FDA label 60452b8f-e4ad-4a99-9777-ea1cb9394fc6

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SPL set ID
4fc97f16-2ff6-c8a3-7419-b31fff4f7c5b
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60452b8f-e4ad-4a99-9777-ea1cb9394fc6
Version
8
Effective date
2014-08-19
Source export date
2026-09-28
Source partition
12
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https://download.open.fda.gov/drug/label/drug-label-0012-of-0014.json.zip
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raw/openfda/drug-label/2026-09-28/663999d0fe1757c1e2cd13a4799d76d875f663e0bc57701092264ebe7febfc18/drug-label-0012-of-0014.json.zip
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cd2e66336a5cd2223fa3995098fdbdb84c6a7ee5c0a4addb236ccb22dd1e6887
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20260929T050834Z
Imported at
2026-09-29 06:22:39

Warnings cross-check#

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warnings and cautions

5 WARNINGS AND PRECAUTIONS Intense local inflammatory reactions can occur (e.g., skin weeping, erosion). Dosing interruption may be required. ( 2 , 5.1 , 6 ) Severe local inflammatory reactions of the female external genitalia can lead to severe vulvar swelling. Severe vulvar swelling can lead to urinary retention; dosing should be interrupted or discontinued. ( 5.1 ) Flu-like systemic signs and symptoms including fatigue, nausea, fever, myalgias, arthralgias, and chills can occur. Dosing interruption may be required. ( 2.1 , 2.2 , 5.2 , 6 ) Avoid concomitant use of ZYCLARA Cream and any other imiquimod cream because of increased risk for adverse reactions. ( 5.4 ) 5.1 Local Skin Reactions Intense local skin reactions including skin weeping or erosion can occur after a few applications of ZYCLARA Cream and may require an interruption of dosing [see Dosage and Administration (2) and Adverse Reactions (6) ]. ZYCLARA Cream has the potential to exacerbate inflammatory conditions of the skin, including chronic graft versus host disease. Severe local inflammatory reactions of the female external genitalia can lead to severe vulvar swelling. Severe vulvar swelling can lead to urinary retention. Dosing should be interrupted or discontinued for severe vulvar swelling. Administration of ZYCLARA Cream is not recommended until the skin is healed from any previous drug or surgical treatment. 5.2 Systemic Reactions Flu-like signs and symptoms may accompany, or even precede, local skin reactions and may include fatigue, nausea, fever, myalgias, arthralgias, malaise and chills. An interruption of dosing and an assessment of the patient should be considered [see Adverse Reactions (6) ]. Lymphadenopathy occurred in 2% of subjects with actinic keratosis treated with ZYCLARA Cream, 3.75% and in 3% of subjects treated with ZYCLARA Cream, 2.5% [see Adverse Reactions (6)] . This reaction resolved in all subjects by 4 weeks after completion of treatment. 5.3 Ultraviolet Light Exposure Risks Exposure to sunlight (including sunlamps) should be avoided or minimized during use of ZYCLARA Cream. Patients should be warned to use protective clothing (e.g., a hat) when using ZYCLARA Cream. Patients with sunburn should be advised not to use ZYCLARA Cream until fully recovered. Patients who may have considerable sun exposure, e.g. due to their occupation, and those patients with inherent sensitivity to sunlight should exercise caution when using ZYCLARA Cream. In an animal photo-carcinogenicity study, imiquimod cream shortened the time to skin tumor formation [see Nonclinical Toxicology (13.1) ] . The enhancement of ultraviolet carcinogenicity is not necessarily dependent on phototoxic mechanisms. Therefore, patients should minimize or avoid natural or artificial sunlight exposure. 5.4 Increased Risk of Adverse Reactions with Concomitant Imiquimod Use Concomitant use of ZYCLARA and any other imiquimod products, in the same treatment area, should be avoided since they contain the same active ingredient (imiquimod) and may increase the risk for and severity of local skin reactions. The safety of concomitant use of ZYCLARA Cream and any other imiquimod products has not been established and should be avoided since they contain the same active ingredient (imiquimod) and may increase the risk for and severity of systemic reactions. 5.5 Immune Cell Activation in Autoimmune Disease ZYCLARA Cream should be used with caution in patients with pre-existing autoimmune conditions because imiquimod activates immune cells [see Clinical Pharmacology (12.2) ].

