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What Is Hydroquinone? Uses, Side Effects, Dosage & FAQs

by Mariah Powers
written by Mariah Powers
The Wellness Collective

What to Know About Hydroquinone

Reviewed by Ashley Robinson, PharmD, Pharmacy Manager for TelyRx

Hydroquinone cream via TelyRx

Table of Contents

Hydroquinone is a topical prescription medication that lightens dark spots (hyperpigmentation) caused by a range of conditions, including melasma (“mask of pregnancy”), age or liver spots, acne scars, eczema, or hormonal treatments.

Hydroquinone comes in cream and liquid forms, and is applied topically to the affected areas of the skin. Common hydroquinone side effects include skin irritation, redness, dryness, stinging, or cracking.

How Does Hydroquinone Work?

As a depigmenting agent, hydroquinone works by decreasing the amount of melanin in the skin. Melanin is the natural pigment your body produces that gives your skin its distinct color. Using hydroquinone with other sun protection, such as sunscreen, can help dark spots fade away with time.

Drug Facts

Common Brands Obagi-C, Melquin HP
Drug Class Skin-lightening agent
Generic Status Generic for Melquin HP
Availability Prescription only

Dosing

Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs.

Hydroquinone is typically applied to the affected areas of the skin twice daily, or exactly as directed by your healthcare provider. 

  • Wash and dry the skin first. It’s recommended to wash and dry your hands thoroughly before and after applying the medication. Ensure the skin is completely clean and dry before application.
  • Apply to the affected area. Apply just enough hydroquinone to cover the affected area with a thin layer. Rub the medication in gently but completely.
  • Avoid sensitive areas. Hydroquinone should not be applied near or inside the eyes, mouth, or nose. If accidental contact occurs, wash the area thoroughly with large amounts of water.
  • Time other topical medications. If you are using other skin medications, it may be recommended to apply them at different times of the day to avoid potential irritation or interaction with hydroquinone.

Always follow your healthcare provider’s instructions for exact dosing.

FDA-Approved Uses

Hydroquinone is FDA-approved to lighten dark spots (hyperpigmentation) caused by a range of conditions, including melasma, age or liver spots, acne scars, eczema, or hormonal treatments.

Common Off-Label Uses

To date, there are no commonly known off-label uses.

Side Effects

Like all medications, hydroquinone can cause side effects. Common side effects are typically localized to the area where the cream is applied. These effects may improve over time as your body adjusts to the medication. Other side effects may be serious and require medical attention.

Common Side Effects

  • Skin dryness
  • Skin redness
  • Stinging or burning sensation
  • Mild skin irritation
  • Cracking or peeling skin

Serious Side Effects

Serious side effects are rare, but it’s important to know what to look for if they do occur. Stop using hydroquinone and call your doctor immediately if you experience: 

  • Severe allergic reactions: Symptoms include swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; severe rash or itching; and/or fever.
  • Darkening of the skin (exogenous ochronosis): This is a rare condition characterized by a gradual blue-black darkening of the skin. This risk is higher in Black people, but it can occur in Hispanic and Caucasian people as well.
  • Severe skin irritation (contact dermatitis):  While hydroquinone can cause mild contact dermatitis, severe reactions can also occur, such as severe blistering, crusting, burning, or swelling of the treated skin.

Call your doctor immediately if you experience any concerning or prolonged symptoms.
Starting at $42.99

Hydroquinone

Hydroquinone is a prescription-strength skin lightening cream used to fade hyperpigmentation such as dark spots, age spots, and acne scars. Considered the gold standard for treating melasma, it works by blocking melanin production to even out skin tone over 3 to 6 months of use.

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Pharmacist Tips

  • Perform a patch test. Before using hydroquinone for the first time, it is recommended to apply a small amount to an unbroken spot of skin. Wait 24 hours to check for severe reactions such as blistering or extreme itching. If only minor redness or itching occurs, it is generally considered safe to proceed.
  • Use sun protection. When using hydroquinone, it is recommended to use sunscreen with an SPF of 30 or higher, wear protective clothing to cover the treated skin, and avoid sunlamps and tanning beds. Even a small amount of sunlight can darken the treated area again, reversing the effects of the medication.
  • Store it at room temperature. Hydroquinone should be stored at room temperature between 68°F and 77°F (20°C and 25°C), although it can be temporarily exposed to lower temperatures if needed (such as transportation). Keep it in a cool, dry place and ensure the container is tightly closed.
  • Monitor your progress. If you do not see any improvement after two months of treatment with the cream (or three months with the solution), consult your healthcare provider.

