imiquimod
Imiquimod 2.5% and 3.75% cream (Zyclara) is a prescription topical medication. It's used to treat actinic keratosis on the face or scalp in adults. The 3.75% version can also treat genital and anal warts in people ages 12 years and older. Imiquimod (Zyclara) is applied to the affected areas of the skin once each night. How long you'll use the cream depends on the condition being treated. Common side effects are skin redness, scabbing, and crusting.
What is Imiquimod (Zyclara)?
What is Imiquimod (Zyclara) used for?
- Actinic keratosis on the face or scalp in adults - 2.5% and 3.75% cream
- Genital and anal warts in adults and children ages 12 years and older - 3.75% cream only
How Imiquimod (Zyclara) works
Imiquimod (Zyclara) is a topical skin product. It's known as an immune response modifier.
It's not exactly clear how imiquimod (Zyclara) works. It's thought to turn on certain parts of your immune system. When you apply it to your skin, certain immune cells move to the treated area. These immune cells help treat skin damage from the sun and genital warts.
Drug facts
| Common Brands | Zyclara |
|---|---|
| Drug Class | Topical skin product |
| Controlled Substance Classification | Not a controlled medication |
| Generic Status | Lower-cost generic available |
| Availability | Prescription only |
Side effects of Imiquimod (Zyclara)
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 redness
- Scabbing or crusting
- Flaky, scaly, or dry skin
- Swollen skin
- Ulcer or sore on the skin
- Oozing from the skin
Less Common Side Effects
- Other skin irritation
- Headache
- Fever
- Nausea
- Joint pain
The following Imiquimod (Zyclara) 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 (Zyclara)
Pros
- Applied directly onto the affected areas
- Can use at home
Cons
- Need to remember to wash off the next morning
- Can cause skin irritation where it's applied
Pharmacist tips for Imiquimod (Zyclara)
- Only apply imiquimod (Zyclara) to your skin. Avoid getting it your eyes, nose, mouth, or on your lips. Don't put it inside your anus or vagina. These areas are very sensitive and can become irritated. If the cream gets where it shouldn't (like in your eyes), rinse the area well with water.
- Imiquimod (Zyclara) can cause skin reactions where it's applied. These can include redness, itching, dry or flaky skin, burning, swelling, and oozing. These reactions can sometimes change how your skin looks but they usually go away after your skin heals. If your skin becomes very irritated, wash the cream off with soap and water and tell your prescriber. They can recommend ways to help relieve the irritation.
- Imiquimod (Zyclara) can sometimes make the skin lighter or darker where it's applied. In some people, these skin color changes might not go away after treatment. Talk to your prescriber if you're concerned about these changes.
- Imiquimod (Zyclara) can make your skin more sensitive to sunlight. Try not to spend too much time in the sun and avoid tanning beds while using this medication. Wear protective clothing and use sunscreen when you're outside. If you get a sunburn, wait until your skin heals before applying the cream to that area again.
How to use imiquimod (Zyclara):
- Before applying imiquimod (Zyclara): Wash the affected area(s) with mild soap and water. Let your skin dry completely before applying the cream.
- For the imiquimod (Zyclara) pump bottle: Prime the pump the first time you use it. Push down on the pump a few times until cream starts to come out. Throw away the pump bottle(s) after you've finished a full treatment course.
- For the imiquimod (Zyclara) single-use packets: Use a new packet of cream each time. After using, throw it away, even if there's still some cream left inside. Don't reuse opened packets.
- How to apply imiquimod (Zyclara): Apply the cream before going to bed. Place the cream on your affected area(s) and rub it in until you can't see it anymore. Then, wash your hands well with soap and water.
- After applying imiquimod (Zyclara): Leave the cream on your skin for about 8 hours overnight. Then when you wake up, wash it off with mild soap and water.
- Don't cover the treated area with tight bandages or dressings unless your prescriber says it's okay. This can raise your risk of imiquimod (Zyclara) side effects.
