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Topical immunomodulator (TLR7 agonist) Pregnancy: Avoid unless essential. Limited data in pregnancy.

Imiquimod 5%

Brand names: Aldara, Zyclara (3.75%)

Adult dose

Dose: Apply 3 times per week (every other day) at night for 4–16 weeks
Route: Topical
Frequency: 3 times per week (Mon/Wed/Fri)
Max: 1 sachet per application
Genital warts (external): 3 times/week, wash off after 6–10 hours. Up to 16 weeks. Actinic keratosis (face/scalp): 3 times/week for 4 weeks; 1 sachet per 25 cm² area. Superficial BCC: 5 times/week for 6 weeks (1 sachet per 25 cm²). Apply before sleep.

Paediatric dose

Route: Topical
Frequency: 3 times per week
Max: Not licensed in children <12 years for genital warts
Not routinely used in children. Specialist use only. Some evidence for molluscum contagiosum and warts in children — off-label.

Dose adjustments

Renal

No systemic adjustment for topical use.

Hepatic

No systemic adjustment for topical use.

Clinical pearls

  • Local inflammatory reaction is expected and indicates treatment response
  • If reaction too severe — treatment break of several days then restart
  • Wash off after 6–10 hours (before going out — avoid day use)
  • For BCC: imiquimod is an alternative to surgery for superficial BCC in patients unfit for surgery
  • Condoms may be damaged by imiquimod — use alternative contraception during treatment

Contraindications

  • Hypersensitivity to imiquimod
  • Application to open wounds or mucosal surfaces
  • Internal (vaginal, anal, urethral) genital warts

Side effects

  • Local skin reactions (erythema, erosion, weeping — sign of efficacy)
  • Pain and pruritus at application site
  • Flu-like systemic symptoms (rare — significant application area)
  • Hypopigmentation or hyperpigmentation (post-treatment)

Interactions

  • No significant systemic drug interactions

Monitoring

  • Local skin response
  • Clearance assessment
  • Signs of infection

Reference: BNFc; BNF; BAD Genital Warts Guidelines; NICE CG8 Referral for Suspected Cancer. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways