What is this medication?
Skin and Mucous Membrane Agent
Officially indicated for actinic keratosis, genital/perianal warts, and superficial basal cell carcinoma.
How does this medication work?
Imiquimod, Aldara/Zyclara/Vyloma is a Toll-like receptor 7 agonist/immune modulator that modifies the body’s response to skin infections.
How should I take this medication?
Topical (3.75%/5%): Apply a thin film (using up to 2 packets or 2 full pump actuations) once daily before bedtime for 2 weeks to the skin of the affected area (either the entire face or balding scalp, but not both concurrently); leave on for ~8 hours, then remove with mild soap and water. After a 2-week period of no treatment, repeat with a second 2-week treatment (do not extend treatment cycles because of missed doses or rest periods). Maximum to be prescribed: 56 packets or 2 x 7.5 g pumps per 2 cycles of treatment. Treatment should continue for the full treatment course even if all actinic keratoses appear to be gone (do not extend the treatment period because of missed doses or rest periods).
Genital and Perianal Warts
Topical (3.75%): Apply a thin layer once daily (using up to 1 packet or 1 full actuation of pump) prior to bedtime; leave on skin for ~8 hours, then remove with mild soap and water. Continue treatment until there is total clearance of the warts or for a maximum duration of therapy of 8 weeks. Maximum to be prescribed: 56 packets or 2 x 7.5 g pumps per course of treatment.
Topical (5% cream): Apply a thin layer 3 times per week (on alternate days) prior to bedtime; leave on skin for 6 to 10 hours, then remove with mild soap and water. Continue until there is total clearance of the genital/perianal warts or for a maximum duration of therapy of 16 weeks.
Superficial basal cell carcinoma
(Aldara 5% cream): Topical: Apply once daily 5 days per week, prior to normal sleeping hours, for 6 weeks; leave on skin for ~8 hours, then remove with mild soap and water. Apply enough cream to cover the treatment area, including 1 cm of skin surrounding the tumor. Tumor treatment area should not exceed 3 cm (maximum of 2 cm tumor diameter plus a 1 cm margin of skin around the tumor). The diameter of cream droplet applied should range from 4 mm to 7 mm for tumor areas of 0.5 cm to 2 cm, respectively. Maximum to be prescribed: 36 packets during the 6-week treatment period. Safety/efficacy of repeated use in a previously treated area have not been established.
How to Apply: Wash your hands before and after each application and only use externally. Avoid contacting the lips, eyes, and nostrils. Do not occlude the application site. Pump (Zyclara) should be primed prior to first use only by pressing top of pump completely down repeatedly until cream appears; discard cream obtained during priming; no further priming is required throughout therapy.
What should I watch for while using this medication?
Can cause an intense local inflammatory reaction at the site of application which may be accompanied by systemic symptoms (fever, malaise, myalgia)
Increase sensitivity to sunlight due to photosensitivity
Vulvar swelling and urinary retention can occur with application to female genitalia
Use with caution in patients with pre-existing autoimmune disorders
What if I miss a 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.
How should I store this medication?
Keep out of the reach of children at all times. Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.
Do not keep outdated medicine or medicine no longer needed.
What are the possible side effects of using this medication?
The frequency of adverse reactions can vary and are related to the degree of inflammation which is often dependent upon the dose, duration, and concomitant therapy.
Dermatologic: Localized erythema (58% to 100%; remote: 2%), xeroderma (local; including flaking, scaling; 18% to 93%; remote: 1%), crusted skin (local; 4% to 93%), skin sclerosis (local; 5% to 84%), dermal ulcer (local; 4% to 62%; remote: 2%), localized vesiculation (2% to 31%), excoriation (local; remote: 1%)
Infection: Fungal infection (2% to 11%)
Local: Localized edema (12% to 78%; remote: 1%), application site discharge (22% to 51%), local pruritus (3% to 32%), localized burning (9% to 26%)
Respiratory: Upper respiratory tract infection (15% to 33%)
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