 12 years of age.

Appropriate studies on the relationship of age to the effects of imiquimod topical for actinic keratosis or skin cancer have not been performed in the pediatric population. Safety and efficacy have not been established.

Older adults—

Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of imiquimod topical in the elderly.

Pregnancy—

Pregnancy CategoryExplanation
All TrimestersCAnimal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast-feeding—

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Other medicines—

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Other interactions—

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other medical problems—

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Autoimmune disorders, history of or
  • Infection of the skin at or near the place of application or
  • Large sores, broken skin, or severe skin injury at the place of application or
  • Rheumatoid arthritis, juvenile or adult (chronic, always present) or
  • Sun exposure, including sunlamps or
  • Surgery, recent, at the place of application or
  • Systemic lupus erythematosus (SLE), history of or
  • Vulvar swelling (swelling near the opening of the vagina)—The chance of side effects may be increased.
  • Basal cell nervus syndrome or
  • Human papilloma viral disease (cervical, intra-anal, intravaginal, rectal, urethral) or
  • Weak immune system or
  • Xeroderma pigmentosum (a rare, inherited skin disease)—It is not known if this medicine will work in patients with these conditions.

Proper Use of This Medicine:

It is very important that you use this medicine only as directed by your doctor. Do not use more of it, do not use it more often, and do not use it for a longer time than your doctor ordered. To do so may cause unwanted side effects or skin irritation.

This medicine is for use on the skin only. Do not get it in your eyes, nose, mouth, vagina, or anus. Do not use it on skin areas that have cuts, scrapes, or burns. If it does get on these areas, rinse it off right away with water.

This medicine comes with a patient information leaflet. Read and follow the instructions in the leaflet carefully. Ask your doctor if you have any questions.

This medicine should only be used for skin conditions that your doctor is treating. Check with your doctor before using it for other conditions, especially if you think that a skin infection may be present. This medicine should not be used to treat certain kinds of skin infections or conditions, such as severe burns.

If you are using the Zyclara® cream pump for the first time, prime it by pressing the top of the pump until the cream appears.

To use the cream:

  • Wash your hands with soap and water before and after using the medicine.
  • Use one or two packets or actuations of the pump of cream for each dose as directed by your doctor.
  • Apply a thin layer to the affected area of the skin just before bedtime. Rub it in gently.
  • Allow the medicine to stay on the treated skin for 8 hours (for actinic keratosis or basal cell carcinoma) or 6 to 10 hours (for genital warts). Do not take a bath, swim, or get the treated area wet during this time.
  • After the right amount of time has passed, wash the treated area with mild soap and water.
  • Men who are not circumcised and are treating genital warts under the foreskin should retract the foreskin and clean the area daily.
  • Do not bandage or otherwise wrap the skin being treated, unless directed to do so by your doctor. Materials that are not airtight, such as cotton gauze or cotton underwear, may be used if needed.
  • Throw out any unused cream from the single-dose packet.

Use only the brand of this medicine that your doctor prescribed. Different brands may not work the same way.

Do not use this medicine together with any other products containing imiquimod in the same treatment area. This may increase risk for more serious side effects.

Dosing—

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For topical dosage form (cream):
    • For actinic keratosis:
      • Adults—If you use Zyclara®, apply a thin film to the affected area of skin once a day at bedtime for 2 weeks. Your doctor will repeat the treatment after you go 2 weeks without medicine. If you use Aldara®, apply a thin film to the affected area of skin once a day at bedtime 2 times per week for 16 weeks. Your doctor will tell you which days are best during the week.
      • Children—Use and dose must be determined by your doctor.
    • For skin cancer:
      • Adults—Apply a thin film to the affected area of skin once a day at bedtime 5 times per week for 6 weeks. Your doctor will tell you which days are best during the week.
      • Children—Use and dose must be determined by your doctor.
    • For external warts:
      • Adults and children 12 years of age and older—If you use Zyclara®, apply a thin film to the wart once a day at bedtime for up to 8 weeks or until the wart is gone. If you use Aldara®, apply a thin film to the wart once a day at bedtime 3 times per week. Your doctor will tell you which days are best during the week. Use the medicine until the wart is gone, but for no longer than 16 weeks.
      • Children younger than 12 years of age—Use and dose must be determined by your doctor.

