|PODOPHYLLUM RESIN (Podophyllin)
Classifications: keratolytic agent; Therapeutic: cytotoxic; keratolytic
Pregnancy Category: C
Podophyllum: 25% liquid
Podofilox: 0.5% gel, solution
Potent cytotoxic and keratolytic agent with caustic action, derived from rhizomes and roots of Podophyllum peltatum (mandrake, May apple). Directly affects epithelial cell metabolism, causing degeneration and arrest of mitosis.
Slow disruption of cells and tissue erosion as a result of its caustic action. Selectively affects embryonic and tumor cells
more than adult cells.
Benign growths including external genital and perianal warts, papillomas, fibroids.
Birthmarks, moles, or warts with hair growth from them; cervical, urethral, oral warts; normal skin and mucous membranes
peripheral to treated areas; pregnancy (category C); diabetes mellitus; patient with poor circulation; irritated, friable,
or bleeding skin; application of drug over large area.
Lactation. Safe use in children is not known.
Route & Dosage
Adult: Topical Use 10% solution and repeat 12 times/wk for up to 4 applications
Verruca Vulgaris (Common Wart)
Adult: Topical Apply 0.5% solution q12h for up to 4 wk
Multiple Superficial Epitheliomatosis, Keratoses
Adult: Topical Apply 0.5% solution or gel daily for several days
Note: Use 1025% solution for areas <10 cm2 or 5% solution for areas of 1020 cm2, anal, or genital warts; apply drug to dry surface, allowing area to dry between drops, wash off after 14 h.
- Avoid podophyllum resin contact with eyes or similar mucosal surfaces; if it occurs, flush thoroughly with lukewarm water
for 15 min and remove film precipitated by the water.
- Avoid application of drug to normal tissue. If it occurs, remove with alcohol. Protect surfaces surrounding area to be treated
with a layer of petrolatum or flexible collodion.
- Remove drug thoroughly with soap and water after each treatment of accessible tissue surface.
- Apply a protective coat of talcum powder after treatment and drying of anogenital area.
- Remove drug with alcohol, if application causes extreme pain, pruritus, or swelling.
- Store in a tight, light-resistant container; avoid exposure to excessive heat.
Adverse Effects (≥1%)Body as a Whole: Severe systemic toxicity
(sometimes fatal), sensorimotor neuropathy (reversible), symptomatic orthostatic hypotension, paresthesias and weakness
of extremities, stocking-glove sensory loss, absent ankle reflexes, decreased response to painful stimuli. CNS:
Lethargy, mental confusion, disorientation, delirium, agitation, seizures, progressive stupor, polyneuritis, pyrexia, coma,
visual and auditory hallucinations, acute psychotic reaction, ataxia, hypotonia, areflexia, increased CSF protein, paralytic
Sinus tachycardia. Hematologic: Bone marrow suppression
similar to that caused by antineoplastic drug toxicity, leukopenia, thrombocytopenia. GI: Nausea, vomiting, diarrhea, abdominal pain,
hepatotoxicity, increased serum concentrations of LDH, AST, and alkaline phosphatase. Urogenital: Renal failure,
urinary retention. Respiratory:
Decreased respirations, apnea,
Assessment & Drug Effects
- Warts become blanched, then necrotic within 2448 h. Sloughing begins after about 72 h with no scarring. Frequently,
a mild topical antiinfective agent, with or without a dressing, is applied until the healing is complete.
- Monitor neurologic status. Sensorimotor polyneuropathy, if it occurs, appears about 2 wk after application of drug, worsens
for 3 mo, and may persist for up to 9 mo. Cerebral effects may persist for 710 d; ataxia, hypotonia, and areflexia
improve more slowly than effects on sensorium.
Patient & Family Education
- Learn proper technique of treatment if self-administered as treatment of verruca vulgaris (common wart). Also be fully aware
of the need to report treatment failure to physician.
- Be aware that as with any STD, the patient's sex partner should be examined.
- Systemic toxicity may be severe and serious and is associated with application of drug to large areas, to tissue that is
friable, bleeding, or recently biopsied, or for prolonged time. Toxicity may occur within hours of application. There are
significant dangers from overuse or misuse of this drug.
- Learn symptoms of toxicity and report any that appear promptly to physician (see ADVERSE EFFECTS).