Mechanism of Action

Imiquimod's mechanism of action is via stimulation of innate and acquired immune responses, which ultimately leads to inflammatory cell infiltration within the field of drug application followed by apoptosis of diseased tissue. Imiquimod does not have direct antiviral activity. Studies of mice show that imiquimod may induce cytokines, including interferon-alpha (IFNA) as well as several IFNA genes (IFNA1, IFNA2, IFNA5, IFNA6, and IFNA8) as well as the IFNB gene. Imiquimod also induced the expression of interleukin (IL)-6, IL-8, and tumor necrosis factor-alpha genes. In the treatment of basal cell carcinoma, Imiquimod appears to act as a toll-like receptor-7 agonist and is thought to exert its anti-tumor effect via modification of the immune response and stimulation of apoptosis in BCC cells. In treating basal cell carcinoma it may increase the infiltration of lymphocytes, dendritic cells, and macrophages into the tumor lesion.

or

Imiquimod and resiquimod represent Toll-like receptor (TLR) 7 and 8 agonists, which emerged as attractive candidates for tumor therapy. To elucidate immune cells, which mainly contribute to TLR7/8-mediated antitumoral activity, /the researchers/ investigated the impact of imiquimod and resiquimod on native human 6-sulfo LacNAc (slan) dendritic cells (DCs). /The researchers/ found that both TLR7/8 agonists significantly improve the release of various proinflammatory cytokines by slanDCs and promote their tumor-directed cytotoxic activity. Furthermore, resiquimod efficiently augmented the ability of slanDCs to stimulate T cells and natural killer cells. These results indicate that imiquimod and resiquimod trigger various immunostimulatory properties of plants, which may contribute to their antitumor effects.

Indications

For the topical treatment of clinically typical, nonhyperkeratotic, non hypertrophic actinic keratoses on the face or scalp in immunocompetent adults. Also indicated is the treatment of external genital and perianal warts/condyloma acuminate in individuals 12 years old and above.
Zyclara is indicated for the topical treatment of clinically typical, non-hyperkeratotic, non-hypertrophic, visible or palpable actinic keratosis of the full face or balding scalp in immunocompetent adults when other topical treatment options are contraindicated or less appropriate.
Imiquimod cream is indicated for the topical treatment of external genital and perianal warts (condylomata acuminate) in adults; small superficial basal-cell carcinomas (sBCCs) in adults; clinically typical, non-hyperkeratotic, non-hypertrophic actinic keratoses (AKs) on the face or scalp in immunocompetent adult patients when size or number of lesions limit the efficacy and/or acceptability of cryotherapy and other topical treatment options are contraindicated or less appropriate.
Imiquimod cream is indicated for the topical treatment of external genital and perianal warts (condyloma acuminata) in adult patients.
Imiquimod is used topically for the treatment of clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratosis on the face or scalp in immunocompetent adults; treatment of biopsy-confirmed, primary superficial basal cell carcinoma in immunocompetent adults; and treatment of external genital and perianal exophytic warts (condylomata acuminate) caused by human papillomavirus (HPV).
Topical imiquimod has been effective when used in a limited number of adults and children for the treatment of molluscum contagiosum.
Imiquimod 5% cream has been used for the topical treatment of external genital and perianal HPV warts in a limited number of adults with human immunodeficiency virus (HIV) infection; however, the response rate appears to be lower in these individuals than in those who are not HIV infected.
For the topical treatment of clinically typical, nonhyperkeratotic, non hypertrophic actinic keratoses on the face or scalp in immunocompetent adults. Also indicated for the treatment of external genital and perianal warts/condyloma acuminate in individuals 12 years old and above.
Actinic Keratoses of the face
Actinic Keratoses of the scalp
Condylomata Acuminata
Herpes Simplex Infections
Molluscum Contagiosum
Superficial Basal Cell Carcinoma

Use in Cancer
Imiquimod is approved to treat:

Actinic keratosis in immunocompetent adults. This use is approved for the Aldara and Zyclara brands of imiquimod.
Basal cell carcinoma is superficial. It is used in immunocompetent adults. This use is approved for the Aldara brand of imiquimod.
Genital warts or perianal warts in adults and in children aged 12 years and older. This use is approved for the Aldara and Zyclara brands of imiquimod.

