Podophyllotoxin

Sounds like 'poh-DOFF-lo-tox-in'

Overview
Clinicians

Easy-to-read medicine information about podophyllotoxin – what it is, how to use it safely and possible side effects.

Type of medicine	Also called
A plant extract for removing warts	Condyline®

What is podophyllotoxin?

Podophyllotoxin is used to treat external genital warts. It comes as a solution that is applied onto the warts. Podophyllotoxin acts by preventing viral wart cells from dividing and multiplying. Eventually all the wart cells die and new healthy cells grow in their place. It is not recommended for use in women because it is too difficult to apply to the genital area.

Dose

Apply to warts twice daily (in the morning and the evening) for 3 consecutive days. This is then followed by 4 days without treatment. Repeat the treatment every week until the wart is gone or for up to 5 weeks.

How to use podophyllotoxin

Wash the affected area with soap and water, and dry completely before applying the solution.
Podophyllotoxin solution can irritate healthy skin. To avoid this, apply a protective layer of vaseline or zinc ointment on the area around the wart before applying the solution.
Using one of the supplied cotton-tipped applicators, apply solution to just cover each wart. Make sure the treated area is dry before allowing the treated skin to come in contact with normal, untreated skin.
Take care that the solution does not come into contact with the healthy skin. If it does come into contact with healthy skin, flush with water for 15 minutes.
Wash your hands thoroughly after each application.
Always use the solution exactly as your doctor has told you. The pharmacy label on your medicine will tell you how much to use, how often to use it and any special instructions.

Special instructions

Sexual contact is not generally recommended while you are treating genital warts. You should ideally wait until your warts have gone and your skin has healed.
If you do have sex, use a condom, as the warts can be passed to your partner and also the podophyllotoxin can cause irritation for your partner. It is also commonly advised that you use condoms for a time even after the warts have gone.
Take care not to get the solution in your eyes and nostrils or on your lips. If it does come into contact with these areas, flush with water for 15 minutes.
Let your doctor know if you are pregnant, plan to become pregnant or are breastfeeding.
Keep this medicine out of sight and out of reach of children.

Possible side effects

Like all medicines, podophyllotoxin can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Side effects	What should I do?
Skin redness, itching and burning	This is quite common the second or third day of application, but tends to be mild. Tell your doctor if the area starts to bleed or becomes very painful.

Learn more

The following links have more information on podophyllotoxin.

Condyline Medsafe Consumer Information
Podophyllotoxin DermNet NZ

References

Podophyllotoxin New Zealand Formulary
Condyline Medsafe Data sheet
Guidelines for the management of genital, anal and throat HPV infection in New Zealand 9 ed 2017

Credits: Sandra Ponen, Pharmacist. Reviewed By: Angela Lambie, Pharmacist, Auckland Last reviewed: 04 Jul 2018 Page last updated: 06 Feb 2019

Information for clinicians

This section will be of most interest to clinicians (eg, nurses, doctors, pharmacists and specialists).

Key points

Podophyllotoxin is dispensed as a 0.5% solution (CondylineTM). The 0.15% cream is not available in New Zealand. These contain purified podophyllin in a more standardised form. Podophyllotoxin has been extensively studied in randomised and placebocontrolled trials. It is licensed for 4- to 5-week courses and supervision by medical staff is recommended when the lesion area is greater than 4cm2.

Mechanism of action
The active moiety is an antimitotic and causes localised tissue necrosis. Localised epidermal pallor, caused by intracellular oedema, can usually be seen within 48 hours of application.

Suitable for
Men with external warts that can be visualised. May be less effective for keratinised warts. Not for use in women because of difficulty in application.

Contraindications
A history of hypersensitivity (incidence approximately 1%). They are not used in pregnancy or lactation, or in children. Should not be used on warts which cannot be visualised, on internal warts, and they are not recommended for extensive wart areas (>10cm2).

Application
Patients must be able to visualise, identify and reach their warts, and if necessary should be shown what is wart and what is normal skin, using a mirror. Podophyllotoxin solution should be applied carefully to the warts using one of the applicators enclosed with the product, taking care that the solution does not come into contact with healthy skin and allowing drying after application to avoid inadvertent spreading of the solution. Applying Vaseline or zinc ointment on healthy skin around the wart(s) can be protective. The solution should be applied twice daily for 3 consecutive days followed by 4 days rest each week until the warts have resolved, or for a maximum of 5 consecutive weeks.

Side effects
Mild erythema with slight pain and/or superficial ulceration of the treated area can be expected. More severe skin ulceration, erosions, erythema, irritation, scarring, phimosis, pain, burning and soreness can occur. These effects are usually only mild to moderate in severity and resolve when the warts necrose.

Read more Guidelines for the management of genital, anal and throat HPV infection in New Zealand 9ed, 2017

Resources

Resource	Links
New Zealand Formulary	Podophyllotoxin New Zealand Formulary
Medsafe	Condyline Medsafe Data sheet