Adverse reactions cross-check#

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adverse reactions

6 ADVERSE REACTIONS 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. Most common adverse reactions (>4%) are local skin reactions (erythema, edema, erosion/ulceration, exudate, scabbing/crusting), headache, application site pain, application site irritation, application site pruritus, fatigue, influenza-like illness, and nausea. ( 6.1 , 6.2 ) To report SUSPECTED ADVERSE REACTIONS, contact Graceway Pharmaceuticals, LLC at 1-800-328-0255 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch. 6.1 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 (1%) 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 Lymphadenopathy 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) * All Grades: mild, moderate or severe Erythema Severe erythema 96% 25% 96% 14% 78% 0% Scabbing/Crusting Severe scabbing/crusting 93% 14% 84% 9% 45% 0% Edema Severe edema 75% 6% 63% 4% 19% 0% Erosion/Ulceration Severe erosion/ulceration 62% 11% 52% 9% 9% 0% Exudate Severe exudate 51% 6% 39% 1% 4% 0% Flaking/Scaling/Dryness Severe Flaking/Scaling/Dryness 91% 8% 88% 4% 77% 1% 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. 6.2 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) * percentage based on female population of 6/216 for ZYCLARA Cream 3.75% and 2/106 for vehicle cream 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%) 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) *Mild, Moderate, or Severe Erythema* Severe erythema 70% 9% 27% <1% Edema* Severe edema 41% 2% 8% 0% Erosion/ulceration* Severe erosion/ulceration 36% 11% 4% <1% Exudate* Severe exudate 34% 2% 2% 0% 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. 6.3 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.

adverse reactions table

<table ID="_RefID0EAPAE" cellpadding="0pt" width="100%"> <caption>Table 1: Selected Adverse Reactions Occurring in &#x2265; 2% of ZYCLARA-Treated Subjects and at a Greater Frequency than with Vehicle in the Combined Studies (AK)</caption> <col width="25%"/> <col width="25%"/> <col width="25%"/> <col width="25%"/> <thead> <tr> <th align="left" styleCode="Botrule Toprule " valign="top"> <content styleCode="bold">Adverse Reactions</content> </th> <th align="center" styleCode="Botrule Toprule " valign="top"> <content styleCode="bold">ZYCLARA Cream, 3.75% (N=160)</content> </th> <th align="center" styleCode="Botrule Toprule " valign="top"> <content styleCode="bold">ZYCLARA Cream, 2.5% (N=160)</content> </th> <th align="center" styleCode="Botrule Toprule " valign="top"> <content styleCode="bold">Vehicle (N=159)</content> </th> </tr> </thead> <tbody> <tr> <td styleCode="Toprule "> <paragraph>Headache</paragraph> </td> <td align="center" styleCode="Toprule "> <paragraph>10 (6%)</paragraph> </td> <td align="center" styleCode="Toprule "> <paragraph>3 (2%)</paragraph> </td> <td align="center" styleCode="Toprule "> <paragraph>5 (3%)</paragraph> </td> </tr> <tr> <td> <paragraph>Application site pruritus</paragraph> </td> <td align="center"> <paragraph>7 (4%)</paragraph> </td> <td align="center"> <paragraph>6 (4%)</paragraph> </td> <td align="center"> <paragraph>1 (&lt;1%)</paragraph> </td> </tr> <tr> <td> <paragraph>Fatigue</paragraph> </td> <td align="center"> <paragraph>7 (4%)</paragraph> </td> <td align="center"> <paragraph>2 (1%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> </tr> <tr> <td> <paragraph>Nausea</paragraph> </td> <td align="center"> <paragraph>6 (4%)</paragraph> </td> <td align="center"> <paragraph>1 (1%)</paragraph> </td> <td align="center"> <paragraph>2 (1%)</paragraph> </td> </tr> <tr> <td> <paragraph>Influenza like illness</paragraph> </td> <td align="center"> <paragraph>1 (&lt;1%)</paragraph> </td> <td align="center"> <paragraph>6 (4%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> </tr> <tr> <td> <paragraph>Application site irritation</paragraph> </td> <td align="center"> <paragraph>5 (3%)</paragraph> </td> <td align="center"> <paragraph>4 (3%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> </tr> <tr> <td> <paragraph>Pyrexia</paragraph> </td> <td align="center"> <paragraph>5 (3%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> </tr> <tr> <td> <paragraph>Anorexia</paragraph> </td> <td align="center"> <paragraph>4 (3%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> </tr> <tr> <td> <paragraph>Dizziness</paragraph> </td> <td align="center"> <paragraph>4 (3%)</paragraph> </td> <td align="center"> <paragraph>1 (&lt;1%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> </tr> <tr> <td> <paragraph>Herpes simplex</paragraph> </td> <td align="center"> <paragraph>4 (3%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> <td align="center"> <paragraph>1 (&lt;1%)</paragraph> </td> </tr> <tr> <td> <paragraph>Application site pain</paragraph> </td> <td align="center"> <paragraph>5 (3%)</paragraph> </td> <td align="center"> <paragraph>2 (1%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> </tr> <tr> <td> <paragraph>Lymphadenopathy</paragraph> </td> <td align="center"> <paragraph>3 (2%)</paragraph> </td> <td align="center"> <paragraph>4 (3%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> </tr> <tr> <td> <paragraph>Oral herpes</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> <td align="center"> <paragraph>4 (3%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> </tr> <tr> <td> <paragraph>Arthralgia</paragraph> </td> <td align="center"> <paragraph>2 (1%)</paragraph> </td> <td align="center"> <paragraph>4 (3%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> </tr> <tr> <td> <paragraph>Cheilitis</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> <td align="center"> <paragraph>3 (2%)</paragraph> </td> <td align="center"> <paragraph>0</paragraph> </td> </tr> <tr> <td styleCode="Botrule "> <paragraph>Diarrhea</paragraph> </td> <td align="center" styleCode="Botrule "> <paragraph>3 (2%)</paragraph> </td> <td align="center" styleCode="Botrule "> <paragraph>2 (1%)</paragraph> </td> <td align="center" styleCode="Botrule "> <paragraph>0</paragraph> </td> </tr> </tbody> </table>

