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Imiquimod: Drug information

Imiquimod: Drug information
(For additional information see "Imiquimod: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Aldara [DSC];
  • Zyclara;
  • Zyclara Pump
Brand Names: Canada
  • Aldara P;
  • TARO-Imiquimod Pump;
  • Vyloma;
  • Zyclara
Pharmacologic Category
  • Skin and Mucous Membrane Agent;
  • Topical Skin Product
Dosing: Adult
Actinic keratosis

Actinic keratosis: Topical:

2.5% and 3.75% cream: Apply thin film (using up to 2 packets or 2 full pump actuations) once daily before bedtime for 2 weeks to the skin of the affected area (either the entire face or balding scalp, but not both concurrently); leave on for ~8 hours, then remove with mild soap and water. After a 2-week period of no treatment, repeat with a second 2-week treatment (do not extend treatment cycles because of missed doses or rest periods). Maximum to be prescribed: 56 packets or 2 x 7.5 g pumps per 2 cycles of treatment. Treatment should continue for the full treatment course even if all actinic keratoses appear to be gone (do not extend the treatment period because of missed doses or rest periods).

5% cream: Apply 2 times per week (using up to 1 packet per application), prior to normal sleeping hours, to a defined treatment area(s) on the face or scalp (but not both concurrently; treatment should be limited to areas ≤25 cm2); leave on for ~8 hours, then remove with mild soap and water. Maximum to be prescribed: 36 packets per 16-week treatment period. Treatment should continue for 16 weeks (do not extend the treatment period beyond 16 weeks because of missed doses or rest periods).

Basal cell carcinoma, superficial

Basal cell carcinoma, superficial (Aldara 5% cream): Topical: Apply once daily 5 days per week, prior to normal sleeping hours, for 6 weeks; leave on skin for ~8 hours, then remove with mild soap and water. Apply enough cream to cover the treatment area, including 1 cm of skin surrounding the tumor. Tumor treatment area should not exceed 3 cm (maximum of 2 cm tumor diameter plus a 1 cm margin of skin around the tumor). The diameter of cream droplet applied should range from 4 mm to 7 mm for tumor areas of 0.5 cm to 2 cm, respectively. Maximum to be prescribed: 36 packets during the 6-week treatment period. Safety/efficacy of repeated use in a previously treated area have not been established.

Off- label dosing (may be better tolerated): Apply once every other day; may include a treatment holiday during weekends or in the middle of a treatment course (AAD [Bichakjian 2018]).

Cutaneous flat warts

Cutaneous flat warts (off-label use): Topical (5% cream): Apply once daily at bedtime until warts completely disappear up to a maximum of 12 weeks (Kim 2006). Additional data may be necessary to further define the role of imiquimod in this condition.

Genital and perianal warts

Genital and perianal warts: Topical:

3.75% cream: Apply a thin layer once daily (using up to 1 packet or 1 full actuation of pump) prior to bedtime; leave on skin for ~8 hours, then remove with mild soap and water. Continue treatment until there is total clearance of the warts or for a maximum duration of therapy of 8 weeks. Maximum to be prescribed: 56 packets or 2 x 7.5 g pumps per course of treatment.

5% cream: Apply a thin layer 3 times per week (on alternate days) prior to bedtime; leave on skin for 6 to 10 hours, then remove with mild soap and water. Continue until there is total clearance of the genital/perianal warts or for a maximum duration of therapy of 16 weeks.

Herpes simplex virus infection, genital, acyclovir resistant

Herpes simplex virus infection, genital, acyclovir resistant (off-label use): Topical (5% cream): Apply to lesions 3 times per week (leaving on skin for 8 hours per application) until clinical resolution (in patients with HIV, generally ≥21 to 28 days) (CDC [Workowski 2021]; HHS [OI adult 2020]).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Pediatric
Genital and perianal warts

Genital and perianal warts (3.75% and 5% cream): Children ≥12 years and Adolescents: Topical: Refer to adult dosing.