Imiquimod is also being studied in the treatment of other conditions and types of cancer.

Contraindications

a reduction in the body's resistance to infection
disease in which body has an immune response against itself
sunburn
increased sensitivity of the skin to the sun
graft-versus-host disease

Dosage
Strengths: 5%; 3.75%; 2.5%
Keratosis

2.5% and 3.75% cream: Apply a thin film once a day before bedtime to the affected area (either the entire face or balding scalp)
Treatment should continue for two 2-week treatment cycles separated by a 2-week no-treatment period.
The cream should be applied as a thin film to the entire treatment area and rubbed in until it is no longer visible.
Up to 2 packets or 2 pumps, actuation may be applied per application.
To be left on the skin for about 8 hours, after which, it to be removed with mild soap and water.
5% cream: Apply topically to the affected area on the face or scalp (but not both concurrently) 2 times per week for a full 16 weeks
The treatment area is defined as one contiguous area of about 5 cm by 5 cm on the face (e.g., forehead or 1 cheek) or on the scalp.
Examples of a schedule of 2 times per week are Monday and Thursday, or Tuesday and Friday.
The cream should be applied to the entire treatment area and rubbed in until it is no longer visible.
Not more than 1 packet should be applied to the contiguous treatment are at each application.
To be applied prior to normal sleeping hours and left on the skin for about 8 hours, after which, to be removed with mild soap and water.
For the topical treatment of clinically typical visible or palpable actinic keratoses of the full face or balding scalp in immunocompetent patients

Condylomata Acuminata

3.75% cream: Apply a thin layer once a day to the external genital/perianal warts until total clearance or up to 8 weeks
Up to 1 packet or 1 full actuation of the pump of cream may be used at the treatment site for each application.
To be applied prior to normal sleeping hours and left on the skin for about 8 hours, then removed by washing the area with mild soap and water.
Nonocclusive dressings such as cotton gauze or cotton underwear may be used in the management of skin reaction
5% cream: Apply topically to external genital/perianal warts 3 times per week
Treatment should continue until there is total clearance of warts or up to a maximum of 16 weeks.
Examples of 3 times per week application schedules are Monday, Wednesday, Friday or Tuesday, Thursday, and Saturday.
To be applied prior to normal sleeping hours and left on the skin for 6 to 10 hours, then removed by washing the area with mild soap and water.
For the treatment of external genital and perianal warts (EGW)/condyloma acuminate

Basal Cell Carcinoma

5% cream: Apply topically to a biopsy-confirmed superficial basal cell carcinoma 5 times per week for a full 6 weeks
To be applied prior to normal sleeping hours and left on the skin for about 8 hours, then removed by washing the area with mild soap and water.
The treatment area should include a 1 cm margin of skin around the tumor.
Sufficient cream should be used to cover the treatment area and rubbed in until it is no longer visible.
For the topical treatment of biopsy-confirmed, primary superficial basal cell carcinoma (sBCC) in immunocompetent adults, with a maximum tumor diameter of 2 cm, located on the trunk (excluding anogenital skin), neck, or extremities (excluding hands and feet), only when surgical methods are medically less appropriate and patient follow-up can be reasonably assured

Condylomata Acuminata
12 years or older:

3.75% cream: Apply a thin layer once a day to the external genital/perianal warts until total clearance or up to 8 weeks
Up to 1 packet of cream may be used at the treatment site for each application.
To be applied prior to normal sleeping hours and left on the skin for about 8 hours, then removed by washing the area with mild soap and water.

12 years or older:

5% cream: Apply topically to external genital/perianal warts 3 times per week
Treatment should continue until there is total clearance of warts or up to a maximum of 16 weeks.
Examples of 3 times per week application schedules are Monday, Wednesday, Friday or Tuesday, Thursday, and Saturday.
To be applied prior to normal sleeping hours and left on the skin for 6 to 10 hours, then removed by washing the area with mild soap and water.

