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Antimitotic — Anogenital Warts Pregnancy: CONTRAINDICATED — teratogenic; use cryotherapy or trichloroacetic acid for anogenital warts in pregnancy

Podophyllotoxin

Brand names: Warticon, Condyline

Adult dose

Dose: 0.5% solution or 0.15% cream — apply twice daily for 3 consecutive days, then 4 days rest. Repeat for up to 4 cycles
Route: Topical
Frequency: Twice daily × 3 days per week
Max: 0.5 mL solution per treatment session; cream — 4 cycles maximum
Self-applied treatment for external anogenital warts (condylomata acuminata). Antimitotic: arrests mitosis in metaphase by binding tubulin. Patient applies at home. More convenient than clinic-based cryotherapy. Contraindicated internally or on mucosal surfaces.

Paediatric dose

Dose: Not applicable topical/kg
Route: Topical
Frequency: Twice daily × 3 days
Max: Not established in children
Anogenital warts in children are rare and may indicate sexual abuse — specialist safeguarding assessment mandatory before treating. Seek specialist guidance.

Dose adjustments

Renal

No dose adjustment required (topical)

Hepatic

No dose adjustment required

Paediatric weight-based calculator

Anogenital warts in children are rare and may indicate sexual abuse — specialist safeguarding assessment mandatory before treating. Seek specialist guidance.

Clinical pearls

  • BASHH 2015 Anogenital Warts: patient-applied podophyllotoxin and imiquimod are first-line self-treatment options; cryotherapy is clinic-based first-line alternative
  • Teach application technique carefully: apply only to wart tissue, avoid surrounding normal skin (Vaseline protection of surrounding skin helps)
  • CONTRAINDICATED in pregnancy — teratogenic; imiquimod is also contraindicated; cryotherapy or trichloroacetic acid (TCA) are the options in pregnancy
  • Response assessment at 4 weeks: if no improvement after 4 cycles → switch to alternative (imiquimod or clinic cryotherapy)
  • Anogenital warts in children: HPV types 6 and 11 — consider vertical transmission (perinatal) and sexual abuse; safeguarding referral and specialist assessment mandatory
  • Warticon solution (0.5%) vs Condyline cream (0.15%): cream preferred for keratinised lesions; solution preferred for softer warts

Contraindications

  • Pregnancy — CONTRAINDICATED (teratogenic)
  • Internal warts (vaginal, urethral, anal canal, cervical)
  • Broken or inflamed skin
  • Large wart areas (>4 cm² — systemic absorption risk)
  • Breastfeeding

Side effects

  • Local inflammatory reaction (erythema, burning, erosion — expected and indicates activity)
  • Pain
  • Ulceration (excessive application)
  • Systemic toxicity (rare — nausea, vomiting, paraesthesia — with large area or prolonged use)

Interactions

  • No clinically significant interactions at topical doses

Monitoring

  • Response at 4 weeks (wart clearance)
  • Local skin reaction severity
  • Pregnancy test before initiating in women of childbearing potential

Reference: BNFc; BNF 90; BNFc; BASHH Anogenital Warts Guidelines 2015; NICE CKS Genital Warts. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Pathways