For actinic keratosis on the face or scalp:
- Apply imiquimod (Zyclara) once a day for 2 weeks. Then, take a 2-week break before starting another 2-week treatment. Or, use the cream as directed by your prescriber. After a full treatment course, visit your prescriber to have your skin checked.
- Only apply imiquimod (Zyclara) to the affected areas on your face or scalp. Never use it on other parts of your body unless your prescriber tells you to. Treat only one area at a time — either your face or your scalp, but not both.
- Be sure to finish your full treatment with imiquimod (Zyclara). More lesions might appear at first, but this is normal during treatment. Don't stop using the cream early, even if your skin starts to look better.
For genital and anal warts:
- Apply imiquimod (Zyclara) to your wart(s) once a day. Keep using the cream until your warts are totally gone or for up to 8 weeks, whichever comes first. If your warts haven't gone away after 8 weeks of using the cream, talk to your prescriber.
- You might get new genital or anal warts while using imiquimod (Zyclara). Tell your prescriber if you notice any new warts.
- For women: Don't apply imiquimod (Zyclara) inside your vagina. This can cause pain and swelling and might make it hard to urinate.
- For men who aren't circumcised: If you're treating warts under the foreskin, gently pull the foreskin back and wash underneath every day.
- Avoid vaginal, anal, or oral sex while imiquimod (Zyclara) is on the skin. The cream can irritate your partner's skin. It can also make condoms and vaginal diaphragms work less well at preventing pregnancy.
- To help protect irritated skin, you can cover the treated area with loose cotton gauze or wear cotton underwear. This can help make your skin more comfortable.
Risks and warnings for Imiquimod (Zyclara)
Imiquimod (Zyclara) 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.
Local skin reactions
- Risk factors: Using more than one imiquimod skin product in the same area | Applying to damaged skin
Imiquimod (Zyclara) can cause severe local skin reactions after a few uses. The risk can be higher on damaged or infected skin. These skin reactions can include oozing, blisters, and peeling. It can also make certain inflammatory skin problems worse. If this happens, tell your prescriber. They might recommend you to take a break from the medication.
If you're using imiquimod 3.75% for genital warts on the outside of the vagina, severe swelling around the area can make it hard to urinate. If this happens, let your prescriber know. They can help decide if you should pause or stop treatment.
Minimize or avoid ultraviolet (UV) light
Imiquimod (Zyclara) can make the treated skin more sensitive to the sun. It can also become more sensitive to sunlamps, tanning beds, and other sources of ultraviolet (UV) light. This can make it easier for your skin to get sunburned.
Avoid direct sun exposure and tanning beds while using imiquimod (Zyclara). Also, use sunscreen and wear protective clothing, such as a hat, when you go out. If you get a sunburn, wait until it heals before using imiquimod (Zyclara) again in that area. If you need to be out in the sun for a long time for your job or if you tend to get sunburned easily, talk to your prescriber.
Flu-like symptoms
Some people have had flu-like symptoms while using imiquimod (Zyclara). These include feeling unwell, fever, nausea, muscle aches, or chills. If this happens, tell your prescriber. They might decide to pause treatment until your symptoms improve.
Imiquimod (Zyclara) dosage
Typical dosage for Imiquimod (Zyclara)
-
Actinic keratosis on face or scalp (Zyclara 2.5% and 3.75% cream)
- Adults: Apply up to 0.5 grams (2 packets or 2 full pumps) to the affected area once a day before bedtime for 2 weeks. Then, take a 2-week break before starting another round of treatment. Treat either your face or your scalp, but not both at the same time.
-
Genital and anal warts (Zyclara 3.75% cream)
- Adults and children 12 years and older: Apply up to 0.25 grams (1 packet or 1 full pump) to the wart area once a day before bedtime. Continue until the warts are gone or for up to 8 weeks, whichever comes first.
-
For both uses: Leave the cream on the skin for up to 8 hours and then wash it off with mild soap and water.
Interactions between Imiquimod (Zyclara) 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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