Podophyllotoxin

Podophyllotoxin binds to tubulin at the colchicine-binding site, inhibiting microtubule assembly and arresting cells in mitosis. However, its semisynthetic derivatives etoposide and teniposide have a completely different mechanism — they inhibit topoisomerase II rather than tubulin. Applied topically for genital warts, podophyllotoxin causes necrosis of condylomata through its antimitotic effect on the rapidly proliferating HPV-infected epithelium.

Adult

Apply twice daily for 3 consecutive days, treatment may be repeated at weekly intervals if necessary for a total of five 3-day treatment courses

Max dose

maximum 50 single applications (‘loops’) per session

• Should not be used on large areas of skin
• broken skin
• sensitive skin
• mucous membranes
• avoid contact with eyes
• avoid contact with inside of ears
• avoid contact with inside of nostrils
• avoid contact with lips
• avoid occlusive dressings on treated area
• Impaired peripheral circulation
• not suitable for application to face
• patients with diabetes at risk of neuropathic ulcers
• significant peripheral neuropathy