Imiquimod

Imiquimod is a prescription medication used to treat warts around the genital and anal areas, actinic keratosis (flaking and discoloration of the skin from sun exposure), and superficial basal cell carcinoma (a form of skin cancer) in adults. Imiquimod belongs to a group of drugs called immune response modifiers, which stimulate the body's immune response to treat warts. The exact way imiquimod works to treat other conditions is unknown.

This medication comes in the form of a cream to be applied to the affected area 2 to 5 times a week for up to 16 weeks depending upon the condition being treated.

Common side effects include redness, swelling, sores, blisters and other changes to the area where imiquimod cream is applied. 

Imiquimod cream is a prescription medicine used to treat:

• external genital and perianal warts in people 12 years and older. Imiquimod cream is not a cure for genital warts.
• actinic keratosis in adults with normal immune systems. 
• superficial basal cell carcinoma (a type of skin cancer) in adults with normal immune systems when surgical methods are less appropriate. 

This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information.

Imiquimod may be found in some form under the following brand names:

• Aldara

• Zyclara

The most common side effects with imiquimod are skin reactions where it is applied (treatment area) including:

• redness
• swelling
• a sore, blister, or ulcer
• skin that becomes hard or thickened
• skin peeling
• scabbing and crusting
• itching
• burning
• changes in skin color that do not always go away

Some side effects can be serious. If you experience any of these symptoms, call your doctor right away:

• skin breakdown or sores that may have drainage, especially during the first week of treatment
• flu-like symptoms such as nausea, fever, chills, tiredness, and muscle weakness or pain

This is not a complete list of imiquimod side effects. Ask your doctor or pharmacist for more information.

No imiquimod drug interactions have been identified, however, you should tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements. Be sure to tell your doctor if you are receiving other treatments for genital or anal warts, actinic keratoses, or superficial basal cell carcinoma. Not all drug interactions are known or reported and new drug interactions are continually being reported. 

Imiquimod has not been studied in children under 12 years old for external genital and perianal warts.

Imiquimod has not been studied in children under 18 years old for actinic keratosis or superficial basal cell carcinoma. Children usually do not get actinic keratoses or basal cell carcinoma. 

Imiquimod will not cure your genital or perianal warts. New warts may develop during treatment with imiquimod. It is not known if imiquimod can stop you from spreading genital or perianal warts to other people.

Avoid exposure to sunlight as much as possible and wear protective clothing (such as a hat), sunglasses, and sunscreen if you go outside during daylight hours. Do not use tanning beds or sunlamps. Imiquimod may make your skin sensitive to sunlight.

Imiquimod may cause changes in your skin color. These changes may not go away after you finish treatment with imiquimod. Tell your doctor if you notice any changes in your skin color.

Medicines can interact with certain foods. In some cases, this may be harmful and your doctor may advise you to avoid certain foods. In the case of imiquimod cream there are no specific foods that you must exclude from your diet when receiving imiquimod cream.

Before receiving imiquimod tell your doctor about all of your medical conditions including if you:

• are allergic to imiquimod or to any of the ingredients in imiquimod cream
• have a sunburn
• if you have or have ever had unusual sensitivity to sunlight
• if you have a skin disease such as psoriasis
• if you have graft vs. host disease 
• if you have had a recent surgery to the affected area
• if you have any condition that affects the immune system (such as human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS)

Tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. 

Tell your doctor about all the medicines you take including prescription and non-prescription medicines, vitamins, and herbal supplements.

Tell your doctor if you are pregnant or plan to become pregnant.

The FDA categorizes medications based on safety for use during pregnancy. Five categories - A, B, C, D, and X, are used to classify the possible risks to an unborn baby when a medication is taken during pregnancy.This medication falls into category C.

It is not known if imiquimod will harm your unborn baby.

Tell your doctor if you are breastfeeding or if you are planning to breastfeed. It is not known if imiquimod is excreted in breast milk or if it will harm your baby.

Applying imiquimod cream:

• Imiquimod cream should be applied just before your bedtime.
• Wash the area to be treated with mild soap and water. Allow the area to dry.
• Uncircumcised males treating warts under their penis foreskin must pull their foreskin back and clean before treatment, and clean daily during the weeks of treatment.
• Wash your hands.
• Open a new packet of imiquimod cream just before use.
• Apply a thin layer of imiquimod cream only to the affected area or areas to be treated. Do not use more imiquimod cream than is needed to cover the treatment area.
• Rub the cream in all the way to the affected area or areas.
• Do not get imiquimod cream in your eyes.
• Do not get imiquimod cream in the anus when applying to perianal warts.
• Female patients treating genital warts must be careful when applying imiquimod cream around the vaginal opening. Female patients should take special care if applying the cream at the opening of the vagina because local skin reactions on the delicate moist surfaces can cause pain or swelling, and may cause problems passing urine. Do not put imiquimod cream in your vagina or on the skin around the genital wart.
• Do not cover the treated area with an airtight bandage. Cotton gauze dressings can be used. Cotton underwear can be worn after applying imiquimod cream to the genital or perianal area.
• Safely throw away the open packet of imiquimod cream so that children and pets cannot get it. The open packet should be thrown away even if all the imiquimod cream was not completely used.
• After applying imiquimod cream, wash your hands well.
• Leave imiquimod cream on the treated area for as long as your doctor tells you to.
• After the right amount of time has passed, wash the treated area or areas with mild soap and water.
• If you forget to apply imiquimod cream, apply the missed dose of cream as soon as you remember and then continue on your regular schedule.
• If you get imiquimod cream in your mouth or in your eyes rinse well with water right away. 

Apply imiquimod cream exactly as prescribed. Follow the directions on your prescription label carefully.

For external genital and perianal warts imiquimod cream is usually used once a day for 3 days a week for 16 weeks.

For actinic keratosis imiquimod cream is usually used once a day for 2 days a week, 3 to 4 days apart for 16 weeks.

For superficial basal cell carcinoma imiquimod cream is usually used once a day for 5 days a week for 6 weeks.

Leave the cream on the affected area or areas for the time your doctor recommends. The length of time that imiquimod cream is left on the skin is not the same for the different skin conditions that imiquimod cream is used to treat. Do not bathe or get the treated area wet before the right time has passed. Do not leave imiquimod cream on your skin longer than prescribed.

If you apply too much imiquimod, or if someone swallows imiquimod cream, call your local poison control center right away or seek emergency medical attention. 

• Store imiquimod at 39 - 77° F (4 - 25° C). Do not freeze.
• Safely throw away imiquimod that is out of date or that you do not need.
• Keep imiquimod and all medicines out of the reach of children.