What is Podophyllotoxin (Podo)

From the Guidelines

Podophylox is a recommended treatment for external genital and perianal warts caused by human papillomavirus (HPV), with a standard treatment regimen of applying a 0.5% solution or gel twice daily for 3 consecutive days, followed by 4 days without treatment, for up to 4 weeks or until the warts clear 1. The medication works by stopping cell division in the wart tissue, causing the wart cells to die.

Key Considerations

• The total wart area treated should not exceed 10 cm², and the total volume of podofilox should be limited to 0.5 mL per day 1.
• Patients should use a cotton swab or applicator to place a small amount only on the warts, avoiding contact with healthy skin to prevent irritation.
• Side effects commonly include mild burning, pain, inflammation, erosion, and itching at the application site.
• Podophylox should not be used on warts larger than 10 cm², on internal warts, during pregnancy, or on open wounds 1.

Application and Precautions

• Patients should wash their hands thoroughly before and after application and avoid sexual contact while the medication is on the skin.
• If severe irritation occurs, patients should discontinue use and consult their healthcare provider.
• The safety of podofilox during pregnancy has not been established, and its use is not recommended in this context 1.

Alternative Treatments

• Other treatment options for external genital and perianal warts include imiquimod, sinecatechin, and cryotherapy, each with its own set of guidelines and precautions 1.
• The choice of treatment should be based on the individual patient's needs and medical history, as well as the severity and location of the warts.

From the FDA Drug Label

Podofilox Topical Solution is an antimitotic drug which can be chemically synthesized or purified from the plant families Coniferae and Berberidaceae (e.g. species of Juniperus and Podophyllum). Podofilox has a molecular weight of 414.4 daltons, and is soluble in alcohol and sparingly soluble in water. Its chemical name is 5,8,8a,9-Tetrahydro-9-hydroxy-5-(3,4,5-trimethoxylphenyl)furo[3',4':6,7] naphtho[2,3,d]-1,3-dioxol-6(5aH)-one. Data are not available on the safe and effective use of this product for treatment of warts occurring in the perianal area or on mucous membranes of the genital area (including the urethra, rectum and vagina). The main use of Podophylox is as an antimitotic drug for topical administration.

• The chemical composition is 5,8,8a,9-Tetrahydro-9-hydroxy-5-(3,4,5-trimethoxylphenyl)furo[3',4':6,7] naphtho[2,3,d]-1,3-dioxol-6(5aH)-one.
• Safety and effectiveness in pediatric patients have not been established 2 2. Key words: Podophylox, antimitotic drug, topical administration.

From the Research

Podophylox Overview

• Podophylox, also known as podophyllotoxin, is a treatment for genital warts, which are caused by the human papillomavirus (HPV) 3.
• It is available in various formulations, including cream and solution, and can be applied topically or administered by a healthcare professional 4, 5, 6, 7.

Efficacy of Podophylox

• Studies have shown that podophylox is effective in treating genital warts, with response rates ranging from 75% to 93% 4, 5, 6, 7.
• A study comparing podophyllotoxin cream to podophyllin solution found that the cream had a significantly better effect, with a final clearance rate of 71% compared to 48% for the solution 7.
• Another study found that 73.6% of original warts in patients treated with podofilox were gone at the end of treatment, compared to 8.3% in the placebo group 5.

Safety and Side Effects

• Podophylox can cause local adverse reactions, such as inflammation, erosion, pain, and burning, but these are generally mild or moderate and transient 4, 5, 6, 7.
• There were no systemic adverse reactions reported in the studies, suggesting that podophylox is well-tolerated when used as directed 5, 6.

Comparison to Other Treatments

• Podophylox has been compared to other treatments for genital warts, including imiquimod, trichloroacetic acid, and interferon, and has been found to be effective and well-tolerated 3.
• A review of medical and surgical treatments for genital warts found that podophylox and imiquimod are considered first-line topical treatments, while cryotherapy and surgery are considered first-line destructive treatments 3.