Administration advice:

For topical use only; not for oral, ophthalmic, intra-anal, or intravaginal use.
Wash hands before and after use.
Avoid use in or on lips and nostrils; do not use in or near the eyes.
Use of excessive amounts of cream should be avoided and partially used packets discarded and not reused.
The pump should be primed before first-time use by repeatedly depressing the actuator until the cream is dispensed; it is not necessary to repeat the priming process.
Local skin reactions are common in all treatment areas; a rest period of several days may be taken if required by the patient's discomfort or severity of the reaction; however, neither 2-week treatment cycle when treating actinic keratosis should be extended due to missed doses or rest periods.
A transient increase in lesion counts may be observed during the treatment of actinic keratosis; response to treatment cannot be adequately assessed until the resolution of local skin reactions.
Treatment should continue for the full treatment course even if all actinic keratoses appear to be gone; carefully re-evaluate the patient if lesions do not respond to treatment.

Side Effects
The most common

redness, itching, burning, or bleeding of the treated area
flaking, scaling, dryness, or thickening of the skin
swelling, stinging, or pain in the treated area
blisters, scabs, or bumps on the skin
headache
diarrhea
back pain
tiredness
skin breakdown or sores that may have drainage, especially during the first week of treatment
flu-like symptoms such as nausea, fever, chills, tiredness, and muscle weakness or pain
weight gain
Confusion
dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
blisters, a burning sensation, skin redness, dry skin, itching, skin breakdown, skin crusting or scabbing, skin drainage, skin flaking or scaling, skin ulceration, sores, swelling, as well as systemic reactions, such as fever, "flu-like" symptoms, headache, and tiredness.

More Common

Blisters on the skin
body aches or pain
chills
cough
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
sneezing
sore throat
stuffy or runny nose
tightness of the chest or wheezing
unusual tiredness or weakness

Rare

Abdominal or stomach pain
ankle, knee, or great toe joint pain
bladder pain
bloody or cloudy urine
blurred vision
chest pain
cold flu-like symptoms
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
a 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
a white, yellow, or waxy scar-like area
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

Drug Interactions

DRUG
INTERACTION

Abametapir
The serum concentration of Imiquimod can be increased when it is combined with Abametapir.

Allogeneic processed
The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Imiquimod.

Avanafil
The serum concentration of Avanafil can be increased when it is combined with Imiquimod.

Cenobamate
The serum concentration of Imiquimod can be decreased when it is combined with Cenobamate.

Dabrafenib
The serum concentration of Imiquimod can be decreased when it is combined with Dabrafenib.

Enzalutamide
The serum concentration of Imiquimod can be decreased when it is combined with Enzalutamide.

Haloperidol
The serum concentration of Haloperidol can be increased when it is combined with Imiquimod.

Inebilizumab
The risk or severity of infection can be increased when Imiquimod is combined with Inebilizumab.

Ivosidenib
The metabolism of Imiquimod can be increased when combined with Ivosidenib.

Lopinavir
The serum concentration of Imiquimod can be increased when it is combined with Lopinavir.

Magnesium
The serum concentration of Magnesium can be decreased when it is combined with Imiquimod.

Mavacamten
The serum concentration of Imiquimod can be decreased when it is combined with Mavacamten.

Meningococcal
The therapeutic efficacy of Meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM197 conjugate vaccine can be decreased when used in combination with Imiquimod.

Ritonavir
The serum concentration of Imiquimod can be increased when it is combined with Ritonavir.

Satralizumab
The serum concentration of Imiquimod can be decreased when it is combined with Satralizumab.

Somatrogon
The metabolism of Imiquimod can be increased when combined with Somatrogon.

Sotorasib
The serum concentration of Imiquimod can be decreased when it is combined with Sotorasib.

Stiripentol
The metabolism of Imiquimod can be decreased when combined with Stiripentol.

Tacrolimus
Tacrolimus may increase the immunosuppressive activities of Imiquimod.

Telotristat ethyl
The serum concentration of Imiquimod can be decreased when it is combined with Telotristat ethyl.

Trastuzumab
Trastuzumab may increase the neutropenic activities of Imiquimod.

Tucatinib
The metabolism of Tucatinib can be decreased when combined with Imiquimod.

Ublituximab
The risk or severity of infection can be increased when Ublituximab is combined with Imiquimod.

Vibrio cholerae
The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Imiquimod.

