imiquimod: clinical use

Prescribing considerations

• Confirm that lesion type and site fit the selected indication; biopsy atypical actinic keratoses or lesions suspicious for malignancy.
• Avoid starting treatment on open wounds or skin not healed after previous medical or surgical treatment.
• Use caution with autoimmune disease, organ transplantation, immunosuppression, inflammatory skin conditions or reduced haematological reserve.
• For foreskin-associated warts, ensure the patient can perform daily foreskin hygiene and recognise early phimosis or stricture symptoms.
• Remove cream before sexual activity because it may weaken condoms and diaphragms; it does not prevent HPV or other STI transmission.
• Protect treated actinic keratosis and superficial basal-cell-carcinoma areas from solar exposure.

Contraindications and cautions

• Hypersensitivity to imiquimod or any formulation excipient.

Monitoring

• Review local inflammation, ulceration, infection and systemic flu-like symptoms; intolerable reactions require clinical reassessment.
• Reassess clinical clearance after treated skin has regenerated.
• Monitor for urinary difficulty when treating lesions near the urethral opening and for impaired foreskin retraction.
• Consider blood-cell abnormalities if unexplained infection, bruising or marked fatigue develops, particularly with reduced haematological reserve.

Clinical pharmacology

Imiquimod is a locally acting immune-response modifier that induces interferon-alpha and other cytokines. It has no direct antiviral activity, and systemic exposure after application to intact skin is minimal.

Formulation and product differences

• The selected product is a white to slightly yellow cream supplied in single-use foil sachets.
• Opened sachets must not be stored or reused.
• Parabens, cetyl alcohol, stearyl alcohol and benzyl alcohol may cause allergic or local skin reactions.

Cream

Route: Cutaneous

Strengths: 50 mg/g, 3.75%, 5%