ZYCLARA SIDE EFFECTS
- Generic Name: imiquimod cream
- Brand Name: Zyclara
- Drug Class: Topical Skin Products
SIDE EFFECTS
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Clinical Trials Experience: Actinic Keratosis
The data described below reflect exposure to ZYCLARA Cream or vehicle in 479 subjects enrolled in two double-blind, vehicle-controlled trials. Subjects applied up to two packets of ZYCLARA Cream or vehicle daily to the skin of the affected area (either entire face or balding scalp) for two 2-week treatment cycles separated by a 2-week no treatment period.
Table 1: Selected Adverse Reactions Occurring in ≥ 2% of ZYCLARA-Treated Subjects and at a Greater Frequency than with Vehicle in the Combined Studies (AK)
| Adverse Reactions | ZYCLARA Cream, 3,75% (N=160) |
ZYCLARA Cream, 2.5% (N=160) |
Vehicle (N=159) |
| Headache | 10(6%) | 3 (2%) | 5 (3%) |
| Application site pruritus | 7 (4%) | 6 (4%) | 1 ( < 1%) |
| Fatigue | 7 (4%) | 2 (1%) | 0 |
| Nausea | 6 (4%) | 1 d%) | 2 (1%) |
| Influenza like illness | 1 ( < 1%) | 6 (4%) | 0 |
| Application site irritation | 5 (3%) | 4 (3%) | 0 |
| Pyrexia | 5 (3%) | 0 | 0 |
| Anorexia | 4 (3%) | 0 | 0 |
| Dizziness | 4 (3%) | 1 ( < 1%) | 0 |
| Herpes simplex | 4 (3%) | 0 | 1 ( < 1%) |
| Application site pain | 5 (3%) | 2 (1%) | 0 |
| Lymphade nopat hy | 3 (2%) | 4 (3%) | 0 |
| Oral herpes | 0 | 4 (3%) | 0 |
| Arthralgia | 2 (1%) | 4 (3%) | 0 |
| Cheilitis | 0 | 3 (2%) | 0 |
| Diarrhea | 3 (2%) | 2 (1%) | 0 |
Local skin reactions were recorded as adverse reactions only if they extended beyond the treatment area, if they required any medical intervention, or they resulted in patient discontinuation from the study. The incidence and severity of selected local skin reactions are shown in Table 2.
Table 2: Local Skin Reactions in the Treatment Area in ZYCLARA-Treated Subjects as Assessed by the Investigator (AK)
| All Grades* (%) Severe (%) | ZYCLARA Cream, 3,75% (N=160) |
ZYCLARA Cream, 2,5% (N=160) |
Vehicle (N=159) |
| Erythema* | 96% | 96% | 78% |
| Severe erythema | 25% | 14% | 0% |
| Scabbing/Crusting* | 93% | 84% | 45% |
| Severe scabbing/crusting | 14% | 9% | 0% |
| Edema* | 75% | 63% | 19% |
| Severe edema | 6% | 4% | 0% |
| Erosion/Ulceration* | 62% | 52% | 9% |
| Severe erosion/ulceration | 11% | 9% | 0% |
| Exudate* | 51% | 39% | 4% |
| Severe exudate | 6% | 1% | 0% |
| Flaking/Scaling/Dryness* | 91% | 88% | 77% |
| Severe Flaking/Scaling/Dryness | 8% | 4% | 1% |
| * Mild, moderate or severe | |||
Overall, in the clinical trials, 11% (17/160) of subjects in the ZYCLARA Cream, 3.75% arm, 7% (11/160) of subjects in the ZYCLARA Cream, 2.5% arm, and 0% in the vehicle cream arm required rest periods due to adverse local skin reactions.
Other adverse reactions observed in subjects treated with ZYCLARA Cream include: application site bleeding, application site swelling, chills, dermatitis, herpes zoster, insomnia, lethargy, myalgia, pancytopenia, pruritus, squamous cell carcinoma, and vomiting.
