Ornithine decarboxylase inhibitor (topical hirsutism) Pregnancy: Women who are pregnant or planning pregnancy should use an alternative means to manage facial hair (animal reproductive toxicity; human risk unknown). Should not be used while breast-feeding (excretion in human milk unknown).

Eflornithine

Brand names: Vaniqa

Eflornithine is a topical cream used to reduce unwanted facial hirsutism in women.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: Vaniqa 11.5% cream: apply to the affected area twice daily, at least eight hours apart. Efficacy demonstrated only for the face and under the chin; limit application to these areas.

Route: Cutaneous (topical), thin layer rubbed in thoroughly

Frequency: Twice daily, at least 8 hours apart

Max: Up to 30 g per month (maximum applied dose used safely in clinical trials)

Source is the UK SPC for Vaniqa 11.5% cream (topical treatment of facial hirsutism in women). Maximal applied dose used safely in clinical trials was up to 30 grams per month. Improvement may be seen within 8 weeks; discontinue if no beneficial effect within 4 months. If a hair removal method is also used, apply the cream no sooner than 5 minutes afterwards. Do not cleanse the treated area within 4 hours of application. Elderly (>=65 years): no dosage adjustment. Paediatric population (0-18 years): safety and efficacy not established; no data. NOTE: the US FDA product under this ingredient (iwilfin, oral eflornithine for high-risk neuroblastoma) is a different formulation/indication — do not conflate; verify the intended product before dosing.

Dose adjustments

Renal

Safety/efficacy not established in renal impairment; use caution in severe renal impairment (not studied). No data available.

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC; US FDA prescribing information (openFDA / DailyMed) — cross-check; US labelling may differ from UK — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients

Side effects

Very common: acne (generally mild)
Common: pseudofolliculitis barbae, alopecia, stinging/burning skin, dry skin, pruritus, erythema, tingling skin, irritated skin, rash, folliculitis
Uncommon: ingrown hair, face/mouth oedema, dermatitis, papular rash, skin bleeding, herpes simplex, eczema, cheilitis, contact dermatitis, hypopigmentation
Rare: rosacea, seborrhoeic dermatitis, skin neoplasm, skin cysts, hirsutism, skin tightness
Application-site skin effects (burning, stinging, tingling, rash, erythema) more frequent than vehicle

Interactions

No interaction studies have been performed (section 4.5)

Clinical monograph

How it works

It irreversibly inhibits ornithine decarboxylase in the hair follicle, slowing the rate of hair growth rather than removing existing hair.

Prescribing in practice

It controls rather than cures hirsutism; growth returns towards baseline after stopping, and treatment should be discontinued if no improvement is seen after a reasonable trial.
It is for facial application only and existing hair-removal methods may need to be continued alongside it.
Transient stinging, burning or acne-like eruptions at the application site are common and usually mild.

Monitoring

No laboratory monitoring is needed; review for clinical benefit after several weeks and for tolerability of local effects.

Counselling the patient

Effect is gradual and may take several weeks to become apparent.
Continue your usual hair-removal routine as the cream slows but does not remove hair.
Avoid getting the cream in the eyes or on broken skin and wash hands after applying.

Evidence & guidelines

Topical eflornithine is an established adjunct for facial hirsutism, supported by randomised controlled trial data demonstrating reduced hair growth versus vehicle.

Reference: NICE TA61; BAD; SmPC; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways