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 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.
PROS AND CONSpros and consPharmacist 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.
What are the risks and warnings for Imiquimod?
Skin inflammation
Severe skin irritation may develop after using imiquimod a few times. Ensure the skin area has fully healed from any previous surgery or medication before beginning imiquimod treatment. Inform your healthcare provider right away if you develop blisters, weeping, intense peeling, or have difficulty urinating due to genital swelling. It may be necessary to discontinue imiquimod until the inflammation subsides.
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.
Strengths
Carton
28 packets of 3.75%
Cream pump
7.5g of 3.75%
Packet
5%
Dosages
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.
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Interactions
Imiquimod may interact with certain medications or supplements. It is crucial to inform your doctor and pharmacist about all other medications or supplements you are taking, including those prescribed, over-the-counter, vitamins, and dietary or herbal supplements. The following list does not encompass all potential drug interactions with Imiquimod, and only generic names are provided.
While some medicines should never be combined, others can be used concurrently despite potential interactions. In such instances, your doctor might adjust the dosage or implement additional precautions. Always communicate with your healthcare provider about any other prescription or nonprescription (over-the-counter [OTC]) medicines you are using.
Side-effects
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%)
Other Side Effects
Eczema
Skin cancer
Diarrhea
Vomiting
Back pain
Fatigue
Dizziness
Fever
Viral infection
Chills
Atrial fibrillation (irregular heartbeat)
Urinary tract infection
Hair loss
Serious Side Effects
Contact your healthcare provide immediately if you experience any of the following.
Severe skin reactions
Difficulty urinating due to genital swelling
The following 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:
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:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Common Concerns
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.
Feedback from Our Clients
Explore feedbacks from our clients below. They reflect the dedication and expertise we bring to every interaction, and how our services have positively impacted their health.
Miss Victoria Kula
Reviewed on May 31, 2024
Aldara 5% worked very well for the warts. Taking immune boosting supplements keeps the warts from reoccurring.