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing adjustment for toxicity: Children ≥12 years and Adolescents:

Local skin reactions (eg, erythema, edema, skin erosion/weeping, scabbing): Temporarily interrupt treatment for up to several days for severe or intolerable reactions; may consider resuming therapy once reaction subsides.

Systemic/flu-like reactions (eg, malaise, fever, rigors): Consider temporary interruption of therapy.

Vulvar swelling: Interrupt or discontinue therapy for severe vulvar swelling.

Dosing: Kidney Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Older Adult

Refer to adult dosing.

Dosing: Adjustment for Toxicity: Adult

Local skin reactions (eg, erythema, edema, skin erosion/weeping, scabbing): Temporarily interrupt treatment for up to several days for severe or intolerable reactions; may consider resuming therapy once reaction subsides.

Systemic/flu-like reactions (eg, malaise, fever, rigors): Consider temporary interruption of therapy.

Vulvar swelling: Interrupt or discontinue therapy for severe vulvar swelling.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Cream, External:

Aldara: 5% (12 ea [DSC]) [contains benzyl alcohol, cetyl alcohol, methylparaben, propylparaben, sorbitan monostearate(sorbitan stearate)]

Zyclara: 3.75% (28 ea) [contains benzyl alcohol, cetyl alcohol, methylparaben, propylparaben]

Zyclara Pump: 2.5% (7.5 g); 3.75% (7.5 g) [contains benzyl alcohol, cetyl alcohol, methylparaben, propylparaben]

Generic: 3.75% (28 ea, 7.5 g); 5% (1 ea, 12 ea, 24 ea)

Generic Equivalent Available: US

Yes

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling.

Cream, External:

Aldara P: 5% (1 ea) [contains benzyl alcohol, cetyl alcohol, methylparaben, propylparaben]

Vyloma: 3.75% (4 ea, 7.5 g, 15 g, 28 ea) [contains benzyl alcohol, cetyl alcohol, methylparaben, propylparaben]

Zyclara: 3.75% (7.5 g, 12 ea, 28 ea) [contains benzyl alcohol, cetyl alcohol, methylparaben, propylparaben]

Generic: 5% (7.5 g)

Administration: Adult

Topical: Wash hands prior to and following application. For topical use only; not for ophthalmic, oral, intra-anal, or intravaginal use. Avoid use in or on the lips and nostrils; do not use in or near the eyes. Do not occlude the application site. Pump (Zyclara) should be primed prior to first use only by pressing top of pump completely down repeatedly until cream appears; discard cream obtained during priming; no further priming is required throughout therapy.

Actinic keratosis: The treatment area should be washed with mild soap and thoroughly dried (~10 minutes) prior to application. Apply 5% cream over a single contiguous area (~25 cm2) on the face or scalp or 2.5% and 3.75% cream over an area on the face or scalp. Both face and scalp should not be treated concurrently. Apply a thin layer to the affected area and rub in until the cream is no longer visible. A transient increase in actinic keratosis lesion counts may be observed during treatment.

Basal cell carcinoma, superficial (Aldara): Treatment area should have a maximum diameter no more than 2 cm on the trunk, neck, or extremities (excluding the hands, feet, and anogenital skin). Treatment area should include a 1 cm margin around the tumor. Wash and thoroughly dry treatment area prior to application; apply a thin layer to the affected area (and margin) and rub in until the cream is no longer visible.

Genital/perianal warts: Apply a thin layer to external or perianal wart area and rub in until the cream is no longer visible. Avoid use of excessive amounts of cream. Nonocclusive dressings (such as cotton gauze or cotton underwear) may be used in the management of skin reactions.

Administration: Pediatric

Topical: Wash hands prior to and following application. For topical use only; not for ophthalmic, oral, intra-anal, or intravaginal use. Avoid use in or on the lips and nostrils; do not use in or near the eyes. Do not occlude the application site. Pump (Zyclara) should be primed prior to first use by pressing top of pump completely down repeatedly until cream appears; discard cream obtained during priming; no further priming is required throughout therapy.