Viloxazine
The metabolism of Imiquimod can be decreased when combined with Viloxazine.

Pregnancy and Lactation
US FDA pregnancy category C
Pregnancy
Drugs that have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have not shown evidence of an increased occurrence of fetal damage.
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant the use of the drug in pregnant women despite potential risks.

Use with caution; benefits should outweigh risks. According to some authorities: Use is not recommended.
Lactation
Caution is recommended. According to some authorities: Use is not recommended. Excreted into human milk: Unknown Excreted into animal milk: Unknown.m No adverse effects were demonstrated in animal studies with rats treated with this drug during gestation and lactation at doses up to 8 times the maximum human dose on an mg/m2 basis.

How should this medicine be used?

Question

Mechanism of Action





Imiquimod's mechanism of action is via stimulation of innate and acquired immune responses, which ultimately leads to inflammatory cell infiltration within the field of drug application followed by apoptosis of diseased tissue. Imiquimod does not have direct antiviral activity. Studies of mice show that imiquimod may induce cytokines, including interferon-alpha (IFNA) as well as several IFNA genes (IFNA1, IFNA2, IFNA5, IFNA6, and IFNA8) as well as the IFNB gene. Imiquimod also induced the expression of interleukin (IL)-6, IL-8, and tumor necrosis factor-alpha genes. In the treatment of basal cell carcinoma, Imiquimod appears to act as a toll-like receptor-7 agonist and is thought to exert its anti-tumor effect via modification of the immune response and stimulation of apoptosis in BCC cells. In treating basal cell carcinoma it may increase the infiltration of lymphocytes, dendritic cells, and macrophages into the tumor lesion.

or




Imiquimod and resiquimod represent Toll-like receptor (TLR) 7 and 8 agonists, which emerged as attractive candidates for tumor therapy. To elucidate immune cells, which mainly contribute to TLR7/8-mediated antitumoral activity, /the researchers/ investigated the impact of imiquimod and resiquimod on native human 6-sulfo LacNAc (slan) dendritic cells (DCs). /The researchers/ found that both TLR7/8 agonists significantly improve the release of various proinflammatory cytokines by slanDCs and promote their tumor-directed cytotoxic activity. Furthermore, resiquimod efficiently augmented the ability of slanDCs to stimulate T cells and natural killer cells. These results indicate that imiquimod and resiquimod trigger various immunostimulatory properties of plants, which may contribute to their antitumor effects.





Indications





 	For the topical treatment of clinically typical, nonhyperkeratotic, non hypertrophic actinic keratoses on the face or scalp in immunocompetent adults. Also indicated is the treatment of external genital and perianal warts/condyloma acuminate in individuals 12 years old and above.
 	Zyclara is indicated for the topical treatment of clinically typical, non-hyperkeratotic, non-hypertrophic, visible or palpable actinic keratosis of the full face or balding scalp in immunocompetent adults when other topical treatment options are contraindicated or less appropriate.
 	Imiquimod cream is indicated for the topical treatment of external genital and perianal warts (condylomata acuminate) in adults; small superficial basal-cell carcinomas (sBCCs) in adults; clinically typical, non-hyperkeratotic, non-hypertrophic actinic keratoses (AKs) on the face or scalp in immunocompetent adult patients when size or number of lesions limit the efficacy and/or acceptability of cryotherapy and other topical treatment options are contraindicated or less appropriate.
 	Imiquimod cream is indicated for the topical treatment of external genital and perianal warts (condyloma acuminata) in adult patients.
 	Imiquimod is used topically for the treatment of clinically typical, nonhyperkeratotic, nonhypertrophic actinic keratosis on the face or scalp in immunocompetent adults; treatment of biopsy-confirmed, primary superficial basal cell carcinoma in immunocompetent adults; and treatment of external genital and perianal exophytic warts (condylomata acuminate) caused by human papillomavirus (HPV).
 	Topical imiquimod has been effective when used in a limited number of adults and children for the treatment of molluscum contagiosum.
 	Imiquimod 5% cream has been used for the topical treatment of external genital and perianal HPV warts in a limited number of adults with human immunodeficiency virus (HIV) infection; however, the response rate appears to be lower in these individuals than in those who are not HIV infected.
 	For the topical treatment of clinically typical, nonhyperkeratotic, non hypertrophic actinic keratoses on the face or scalp in immunocompetent adults. Also indicated for the treatment of external genital and perianal warts/condyloma acuminate in individuals 12 years old and above.
 	Actinic Keratoses of the face
 	Actinic Keratoses of the scalp
 	Condylomata Acuminata
 	Herpes Simplex Infections
 	Molluscum Contagiosum
 	Superficial Basal Cell Carcinoma



