Imiquimod 5% Cream

What is Imiquimod?

Imiquimod is a topical cream that is used to treat external genital warts in people over the age of 12. Imiquimod can be used to fight the warts, but it doesn’t cure the underlying virus that causes the warts. You apply Imiquimod cream at night and it helps to encourage the immune cells to attack the warts.

How does Imiquimod work?

Imiquimod works by stimulating the immune system to identify abnormal cells. This produces inflammation and encourages the immune system to combat genital warts.

What can Imiquimod be used for?

Imiquimod works by helping the immune system to identify abnormal cells. Therefore, Imiquimod can be used for genital warts, actinic keratosis and basal cell carcinoma (an early form of skin cancer). 

How to Use

Imiquimod is designed for external use only. Before applying Imiquimod topical, wash your hands and the area of skin to be treated. Allow to dry. To treat genital warts, see the following instructions:

• 3.75% cream: Apply cream daily before you go to bed. Wash your hands after applying the cream. Leave the cream on the skin for 8 hours, then wash off with mild soap and water. Continue treatment for a maximum of 8 weeks. If symptoms persist after this time, consult your doctor.
• 5% cream: Apply the cream every other day (3-4 times a week) before you go to bed. Always wash your hands after each application. Leave the cream on the skin for 6-10 hours. Then remove the cream with soap and water. Use for a maximum of 16 weeks. If your symptoms remain, consult your doctor.

Note: Do not use Imiquimod on areas of broken, wounded, or burned skin.

Imiquimod can also be used for other conditions such as Actinic keratosis and superficial basal cell carcinoma. Always follow the instructions provided by the prescribing physician.

Side Effects

Get medical help if you have signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Up to 10% of people experience the following side effects of Imiquimod:

Dermatologic: Localized redness (58% to 100%), including flaking, scaling (18% to 93%) crusted skin ( 4% to 93%), skin scarring (local; 5% to 84%), ulcer ( 4% to 62%)

Infections: Fungal infection (2% to 11%)

Skin: Localized edema (12% to 78%), application site discharge (22% to 51%), local itching (3% to 32%), burning (9% to 26%)

Respiratory: Upper respiratory tract infection (15% to 33%)

Other, less serious side effects include:

• Mild skin irritation, itching, dryness, flaking, scabbing, crusting, redness, or hardening of the skin. This is expected to exert its desired effect;
• Changes in the color of skin;
• Headache,
• Chest pain,
• Back pain
• Cold sores,
• Cold symptoms such as stuffy nose, sneezing, sore throat;
• Nausea, diarrhea, loss of appetite
• Vaginal itching or discharge

Actinic keratosis:

2.5% and 3.75% cream: Apply thin layer once daily before bedtime for 2 weeks to the skin of the affected area

5% cream: Apply 2 times per week prior to normal sleeping hours, to a  treatment area. Maximum to be prescribed for 16-week

Aldara is usually applied 2 times per week for 16 weeks.

Zyclara is applied daily for 2 weeks followed by 2 weeks without treatment. Use the medicine at night and leave it on for 8 hours. Wash off the medicine in the morning with water and a mild soap.

Superficial basal cell carcinoma:

Usually applied 5 times per week (such as Monday through Friday) for a full 6 weeks.  Rub in the cream. Use the medicine at night and leave it on for 8 hours. Wash off the medicine with water and soap.

Drug Interactions

Imiquimod can interact with a number of other drugs. You should let your doctor know if you are taking any other medication and you should avoid combining Imiquimod with any of the following medications:

• Baricitinib: Immunosuppressants
• BCG (Intravesical
• Cladribine
• Coccidioides immitis Skin Test
• Denosumab
• Echinacea
• Fingolimod
• Leflunomide
• Natalizumab: Immunosuppressants
• Nivolumab
• Ocrelizumab
• Pidotimod
• Pimecrolimus
• Roflumilast
• Siponimod
• Sipuleucel
• Tacrolimus
• Tertomotide
• Tofacitinib
• Trastuzumab
• Vaccines (Inactivated): Immunosuppressants may diminish the therapeutic effect of Vaccines (Inactivated). Management: Vaccine efficacy may be reduced.
• Vaccines (Live)

Contraindications/ Warnings

• Do not use during pregnancy unless approved by a physician.
• Not to be used in children under 12 .
• Avoid sunlight or tanning beds because you can sunburn more easily. Wear protective clothing and use sunscreen (SPF 30 or higher) when outdoors.
• Imiquimod is not a cure for condyloma (genital warts).
• It is not known whether imiquimod is safe for use in pregnancy (Pregnancy category C).
• If you are treating the genital or rectal area with imiquimod topical, avoid sexual activity .
• Do not use this medication without telling your doctor if you are breastfeeding.