Genital/perianal warts: Apply a thin layer to external or perianal wart area and rub in until the cream is no longer visible. Avoid use of excessive amounts of cream. Apply at bedtime and leave on for 6 to 10 hours, then remove with soap and water. Nonocclusive dressings (such as cotton gauze or cotton underwear) may be used in the management of skin reactions.

Use: Labeled Indications

Actinic keratosis (2.5%, 3.75% and 5% cream): Topical treatment of clinically typical, nonhyperkeratotic, nonhypertrophic, visible or palpable actinic keratoses on the full face or scalp in immunocompetent adults.

Basal cell carcinoma, superficial (Aldara 5% cream): Topical treatment of biopsy-confirmed, primary superficial basal cell carcinoma in immunocompetent adults with a maximum tumor diameter of 2 cm located on the trunk (excluding anogenital skin), neck, or extremities (excluding hands and feet), only when surgical methods are medically less appropriate and patient follow-up can be reasonably assured.

Genital and perianal warts (3.75% and 5% cream): Treatment of external genital and perianal warts (condyloma acuminata) in patients 12 years and older.

Limitations of use: Safety and efficacy has not been established in immunosuppressed patients and in patients with basal cell nevus syndrome or xeroderma pigmentosum, or for prevention or transmission of HPV. Imiquimod should be used with caution in patients with preexisting autoimmune conditions. Imiquimod has been evaluated in pediatrics ages 2 to 12 with molluscum, contagiosum, however, studies failed to demonstrate efficacy.

Use: Off-Label: Adult

Cutaneous flat wart; Herpes simplex virus infection, genital, acyclovir resistant

Medication Safety Issues
Sound-alike/look-alike issues:

Aldara may be confused with Alora, Lialda

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency of reactions vary and are related to the degree of inflammation associated with the treated disease, number of weekly applications, product formulation, and individual sensitivity.

>10%:

Dermatologic: Localized erythema (58% to 100%; remote: 2%), xeroderma (local; including flaking, scaling; 18% to 93%; remote: 1%), crusted skin (local; 4% to 93%), skin sclerosis (local; 5% to 84%), dermal ulcer (local; 4% to 62%; remote: 2%), localized vesiculation (2% to 31%), excoriation (local; remote: 1%)

Infection: Fungal infection (2% to 11%)

Local: Localized edema (12% to 78%; remote: 1%), application site discharge (22% to 51%), local pruritus (3% to 32%), localized burning (9% to 26%)

Respiratory: Upper respiratory tract infection (15% to 33%)

1% to 10%:

Cardiovascular: Chest pain, localized blanching

Central nervous system: Headache (2% to 6%), fatigue (1% to 4%), dizziness (<1% to 3%), local discomfort (soreness; ≤3%), rigors (1%), anxiety, pain, tingling of skin (local)

Dermatologic: Skin pain (local; 1% to 8%), skin hypertrophy (local; 3%), skin infection (local; 1% to 3%), eczema (2%), cheilitis (≤2%), alopecia (1%), dermal hemorrhage (local), localized rash, papule (local), seborrhoeic keratosis, skin tenderness (local), stinging of the skin (local), tinea (cruris)

Endocrine & metabolic: Increased serum glucose

Gastrointestinal: Nausea (1% to 4%), diarrhea (1% to 3%), anorexia (≤3%), vomiting (1%), dyspepsia

Genitourinary: Bacterial vaginosis (3%), urinary tract infection (1%)

Hematologic & oncologic: Squamous cell carcinoma (4%), lymphadenopathy (2% to 3%)

Infection: Herpes simplex (≤3%)

Local: Local irritation (3% to 6%)