Missed dose—

If you miss a dose of this medicine, apply it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule.

Storage—

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Store the Zyclara® cream pump upright.

Precautions While Using This Medicine:

It is very important that your doctor check the progress of you or your child at regular visits for any unwanted effects that may be caused by this medicine.

Stop using this medicine and check with your doctor right away if you or your child have a skin rash, burning, pain, redness, swelling, bleeding, oozing, scabbing, or peeling on the skin where the medicine was applied.

Stop using this medicine and check with your doctor right away if you have severe swelling near the opening of the vagina. This may cause painful urination, trouble in passing urine, or not able to urinate.

Stop using this medicine and check with your doctor right away if you or your child have severe skin irritation or flu-like symptoms, such as diarrhea, fever, chills, headache, nausea, muscle or joint pain, or unusual tiredness or weakness.

Avoid exposing your skin to sunlight, sunlamps, or tanning beds while you are using this medicine. Always use sunscreen or sun-blocking lotions and wear protective clothing and hats.

If you are being treated for external warts, avoid having genital, oral, or anal sex while the medicine is on your skin. Make sure you wash the cream off your skin before you engage in any sexual activity. The medicine contains oils that can weaken latex (rubber) condoms and diaphragms, which will prevent them from working properly.

Imiquimod is not a cure for genital warts. New warts may develop while you are using the cream. Imiquimod will also not keep you from spreading genital warts to other people.

Do not use cosmetics or any other skin care products on the treated areas, unless directed to do so by your doctor.

Side Effects of This Medicine:

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
Blisters on the skin
body aches or pain
chills
cough
difficulty with breathing
ear congestion
itching in the genital or other skin areas
loss of voice
open sores or scabs on the skin
pain or tenderness around the eyes and cheekbones
redness of the skin (severe)
scaling
shortness of breath or troubled breathing
skin rash
sneezing
sore throat
stuffy or runny nose
tightness of the chest or wheezing
unusual tiredness or weakness
Less common
Abdominal or stomach pain
ankle, knee, or great toe joint pain
bladder pain
bloody or cloudy urine
blurred vision
chest pain
cold flu-like symptoms
difficult, burning, or painful urination
dizziness
fainting
fast or irregular heartbeat
frequent urge to urinate
hoarseness
joint stiffness or swelling
lower back or side pain
lump in the abdomen or stomach
nervousness
persistent non-healing sore
pink growth on the skin
pounding in the ears
reddish patch or irritated area
severe headache
shiny bump on the skin
slow or fast heartbeat
swollen, painful, or tender lymph glands in the neck, armpit, or groin
white, yellow or waxy scar-like area
Incidence not known
Blue lips and fingernails
convulsions
coughing that sometimes produces a pink frothy sputum
dilated neck veins
extreme fatigue
fast, irregular, or pounding heartbeat
headache
irregular breathing
nausea or vomiting
pain in the shoulders, arms, jaw, or neck
slurred speech
sudden and severe inability to speak
suicide
sweating
swelling of the face, fingers, feet, or lower legs
temporary blindness
weakness in the arm or leg on one side of the body
weight gain

Get emergency help immediately if any of the following symptoms of overdose occur:

Symptoms of overdose
Confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
Burning or stinging of the skin (mild)
flaking of the skin
mild headache
pain, soreness, or tenderness of the skin (mild)
rash
redness of the skin (mild)
swelling at place of application
Less common
Back pain
lightening of the treated skin

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.


Last Updated: 11/4/2014

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