imiquimod
Imiquimod is a topical cream that works well for various skin conditions, including certain skin cancers and genital/anal warts. It takes a long time to work and often causes irritation. The instructions on how often you use the medication also depends on your skin condition and the strength of cream you're using.
What is Imiquimod?
What is Imiquimod used for?
- Face or scalp actinic keratosis (scaly precancerous spot or growth on the skin) in adults - all brands and strengths
- Genital and anal warts in adults and children 12 years and older - Zyclara 3.75% and Aldara 5% only
- Superficial basal cell carcinoma (a type of skin cancer) in adults - Aldara 5% only
How Imiquimod works
Imiquimod is a topical skin product. It's not exactly clear how the medication works, but it activates the immune system to fight off certain types of cancer, warts, and skin damage.
Drug facts
More on Imiquimod essentials
Side effects of Imiquimod
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Skin reaction (33% total), including itching (20%), burning (6%), bleeding, stinging, and pain
- Common cold symptoms (15%)
- Sinus inflammation (7%)
- Headache (5%)
Less Common Side Effects
- Eczema
- Skin cancer
- Diarrhea
- Vomiting
- Back pain
- Fatigue
- Dizziness
- Fever
- Viral infection
- Chills
- Atrial fibrillation (irregular heartbeat)
- Urinary tract infection
- Hair loss
Imiquimod serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Severe skin reactions
- Difficulty urinating due to genital swelling
The following Imiquimod side effects have also been reported
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
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
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
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
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
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.
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Pros and cons of Imiquimod
Pros
- A first-choice treatment for genital and anal warts
- A good option if you prefer treating your condition privately at home rather than getting in-office procedures
- Available as a lower-cost, generic form
Cons
- Need to remember to wash off after the recommended amount of time (usually first thing in the morning)
- Doesn't work as fast as lasers or surgery
- Not the first-choice treatment for skin cancer
- Skin reactions and irritation are pretty common.
Pharmacist tips for Imiquimod
- It's important to use imiquimod exactly as prescribed. When you first start using this medication, your provider may show you how to apply it correctly in order to get the best effect.
- Before applying imiquimod, wash the affected area(s) with soap and water, then let it dry completely for at least 10 minutes. Make sure to wash your hands beforehand too.
- Apply imiquimod just before going to bed. Be sure to rub it in gently and completely, and leave it on the affected area(s) for about 8 hours (can be 6 to 10 hours if using Aldara for warts). Afterwards, remove the medication by washing with soap and water.
- After applying imiquimod, wash your hands well to prevent it from getting on other parts of the body. Keep this medication away from your eyes, lips, and nostrils. If it gets in your eyes or anywhere that it doesn't belong, rinse well with water.
- Do not place bandages or dressings over the areas where you have applied this medication, since this can lead to more side effects.
- Skin redness, swelling, scabbing, crusting, and flakiness are typical side effects from using imiquimod. If the irritation is severe, wash the medication off with soap and water, and talk to your provider.
- If you are getting Zyclara from a pump, you'll need to "prime" the pump the first time you use it. Push down a few times until cream starts to come out, like how you would start using a brand new bottle of lotion.
- Since Aldara is not used every day, you may want to mark your calendar or set a reminder to remember to apply your dose as scheduled.
- Imiquimod packets are for single-use only. If there is any cream left in an opened packet, throw it out and do not reuse it. Throw away the Zyclara pump after you have finished your treatment.
- Imiquimod should only be used on the skin. Do not take it by mouth, or apply it on the eye or in the vagina.
- Tips for treating actinic keratosis (scaly precancerous spot or growth on the skin): Only use imiquimod to treat one area at a time - for example, only on the face, or only on the scalp, but not both at the same time. Try to stay out of the sun or any artificial sunlight, and if necessary, wear sunscreen or use protective hats and face coverings. Some areas of disease will become more noticeable when you first start this medication, but should go away with time.
- Tips for treating genital or anal warts: Avoid all types of sexual contact while you are using imiquimod to avoid giving other people side effects from the medication and also because this medication doesn't necessarily prevent spread of warts. Imiquimod can also make condoms and vaginal diaphragms work less effectively, so it's best not to use those types of protection until you are done with treatment. Imiquimod doesn't cure warts, so it's possible to get new warts while you are taking this medication. Do not put any of this medication inside the vagina or anus. If you are female, be extra careful about getting it on the most sensitive parts (unless those areas have warts) to avoid pain, swelling, and irritation. Let your provider know immediately if it affects your ability to urinate. If you are a male with genital warts near the tip of the penis and are not circumcised, remember to clean thoroughly under the foreskin every day.
- Tips for treating basal cell carcinoma (skin cancer): Aldara should only be used on skin cancer that's located on your torso, neck, arms (not hands), or legs (not feet). Your provider will tell you the right amount to use, but make sure the medication covers 1 cm around all the edges of the tumor to be certain that you have treated it fully. Stay out of the sun or any artificial sunlight, and if necessary, wear sunscreen or use protective hats and clothing. Follow-up with your provider regularly to make sure the tumor is healing appopriately.
