IMIQUIMOD: Mechanism of Action An unknown mechanism in treating actinic keratosis and external genital was; immune response modifier, stimulates the release of inflammatory cytokines and proliferation/migration of immune cells No direct antiviral activity Absorption Appears to be dependent on the area of application rather than the amount applied Peak plasma concentration (Aldara): 0.1-3.5 ng/mL Peak plasma concentration (Zyclara): 0.323 ng/mL Elimination Excretion: Urine USES: Actinic Keratosis Indicated for topical treatment of clinically typical, nonhyperkeratotic, nonhyperophic actinic keratoses on the face or scalp in immunocompetent adults Zyclara 2.5% or 3.75%: Apply qDay to the skin of affected area (either entire face or balding scalp) for two 2-week treatment cycles separated by 2-week no-treatment period Aldara 5%: Apply 2 times a week for 16 weeks to one defined treatment area (contiguous area <25 cm2); examples of dosing schedules include Monday and Thursday or Tuesday and Friday Superficial Basal Cell Carcinoma Target tumor should have maximum <2 cm diameter and be located on trunk (excluding anogenital skin), neck, or extremities (excluding hands and feet); treatment area should include 1 cm margin of skin around tumor Aldara 5%: Apply 5 times a week for 6 weeks to biopsy-confirmed superficial basal cell carcinoma and include 1 cm margin of skin around tumor External Genital Was Indicated for the treatment of external genital and perianal was/condyloma acuminata Zyclara 3.75%: Apply a thin film to the entire treatment area and rub in until the cream is no longer visible; may wash with mild soap and water after 8 hours of application; use 1 packet or 1 full actuation of the pump Aldara 5%: Apply 3 times a week until total clearance of was or for a maximum of 16 weeks; examples of application schedules are Monday, Wednesday, Friday or Tuesday, Thursday, Saturday; use 1 packet only for each application Bladder Cancer (Orphan) Orphan designation for the treatment of carcinoma in situ of the urinary bladder. Adverse Effects >10% Application site reaction (33%) UI (15%) Erythema (54-61%) Erosion (29-31%) Excoriation/flaking (18-25%) Edema (12-17%) Itching (20%) 1-10% Sinusitis (7%) Burning (6%) Headache (5%) Carcinoma squamous (4%) Diarrhea (3%) Bleeding (3%) Stinging (3%) Pain (3%) Eczema (2%) Induration (2%) Tenderness (2%) Irritation (2%) Back pain (1%) Fatigue (1%) Atrial fibrillation (1%) REF KD Tripathi 8th ed