Use in Cancer
Imiquimod is approved to treat:


 	Actinic keratosis in immunocompetent adults. This use is approved for the Aldara and Zyclara brands of imiquimod.
 	Basal cell carcinoma is superficial. It is used in immunocompetent adults. This use is approved for the Aldara brand of imiquimod.
 	Genital warts or perianal warts in adults and in children aged 12 years and older. This use is approved for the Aldara and Zyclara brands of imiquimod.

Imiquimod is also being studied in the treatment of other conditions and types of cancer.

Contraindications

 	a reduction in the body's resistance to infection
 	disease in which body has an immune response against itself
 	sunburn
 	increased sensitivity of the skin to the sun
 	graft-versus-host disease

Dosage
Strengths: 5%; 3.75%; 2.5%
Keratosis

 	2.5% and 3.75% cream: Apply a thin film once a day before bedtime to the affected area (either the entire face or balding scalp)
 	Treatment should continue for two 2-week treatment cycles separated by a 2-week no-treatment period.
 	The cream should be applied as a thin film to the entire treatment area and rubbed in until it is no longer visible.
 	Up to 2 packets or 2 pumps, actuation may be applied per application.
 	To be left on the skin for about 8 hours, after which, it to be removed with mild soap and water.
 	5% cream: Apply topically to the affected area on the face or scalp (but not both concurrently) 2 times per week for a full 16 weeks
 	The treatment area is defined as one contiguous area of about 5 cm by 5 cm on the face (e.g., forehead or 1 cheek) or on the scalp.
 	Examples of a schedule of 2 times per week are Monday and Thursday, or Tuesday and Friday.
 	The cream should be applied to the entire treatment area and rubbed in until it is no longer visible.
 	Not more than 1 packet should be applied to the contiguous treatment are at each application.
 	To be applied prior to normal sleeping hours and left on the skin for about 8 hours, after which, to be removed with mild soap and water.
 	For the topical treatment of clinically typical visible or palpable actinic keratoses of the full face or balding scalp in immunocompetent patients

Condylomata Acuminata

 	3.75% cream: Apply a thin layer once a day to the external genital/perianal warts until total clearance or up to 8 weeks
 	Up to 1 packet or 1 full actuation of the pump of cream may be used at the treatment site for each application.
 	To be applied prior to normal sleeping hours and left on the skin for about 8 hours, then removed by washing the area with mild soap and water.
 	Nonocclusive dressings such as cotton gauze or cotton underwear may be used in the management of skin reaction
 	5% cream: Apply topically to external genital/perianal warts 3 times per week
 	Treatment should continue until there is total clearance of warts or up to a maximum of 16 weeks.
 	Examples of 3 times per week application schedules are Monday, Wednesday, Friday or Tuesday, Thursday, and Saturday.
 	To be applied prior to normal sleeping hours and left on the skin for 6 to 10 hours, then removed by washing the area with mild soap and water.
 	For the treatment of external genital and perianal warts (EGW)/condyloma acuminate

Basal Cell Carcinoma

 	5% cream: Apply topically to a biopsy-confirmed superficial basal cell carcinoma 5 times per week for a full 6 weeks
 	To be applied prior to normal sleeping hours and left on the skin for about 8 hours, then removed by washing the area with mild soap and water.
 	The treatment area should include a 1 cm margin of skin around the tumor.
 	Sufficient cream should be used to cover the treatment area and rubbed in until it is no longer visible.
 	For the topical treatment of biopsy-confirmed, primary superficial basal cell carcinoma (sBCC) in immunocompetent adults, with a maximum tumor diameter of 2 cm, located on the trunk (excluding anogenital skin), neck, or extremities (excluding hands and feet), only when surgical methods are medically less appropriate and patient follow-up can be reasonably assured

Condylomata Acuminata
12 years or older:

 	3.75% cream: Apply a thin layer once a day to the external genital/perianal warts until total clearance or up to 8 weeks
 	Up to 1 packet of cream may be used at the treatment site for each application.
 	To be applied prior to normal sleeping hours and left on the skin for about 8 hours, then removed by washing the area with mild soap and water.