Clinical Trials Experience: External Genital Warts
In two double-blind, placebo-controlled studies 602 subjects applied up to one packet of ZYCLARA Cream or vehicle daily for up to 8 weeks.
The most frequently reported adverse reactions were application site reactions and local skin reactions. Selected adverse reactions are listed in Table 3.
Table 3: Selected Adverse Reactions Occurring in ≥ 2% of ZYCLARA-Treated Subjects and at a Greater Frequency than with Vehicle in the Combined Trials (EGW)
| Preferred Term | ZYCLARA Cream, 3,75% (N=400) |
Vehicle Cream (N=202) |
| Application site pain | 28 (7%) | 1 ( < 1%) |
| Application site irritation | 24 (6%) | 2 (1%) |
| Application site pruritus | 11 (3%) | 2 (1%) |
| Vaginitis bacterial* | 6 (3%) | 2 (2%) |
| Headache | 6 (2%) | 1 ( < 1%) |
| * percentage based on female population of 6/216 for ZYCLARA Cream 3.75% and 2/106 for vehicle cream | ||
Local skin reactions were recorded as adverse reactions only if they extended beyond the treatment area, if they required any medical intervention, or they resulted in patient discontinuation from the study. The incidence and severity of selected local skin reactions are shown in Table 4.
Table 4: Selected Local Skin Reactions in the Treatment Area Assessed by the Investigator (EGW)
| All Grades* (%) Severe (%) | ZYCLARA Cream, 3,75% (N=400) |
Vehicle Cream (N=202) |
| Erythema* | 70% | 27% |
| Severe erythema | 9% | < 1% |
| Edema* | 41% | 8% |
| Severe edema | 2% | 0% |
| Erosion/ulceration* | 36% | 4% |
| Severe erosion/ulceration | 11% | < 1% |
| Exudate* | 34% | 2% |
| Severe exudate | 2% | 0% |
| * Mild, Moderate, or Severe | ||
The frequency and severity of local skin reactions were similar in both genders, with the following exceptions: a) flaking/scaling occurred in 40% of men and in 26% of women and b) scabbing/crusting occurred in 34% of men and in 18% of women.
In the clinical trials, 32% (126/400) of subjects who used ZYCLARA Cream and 2% (4/202) of subjects who used vehicle cream discontinued treatment temporarily (required rest periods) due to adverse local skin reactions, and 1% (3/400) of subjects who used ZYCLARA Cream discontinued treatment permanently due to local skin/application site reactions.
Other adverse reactions reported in subjects treated with ZYCLARA Cream include: rash, back pain, application site rash, application site cellulitis, application site excoriation, application site bleeding, scrotal pain, scrotal erythema, scrotal ulcer, scrotal edema, sinusitis, nausea, pyrexia, and influenza-like symptoms.
Postmarketing Experience
The following adverse reactions have been identified during post-approval use of imiquimod. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Application Site Disorders: tingling at the application site
Body as a Whole: angioedema
Cardiovascular: capillary leak syndrome, cardiac failure, cardiomyopathy, pulmonary edema, arrhythmias (tachycardia, supraventricular tachycardia, atrial fibrillation, palpitations), chest pain, ischemia, myocardial infarction, syncope
Endocrine: thyroiditis
Gastro-Intestinal System Disorders: abdominal pain
Hematological: decreases in red cell, white cell and platelet counts (including idiopathic thrombocytopenic purpura), lymphoma
Hepatic: abnormal liver function
Infections and Infestations: herpes simplex
Musculo-Skeletal System Disorders: arthralgia
Neuropsychiatric: agitation, cerebrovascular accident, convulsions (including febrile convulsions), depression, insomnia, multiple sclerosis aggravation, paresis, suicide
Respiratory: dyspnea
Urinary System Disorders: proteinuria, urinary retention, dysuria
Skin and Appendages: exfoliative dermatitis, erythema multiforme, hyperpigmentation, hypertrophic scar, hypopigmentation
Vascular: Henoch-Schonlein purpura syndrome.
SRC: NLM .