adverse reactions table

<table ID="_RefID0EXTAE" cellpadding="0pt" width="100%"> <caption>Table 2: Local Skin Reactions in the Treatment Area in ZYCLARA-Treated Subjects as Assessed by the Investigator (AK)</caption> <col width="25%"/> <col width="25%"/> <col width="25%"/> <col width="25%"/> <thead> <tr> <th align="left" styleCode="Botrule Toprule " valign="top"> <content styleCode="bold">All Grades* (%)Severe</content> </th> <th align="center" styleCode="Botrule Toprule " valign="top"> <content styleCode="bold">ZYCLARA Cream 3.75% (N=160)</content> </th> <th align="center" styleCode="Botrule Toprule " valign="top"> <content styleCode="bold">ZYCLARA Cream 2.5% (N=160)</content> </th> <th align="center" styleCode="Botrule Toprule " valign="top"> <content styleCode="bold">Vehicle (N=159)</content> </th> </tr> </thead> <tfoot> <tr> <td align="left" colspan="8" styleCode="Botrule" valign="top">* All Grades: mild, moderate or severe</td> </tr> </tfoot> <tbody> <tr> <td styleCode="Toprule "> <paragraph>Erythema </paragraph> <paragraph> Severe erythema</paragraph> </td> <td align="center" styleCode="Toprule "> <paragraph>96%</paragraph> <paragraph> 25%</paragraph> </td> <td align="center" styleCode="Toprule "> <paragraph>96%</paragraph> <paragraph> 14%</paragraph> </td> <td align="center" styleCode="Toprule "> <paragraph>78%</paragraph> <paragraph> 0%</paragraph> </td> </tr> <tr> <td> <paragraph>Scabbing/Crusting</paragraph> <paragraph> Severe scabbing/crusting</paragraph> </td> <td align="center"> <paragraph>93%</paragraph> <paragraph>14%</paragraph> </td> <td align="center"> <paragraph>84%</paragraph> <paragraph> 9%</paragraph> </td> <td align="center"> <paragraph>45%</paragraph> <paragraph> 0%</paragraph> </td> </tr> <tr> <td> <paragraph>Edema</paragraph> <paragraph> Severe edema</paragraph> </td> <td align="center"> <paragraph>75%</paragraph> <paragraph> 6%</paragraph> </td> <td align="center"> <paragraph>63%</paragraph> <paragraph> 4%</paragraph> </td> <td align="center"> <paragraph>19%</paragraph> <paragraph> 0%</paragraph> </td> </tr> <tr> <td> <paragraph>Erosion/Ulceration</paragraph> <paragraph> Severe erosion/ulceration</paragraph> </td> <td align="center"> <paragraph>62%</paragraph> <paragraph> 11%</paragraph> </td> <td align="center"> <paragraph>52%</paragraph> <paragraph> 9%</paragraph> </td> <td align="center"> <paragraph>9%</paragraph> <paragraph> 0%</paragraph> </td> </tr> <tr> <td> <paragraph>Exudate</paragraph> <paragraph> Severe exudate</paragraph> </td> <td align="center"> <paragraph>51%</paragraph> <paragraph> 6%</paragraph> </td> <td align="center"> <paragraph>39%</paragraph> <paragraph> 1%</paragraph> </td> <td align="center"> <paragraph>4%</paragraph> <paragraph> 0%</paragraph> </td> </tr> <tr> <td styleCode="Botrule "> <paragraph>Flaking/Scaling/Dryness</paragraph> <paragraph> Severe Flaking/Scaling/Dryness</paragraph> </td> <td align="center" styleCode="Botrule "> <paragraph>91%</paragraph> <paragraph> 8%</paragraph> </td> <td align="center" styleCode="Botrule "> <paragraph>88%</paragraph> <paragraph> 4%</paragraph> </td> <td align="center" styleCode="Botrule "> <paragraph>77%</paragraph> <paragraph> 1%</paragraph> </td> </tr> </tbody> </table>