Neuromuscular & skeletal: Arthralgia (1% to 3%), myalgia (≥1%), back pain

Respiratory: Sinusitis (7%), flu-like symptoms (<1% to 4%), cough, pharyngitis, rhinitis

Miscellaneous: Fever (≤3%)

Postmarketing and/or case reports: Abdominal pain, acute exacerbations of multiple sclerosis, agitation, anemia, angioedema, atrial fibrillation, capillary leak syndrome, cardiac failure, cardiomyopathy, cellulitis (local), cerebrovascular accident, chills, depression, dermatitis, dyspnea, dysuria, erythema multiforme, erythema (scrotal), exacerbation of psoriasis, exacerbation of ulcerative colitis, exfoliative dermatitis, febrile seizures, Henoch-Schönlein purpura (IgA vasculitis), hepatic insufficiency, herpes zoster, hyperpigmentation, immune thrombocytopenia (ITP), insomnia, ischemia, lethargy, leukopenia, malignant lymphoma, myocardial infarction, pain (scrotal), palpitations, pancytopenia, paresis, proteinuria, psoriasis, pulmonary edema, scrotal edema, seizure, squamous cell carcinoma, supraventricular tachycardia, syncope, tachycardia, thrombocytopenia, thyroiditis, ulcerative colitis, ulcer (scrotal), urinary retention, urticaria, vertebral disk disease (spondylitis onset or exacerbated)

Contraindications

There are no contraindications listed in the manufacturer's US labeling.

Canadian labeling: Hypersensitivity to imiquimod or any component of the formulation

Warnings/Precautions

Concerns related to adverse effects:

• Local inflammatory reactions: Intense local inflammatory reactions (including skin weeping or erosion) may occur after a few applications; may require treatment interruption and may be accompanied by systemic symptoms (fever, malaise, myalgia); reactions may extend beyond the application site. Imiquimod has the potential to exacerbate inflammatory conditions of the skin (including chronic graft-versus-host disease).

• Photosensitivity: Due to the potential for increased sensitivity to sunlight, avoid or minimize sunlight exposure (including sunlamps or other artificial sunlight exposure) during treatment. Advise patients to wear protective clothing (eg, a hat) during treatment. Patients with sunburn should not to use imiquimod until full recovery form sunburn. Patients with a potential for considerable sun exposure (eg, due to their occupations) or inherent sensitivity to sunlight should use caution during imiquimod treatment.

• Systemic reactions: Flu-like symptoms (arthralgias, chills, fatigue, fever, malaise, myalgias, nausea, rigors) may accompany or precede local inflammatory reactions; may require treatment interruption.

• Vulvar swelling: Severe local inflammation of female external genitalia following topical application may lead to severe vulvar swelling and urinary retention; interrupt or discontinue treatment for severe symptoms.

Disease related concerns:

• Actinic keratosis: Safety and efficacy have not been established in the treatment of actinic keratosis with repeat use (more than 1 treatment course) in the same area. Safety of imiquimod 5% applied to areas of skin larger than 25 cm2 has not been established. Lymphadenopathy has occurred in patients being treated for actinic keratosis; lymphadenopathy resolved within 4 weeks after completion of treatment.

• Autoimmune disorders: Safety and efficacy in immunosuppressed patients have not been established. Use with caution in patients with preexisting autoimmune disorders (onset or exacerbation of disease has been reported).

• Basal cell carcinoma: Use should be limited to superficial carcinomas with a maximum diameter of 2 cm. Safety and efficacy in treatment of other types of basal cell carcinoma (BCC) lesions of the face, head, and anogenital area, or other subtypes of BCC (including nodular and morpheaform), have not been established. Patients with superficial BCC treated with imiquimod should have regular follow up of the treatment site.

• Human papilloma viral disease: Imiquimod has not been evaluated for the treatment of urethral, intravaginal, cervical, rectal, or intra-anal human papilloma viral disease and is not recommended for these conditions.

Dosage forms specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP 1997; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.