12 years or older:

 	5% cream: Apply topically to external genital/perianal warts 3 times per week
 	Treatment should continue until there is total clearance of warts or up to a maximum of 16 weeks.
 	Examples of 3 times per week application schedules are Monday, Wednesday, Friday or Tuesday, Thursday, and Saturday.
 	To be applied prior to normal sleeping hours and left on the skin for 6 to 10 hours, then removed by washing the area with mild soap and water.

Administration advice:

 	For topical use only; not for oral, ophthalmic, intra-anal, or intravaginal use.
 	Wash hands before and after use.
 	Avoid use in or on lips and nostrils; do not use in or near the eyes.
 	Use of excessive amounts of cream should be avoided and partially used packets discarded and not reused.
 	The pump should be primed before first-time use by repeatedly depressing the actuator until the cream is dispensed; it is not necessary to repeat the priming process.
 	Local skin reactions are common in all treatment areas; a rest period of several days may be taken if required by the patient's discomfort or severity of the reaction; however, neither 2-week treatment cycle when treating actinic keratosis should be extended due to missed doses or rest periods.
 	A transient increase in lesion counts may be observed during the treatment of actinic keratosis; response to treatment cannot be adequately assessed until the resolution of local skin reactions.
 	Treatment should continue for the full treatment course even if all actinic keratoses appear to be gone; carefully re-evaluate the patient if lesions do not respond to treatment.

Side Effects
The most common

 	redness, itching, burning, or bleeding of the treated area
 	flaking, scaling, dryness, or thickening of the skin
 	swelling, stinging, or pain in the treated area
 	blisters, scabs, or bumps on the skin
 	headache
 	diarrhea
 	back pain
 	tiredness
 	skin breakdown or sores that may have drainage, especially during the first week of treatment
 	flu-like symptoms such as nausea, fever, chills, tiredness, and muscle weakness or pain
 	weight gain
 	Confusion
 	dizziness, faintness, or lightheadedness when getting up suddenly from a lying or sitting position
 	blisters, a burning sensation, skin redness, dry skin, itching, skin breakdown, skin crusting or scabbing, skin drainage, skin flaking or scaling, skin ulceration, sores, swelling, as well as systemic reactions, such as fever, "flu-like" symptoms, headache, and tiredness.

More Common

 	Blisters on the skin
 	body aches or pain
 	chills
 	cough
 	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
 	sneezing
 	sore throat
 	stuffy or runny nose
 	tightness of the chest or wheezing
 	unusual tiredness or weakness

Rare

 	Abdominal or stomach pain
 	ankle, knee, or great toe joint pain
 	bladder pain
 	bloody or cloudy urine
 	blurred vision
 	chest pain
 	cold flu-like symptoms
 	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
 	a 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
 	a white, yellow, or waxy scar-like area
 	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

Drug Interactions



DRUG
INTERACTION




Abametapir
The serum concentration of Imiquimod can be increased when it is combined with Abametapir.


Allogeneic processed
The therapeutic efficacy of Allogeneic processed thymus tissue can be decreased when used in combination with Imiquimod.


Avanafil
The serum concentration of Avanafil can be increased when it is combined with Imiquimod.


Cenobamate
The serum concentration of Imiquimod can be decreased when it is combined with Cenobamate.


Dabrafenib
The serum concentration of Imiquimod can be decreased when it is combined with Dabrafenib.


Enzalutamide
The serum concentration of Imiquimod can be decreased when it is combined with Enzalutamide.


Haloperidol
The serum concentration of Haloperidol can be increased when it is combined with Imiquimod.


Inebilizumab
The risk or severity of infection can be increased when Imiquimod is combined with Inebilizumab.


Ivosidenib
The metabolism of Imiquimod can be increased when combined with Ivosidenib.