adverse reactions table

<table ID="_RefID0EDYAE" cellpadding="0pt" width="100%"> <caption>Table 3: Selected Adverse Reactions Occurring in &#x2265;2% of ZYCLARA Treated Subjects and at a Greater Frequency than with Vehicle in the Combined Trials (EGW)</caption> <col width="33%"/> <col width="33%"/> <col width="33%"/> <thead> <tr> <th align="left" styleCode="Botrule Toprule " valign="top"> <content styleCode="bold">Preferred Term</content> </th> <th align="center" styleCode="Botrule Toprule " valign="top"> <content styleCode="bold">ZYCLARA Cream, 3.75%</content> <content styleCode="bold">(N=400)</content> </th> <th align="center" styleCode="Botrule Toprule " valign="top"> <content styleCode="bold">Vehicle Cream</content> <content styleCode="bold">(N=202)</content> </th> </tr> </thead> <tfoot> <tr> <td align="left" colspan="3" styleCode="Botrule" valign="top"> <content styleCode="bold">*</content> percentage based on female population of 6/216 for ZYCLARA Cream 3.75% and 2/106 for vehicle cream</td> </tr> </tfoot> <tbody> <tr> <td styleCode="Toprule "> <paragraph>Application site pain</paragraph> </td> <td align="center" styleCode="Toprule "> <paragraph>28 (7%)</paragraph> </td> <td align="center" styleCode="Toprule "> <paragraph>1 (&lt;1%)</paragraph> </td> </tr> <tr> <td> <paragraph>Application site irritation</paragraph> </td> <td align="center"> <paragraph>24 (6%)</paragraph> </td> <td align="center"> <paragraph>2 (1%)</paragraph> </td> </tr> <tr> <td> <paragraph>Application site pruritus</paragraph> </td> <td align="center"> <paragraph>11 (3%)</paragraph> </td> <td align="center"> <paragraph>2 (1%)</paragraph> </td> </tr> <tr> <td> <paragraph>Vaginitis bacterial*</paragraph> </td> <td align="center"> <paragraph>6 (3%)</paragraph> </td> <td align="center"> <paragraph>2 (2%)</paragraph> </td> </tr> <tr> <td styleCode="Botrule "> <paragraph>Headache</paragraph> </td> <td align="center" styleCode="Botrule "> <paragraph>6 (2%)</paragraph> </td> <td align="center" styleCode="Botrule "> <paragraph>1 (&lt;1%)</paragraph> </td> </tr> </tbody> </table>

Reported adverse events (FAERS/openFDA)#

Adverse event summaries are temporarily unavailable. Other product information remains available.