Other warnings/precautions:

• Appropriate use: Not intended for oral, nasal, intravaginal, or ophthalmic use. Administration is not recommended until tissue is healed from any previous drug or surgical treatment. Treatment should not be prolonged beyond recommended period due to missed doses or rest periods. Safety and efficacy have not been established for basal cell nevus syndrome, in immunocompromised patients, or for xeroderma pigmentosum. Safety and efficacy of the 2.5% cream in the treatment of external genital warts have not been established.

Metabolism/Transport Effects

Substrate of CYP1A2 (minor), CYP3A4 (minor); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

There are no known significant interactions.

Reproductive Considerations

Imiquimod may weaken condoms and vaginal diaphragms.

Pregnancy Considerations

Imiquimod appears to pose a low risk when used topically for anogenital warts but use in pregnant patients should be avoided until additional data are available (CDC [Workowski 2021]).

Breastfeeding Considerations

It is not known if imiquimod is present in breast milk. The manufacturer recommends that caution be exercised when administering imiquimod to breastfeeding patients.

Monitoring Parameters

Assess response to therapy periodically (reduction in lesion size is indicative of a therapeutic response); monitor for local skin reactions and for signs and symptoms of hypersensitivity to imiquimod.

Mechanism of Action

Imiquimod, an immune response modifier, is a Toll-like receptor 7 agonist that activates immune cells. Topical application to the skin is associated with increases in markers for cytokines and immune cells.

Pharmacokinetics

Absorption: Minimal; systemic absorption more dependent upon surface area of application as opposed to dose

Time to peak: 9 to 12 hours

Excretion: Urine (<3% of applied dose as imiquimod and metabolites)

Pricing: US

Cream (Imiquimod External)

3.75% (per each): $46.47

5% (per each): $2.50 - $36.32

Cream (Zyclara External)

3.75% (per each): $52.81

Cream (Zyclara Pump External)

2.5% (per gram): $197.15

3.75% (per gram): $197.15

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • Akdara (KW);
  • Aldara (AE, AR, AT, AU, BB, BE, BG, BH, CH, CL, CN, CR, CY, CZ, DE, DK, DO, EE, EG, FI, FR, GB, GR, GT, HK, HN, HR, HU, IE, IL, IS, IT, JO, KR, LB, LK, LT, LU, MT, MX, MY, NI, NL, NO, NZ, PA, PH, PL, PT, QA, RO, RU, SA, SE, SG, SI, SK, SV, TH, TR, UA, VN, ZA);
  • Aldiq (AR, AU);
  • Aquimod Cream (IL);
  • Beselna (JP);
  • Imimore (PE);
  • Imiquad (VN);
  • Imoxy (BR);
  • Imunocare (ES);
  • Inmuderm (CO);
  • Ixium (BR);
  • Labimiq (CL);
  • Miquimod (EC);
  • Modik (BR);
  • Perrimod (IL);
  • Quimara (CR, GT, HN, NI, PA, SV);
  • Quimara-1 (MX);
  • Qumara (DO);
  • Vetland (MX);
  • Youbiqing (CN);
  • Zyclara (BE, DE, ES, GB, HR, IE, MT, NL, NO, PL)