Lopinavir
The serum concentration of Imiquimod can be increased when it is combined with Lopinavir.


Magnesium
The serum concentration of Magnesium can be decreased when it is combined with Imiquimod.


Mavacamten
The serum concentration of Imiquimod can be decreased when it is combined with Mavacamten.


Meningococcal
The therapeutic efficacy of Meningococcal (groups A, C, Y and W-135) oligosaccharide diphtheria CRM197 conjugate vaccine can be decreased when used in combination with Imiquimod.


Ritonavir
The serum concentration of Imiquimod can be increased when it is combined with Ritonavir.


Satralizumab
The serum concentration of Imiquimod can be decreased when it is combined with Satralizumab.


Somatrogon
The metabolism of Imiquimod can be increased when combined with Somatrogon.


Sotorasib
The serum concentration of Imiquimod can be decreased when it is combined with Sotorasib.


Stiripentol
The metabolism of Imiquimod can be decreased when combined with Stiripentol.


Tacrolimus
Tacrolimus may increase the immunosuppressive activities of Imiquimod.


Telotristat ethyl
The serum concentration of Imiquimod can be decreased when it is combined with Telotristat ethyl.


Trastuzumab
Trastuzumab may increase the neutropenic activities of Imiquimod.


Tucatinib
The metabolism of Tucatinib can be decreased when combined with Imiquimod.


Ublituximab
The risk or severity of infection can be increased when Ublituximab is combined with Imiquimod.


Vibrio cholerae
The therapeutic efficacy of Vibrio cholerae CVD 103-HgR strain live antigen can be decreased when used in combination with Imiquimod.


Viloxazine
The metabolism of Imiquimod can be decreased when combined with Viloxazine.



 
Pregnancy and Lactation
US FDA pregnancy category C
Pregnancy
Drugs that have been taken by only a limited number of pregnant women and women of childbearing age, without an increase in the frequency of malformation or other direct or indirect harmful effects on the human fetus having been observed. Studies in animals have not shown evidence of an increased occurrence of fetal damage.
Animal reproduction studies have shown an adverse effect on the fetus and there are no adequate and well-controlled studies in humans, but potential benefits may warrant the use of the drug in pregnant women despite potential risks.

Use with caution; benefits should outweigh risks. According to some authorities: Use is not recommended.
Lactation
Caution is recommended. According to some authorities: Use is not recommended. Excreted into human milk: Unknown Excreted into animal milk: Unknown.m No adverse effects were demonstrated in animal studies with rats treated with this drug during gestation and lactation at doses up to 8 times the maximum human dose on an mg/m2 basis.





How should this medicine be used?

Accepted Answer

Imiquimod comes as a cream to apply to the skin. If you are using imiquimod cream to treat actinic keratoses, you will probably apply it once a day for 2 days a week, 3 to 4 days apart (e.g., Monday and Thursday or Tuesday and Friday). Do not apply the cream to an area larger than your forehead or cheek (about 2 inches by 2 inches). Imiquimod cream should be left on the skin for approximately 8 hours. Continue using&hellip;

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Key Takeaways

Seek urgent medical care if you notice

Emergency now

See a doctor

Learn safely

RX Patient Tools

Mechanism of Action

Indications

Use in Cancer

Contraindications

Dosage?

Keratosis

Condylomata Acuminata

Basal Cell Carcinoma

Condylomata Acuminata

Side Effects

The most common

More Common

Rare

Drug Interactions

Pregnancy and Lactation

Pregnancy

Lactation

How should this medicine be used?

To use the cream, follow these steps:

What special precautions should I follow?

Before using imiquimod,

Prepare before seeing a doctor

Which doctor may help?

What to tell the doctor

Questions to ask

Tests to discuss

Avoid these mistakes

Medicine safety and first-aid guide

Safe first steps

OTC medicine safety

Avoid these mistakes

Get urgent help if

Patient health record and symptom diary

Care roadmap for: Imiquimod – Uses, Dosage, Side Effects, Interactions

Check danger signs first

Record the symptom story

Visit a qualified clinician

Do only useful tests

Follow up and return early if worse

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Frequently Asked Questions

References

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