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imiquimod (Aldara)
Tradename: Aldara.
Indications:
- genital warts & other warts (only FDA approval [5])
- skin cancer
- basal cell carcinoma [7]
- squamous cell carcinoma
- vitiligo
- alopecia areata
- reduce recurrence of keloid scars [4]
- actinic keratosis [5,6,8,9]
- superficial infantile hemangiomas [10]
- vulvar intraepithelial neoplasia [11] Dosing:
1) QHS or every other night to reduce skin irritation
2) actinic keratosis:
a) QHS 2-3 times/week for 4 months
b) wash off after 8 hours
Cream:
- 2,5%, 3.75% & 5% in 0.25 g of cream (single use packets)
- 12 packets $340 (CVS 2014)
Pharmacokinetics: takes about 10 weeks for improvement
Adverse effects:
1) local skin reactions
a) rash, erythema
b) hypopigmentation
c) pruritus
d) erosions
e) scabbing
2) remote skin reaction
a) bleeding
b) pruritus
c) pain
d) Tinea cruris
3) systemic
a) fever
b) fatigue
c) flu-like syndrome
d) headache
e) diarrhea
f) myalgia
Mechanism of action:
1) an immune response modifier
2) 80% histological cure rate for basal cell carcinoma [7]
3) advantage over surgery is does NOT leave scar [7]
Notes: cost about $116/month (2004) [6]
Interactions
drug interactions
General
antiviral agent
heterocyclic compound, 3 rings
Properties
MISC-INFO: pregnancy-category B
safety in lactation ?
Database Correlations
PUBCHEM cid=57469
References
- 3M package insert
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Prescriber's Letter 7(2):10, Feb. 2000
- Prescriber's Letter 8(5):29 2001
- Prescriber's Letter 10(1):4 2003
- Prescriber's Letter 11(5):27-28 2004
Detail-Document#: 200507
(subscription needed) http://www.prescribersletter.com
- Journal Watch 24(13):102, 2004
Geisse J, Caro I, Lindholm J, Golitz L, Stampone P, Owens M.
Imiquimod 5% cream for the treatment of superficial basal cell
carcinoma: results from two phase III, randomized, vehicle-
controlled studies.
J Am Acad Dermatol. 2004 May;50(5):722-33.
PMID: 15097956
- Journal Watch 25(11):92, 2005
Korman N, Moy R, Ling M, Matheson R, Smith S, McKane S, Lee JH.
Dosing with 5% imiquimod cream 3 times per week for the
treatment of actinic keratosis: results of two phase 3,
randomized, double-blind, parallel-group, vehicle-controlled
trials.
Arch Dermatol. 2005 Apr;141(4):467-73.
PMID: 15837864
- Hadley G, Derry S, Moore RA.
Imiquimod for actinic keratosis: systematic review and
meta-analysis.
J Invest Dermatol. 2006 Jun;126(6):1251-5.
PMID: 16557235
- Ho NTC et al
Topical imiquimod in the treatment of infantile hemangiomas:
A retrospective study.
J Am Acad Dermatol 2007, 56:63
PMID: 17190622
- Deprecated Reference