For country abbreviations used in Lexicomp (show table)
  1. Abbo L, Vincek V, Dickinson G, Shrestha N, Doblecki S, Haslett PA. Selective defect in plasmacyoid dendritic cell function in a patient with AIDS-associated atypical genital herpes simplex vegetans treated with imiquimod. Clin Infect Dis. 2007;44(3):e25-e27. doi:10.1086/510426 [PubMed 17205432]
  2. Aldara (imiquimod) [prescribing information]. Bridgewater, NJ: Valeant Pharmaceuticals North America LLC; June 2022.
  3. Aldara (imiquimod) [product monograph]. Laval, Quebec, Canada: Valeant Canada LP; December 2013.
  4. Aldara P (imiquimod) [product monograph]. Laval, Quebec, Canada: Bausch Health, Canada Inc; June 2019.
  5. Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319. [PubMed 11487763]
  6. Bichakjian C, Armstrong A, Baum C, et al; Work Group; Invited Reviewers, Kim JYS, Kozlow JH, Mittal B, Moyer J, Olencki T, Rodgers P. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018;78(3):540-559. doi:10.1016/j.jaad.2017.10.006 [PubMed 29331385]
  7. Brummitt CF. Imiquimod 5% cream for the treatment of recurrent, acyclovir-resistant genital herpes. Clin Infect Dis. 2006;42(4):575. doi:10.1086/499529 [PubMed 16421805]
  8. Centers for Disease Control (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm. [PubMed 6810084]
  9. Geisse JK, Rich P, Pandya A, et al, “Imiquimod 5% Cream for the Treatment of Superficial Basal Cell Carcinoma: A Double-Blind, Randomized, Vehicle-Controlled Study,” J Am Acad Dermatol, 2002, 47(3):390-8. [PubMed 12196749]
  10. Goldgeier M, Fox CA, Zavislan JM, et al, “Noninvasive Imaging, Treatment, and Microscopic Confirmation of Clearance of Basal Cell Carcinoma,” Dermatol Surg, 2003, 29(3):205-10. [PubMed 12614409]
  11. Imiquimod cream 5% [prescribing information]. Melville, NY: Fougera Pharmaceuticals Inc; July 2015.
  12. "Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics (AAP) Committee on Drugs. Pediatrics. 1997;99(2):268-278. [PubMed 9024461]
  13. Kim MB, Ko HC, Jang HS, Oh CK, Kwon KS. Treatment of flat warts with 5% imiquimod cream. J Eur Acad Dermatol Venereol. 2006;20(10):1349-1350. [PubMed 17062069]
  14. Oster-Schmidt C, Altmeyer P, and Stucker M, “Successful Treatment of Basal Cell Carcinoma on the Face With Imiquimod 5% Cream,” Acta Derm Venereol, 2002, 82(6):477. [PubMed 12575864]
  15. Perkins N, Nisbet M, Thomas M. Topical imiquimod treatment of aciclovir-resistant herpes simplex disease: case series and literature review. Sex Transm Infect. 2011;87(4):292-295. doi:10.1136/sti.2010.047431 [PubMed 21406577]
  16. Swanson N, Abramovits W, Berman B, et al, “Imiquimod 2.5% and 3.75% for the Treatment of Actinic Keratoses: Results of Two Placebo-Controlled Studies of Daily Application to the Face and Balding Scalp for Two 2-Week Cycles,” J Am Acad Dermatol, 2010, 62(4):582-90. [PubMed 20133013]
  17. Tandon S, Singh J, Sinha S, Sharma DP. Recalcitrant hypertrophic herpes genitalis in HIV-infected patient successfully treated with topical imiquimod. Dermatol Ther. 2017;30(3). doi:10.1111/dth.12479 [PubMed 28261899]
  18. Tyring S, Conant M, Marini M, et al, “Imiquimod; An International Update on Therapeutic Uses in Dermatology,” Int J Dermatol, 2002, 41(11):810-6. [PubMed 12453012]
  19. US Department of Health and Human Services (HHS) Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. http://aidsinfo.nih.gov/contentfiles/lvguidelines/adult_oi.pdf. Accessed June 15, 2020.
  20. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1 [PubMed 34292926]
  21. Vyloma (imiquimod) [product monograph]. Laval, Quebec, Canada: Bausch Health, Canada Inc; June 2019.
  22. Zyclara (imiquimod) [prescribing information]. Bridgewater, NJ: Bausch Health US, LLC; June 2020.
  23. Zyclara (imiquimod) [product monograph]. Laval, Quebec, Canada: Bausch Health, Canada Inc; October 2020.
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