Common questions about Imiquimod
Imiquimod takes awhile to work. Many people have to use it for a couple weeks or even a month before they start to really notice a difference in their condition. If you have used up all of your prescribed medication and your condition has not improved, contact your provider.
Leaving imiquimod on for longer than recommended can cause more severe skin irritation, and there's no guarantee that it will do a better job of treating your condition. Use this medication exactly as prescribed. Leave it on the affected area(s) for about 8 hours (can be 6 to 10 hours if using Aldara for warts), then wash it off with soap and water.
Imiquimod is not a chemotherapy (chemo) medication. Chemotherapy medications treat cancer by killing specific cells or stopping them from growing and spreading. Imiquimod boosts your body's immune response to help remove abnormal skin cells causing conditions like warts and skin cancer.
Imiquimod does not lower or "suppress" your immune system, so it doesn't make you more likely to get infections. This medication has not been studied in people who already have weakened immune systems.
Tiredness (or fatigue) is a known side effect of imiquimod, though it's pretty rare. If you feel more tired than usual after starting this medication, or if you also notice flu-like symptoms, such as fever, aches, and chills, let your provider know.
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Risks and warnings for Imiquimod
Imiquimod can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Skin inflammation
Severe irritation of the skin can occur after a few uses of imiquimod. If you previously had surgery or used a different medication, make sure that area of the skin has completely healed before starting imiquimod. Let your provider know immediately if you experience blisters, weeping, severe peeling, or if you are having trouble urinating due to genital swelling. You may have to stop using imiquimod until this inflammation goes away.
Flu-like symptoms
Imiquimod can cause flu-like symptoms such as fever, nausea, aches, chills, or swollen lymph nodes. Let your provider know right away, as you may need to stop using imiquimod until you get better.
Sunburn
Imiquimod can make your skin more sensitive to the sun, including sunlamps and ultraviolet (UV) light. Avoid direct sun exposure and tanning, and if necessary, wear sunscreen and protective clothing. If you currently have a sunburn, wait until it heals before using imiquimod in that area. If your job or lifestyle requires that you be in the sun for long periods of time, or if you tend to get sunburned easily, talk to your provider about whether this medication is right for you.
Caution with actinic keratosis (Aldara only)
There are not enough studies to say if it is okay to use imiquimod on the same area of actinic keratosis for more than one treatment cycle (for Zyclara, one treatment cycle means two 2-week treatments with a 2-week break in between). Talk to your provider if your actinic keratosis didn't respond fully to the first treatment cycle or if the symptoms have returned. Do not use this medication on a large area (more than 5 cm x 5 cm) for actinic keratosis unless your provider tells you to do so.
Not for other types of skin cancer (Aldara only)
Imiquimod should only be used to treat basal cell carinoma that is on the outside surface of the skin, and located on your torso, neck, arms (not hands), or legs (not feet). It is not recommended for treating skin cancer on the face, head, anus, or genitals, or for more severe or deeper types of skin cancer. Follow-up with your provider regularly to make sure the tumor is healing appopriately.
Not for HPV (Aldara only)
Imiquimod does not cure human papilloma virus (HPV). This means that new warts can still form, and can be contagious to your sexual partners. If you have questions about HPV, talk to your provider.
Not for use with other imiquimod medications (Zyclara only)
If you are using other imiquimod-containing products, check with your provider first before using imiquimod. Using multiple forms of imiquimod raises your risk of side effects and makes the side effects more severe.
Caution in autoimmune disease (Zyclara only)
Imiquimod activates immune cells. If you have an autoimmune condition, or overactive immune system, talk to your provider before using this medication, since it can trigger a flare-up of your condition.
Imiquimod dosage
Typical dosage for Imiquimod
Actinic keratosis (adults)
- Zyclara 2.5% and 3.75%: Apply up to 0.5 grams (2 packets or 2 pumps) to the affected area once daily for 2 weeks. Afterwards, stop using the medication for 2 weeks, then use it again.
- Aldara 5%: Apply to the affected area 2 times per week (for example, Monday and Thursday, or Tuesday and Friday) for 16 weeks. Use no more than one packet of Aldara per dose.
Genital and anal warts in (adults and children 12 years and older)
- Zyclara 3.75%: Apply up to 0.25 grams (1 packet or 1 pump) to the wart once daily until the wart is totally gone, for no more than 8 weeks.
- Aldara 5%: Apply to the wart 3 times per week (for example, Monday/Wednesday/Friday or Tuesday/Thursday/Saturday) until the wart is totally gone, for no more than 16 weeks.
Superficial basal cell carcinoma (adults)
- Aldara 5%: Apply to the affected area 5 times per week (for example, Monday through Friday) for 6 weeks. Your provider will tell you the right amount to use depending on the size of the tumor.
Interactions between Imiquimod and other drugs
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.
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