Drug Interactions

Hydroquinone can interact with other medications, potentially altering their effectiveness or increasing the risk of side effects. For example:

  • Benzoyl peroxide: This topical acne treatment may interact with hydroquinone and should not be used at the same time.
  • Photosensitizing medications: If you are taking other medications that increase sensitivity to sunlight — such as doxycycline, methotrexate, or tretinoin (Retin-A) — extra care is required to protect your skin from UV exposure.
  • Other topicals: Before starting hydroquinone, ask your healthcare provider if it is safe to combine it with your current prescription or over-the-counter creams, lotions, or supplements.

Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.

FAQs

How long does it take to see results from hydroquinone? 

While individual results vary, people typically apply the cream twice daily. It generally takes a few months of consistent daily use to begin showing significant results. If no improvement is observed after two months of cream use or three months of solution use, talk to your healthcare provider.

Why is it important to take a break or “cycle” off hydroquinone? 

If improvement isn’t seen within 2-3 months, your provider may recommend stopping as long-term use may increase the risk of blue-black darkening of the skin (exogenous ochronosis).

Can I use hydroquinone if I am pregnant or breastfeeding? 

It is currently unknown if hydroquinone affects pregnancy or causes fetal harm. It is also not known if the drug passes into breast milk. Before using hydroquinone, tell your healthcare provider if you are pregnant, planning to become pregnant, or breastfeeding so they can advise you on whether it is safe for you.

Why did my hydroquinone cream turn brown, and is it still safe to use? 

Any change in the product’s appearance or packaging should be reported to your pharmacist immediately.

Can I use hydroquinone during the day, or only at night? 

Hydroquinone is typically applied twice daily. Daily sun protection is strongly recommended when using hydroquinone, such as using a sunscreen with a SPF of 30 or higher and wearing protective clothing.  

Why does my skin look darker or redder after starting hydroquinone? 

Mild skin irritation, redness, and stinging are common side effects of hydroquinone. However, if you experience a blue-black darkening of the skin, it could be a serious condition called exogenous ochronosis. If this occurs, stop using the product and contact your provider. Also, not using sunscreen can cause dark spots to reappear or worsen when exposed to sunlight.

Can I use retinol or tretinoin at the same time as hydroquinone? 

Tretinoin (Retin-A) is a medication that makes you more sensitive to sunlight. If you are using hydroquinone with other medications like tretinoin, you may need to take extra care to protect your skin, such as wearing protective clothing, using sunscreen with a SPF of 30 or higher, and avoiding sunlight or tanning beds. Ask your healthcare provider if it is safe to combine these specific products in your routine.

Is hydroquinone safe for darker skin tones? 

Hydroquinone can be used on various skin tones, but the risk of exogenous ochronosis (gradual blue-black darkening) is noted to be higher in Black people, although it can occur in other races as well. If you notice this discoloration, stop using hydroquinone and contact your healthcare provider immediately.

Can I use benzoyl peroxide with hydroquinone? 

Interactions can occur when hydroquinone is used with benzoyl peroxide. Ask your healthcare provider before combining these acne treatments.

Does hydroquinone permanently lighten skin? 

No. Hydroquinone works by decreasing the amount of melanin your body makes. It temporarily blocks the body from making this pigment. If you stop using it or expose the skin to sunlight without protection, dark spots can reappear.

Can I put hydroquinone on my entire face or just the dark spots? 

It’s recommended to apply just enough hydroquinone to cover the affected area. The medication is used to bleach skin areas that are darkened, rather than for whole-face lightening. Avoid applying it to sensitive areas like the eyes, mouth, nose, or lips.

What SPF sunscreen is required while using hydroquinone? 

It’s recommended to use a sunscreen with a SPF of 30 or higher when using hydroquinone, even on cloudy days.

Can I use vitamin C serum with hydroquinone? 

Vitamin C (ascorbic acid) is not known to interact with hydroquinone. However, it’s best to tell your provider about all vitamins, supplements, and topicals you are using to check for potential interactions before using hydroquinone.

Compare Medications

Compared: Hydroquinone, Thiamidol, Azelaic Acid (Finacea, Azelex), Tretinoin (Retin-A), or Tri-Luma?

There are several medications that your doctor can prescribe in place of Hydroquinone. Here are a few possible alternatives below.

  • Thiamidol: A depigmenting agent that is used to lighten dark spots caused by acne, sun damage, age, and mask of pregnancy (melasma).
  • Azelaic acid (Finacea, Azelex): A topical acne treatment that is FDA-approved to treat mild to moderate acne and rosacea.
  • Tretinoin (Retin-A): A topical treatment used to treat acne, hyperpigmentation, and sun damage along with sunscreen, similar to hydroquinone.
  • Tri-Luma: A topical cream that is FDA-approved to treat moderate to severe melasma (mask of pregnancy).
Disclaimer

Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions.

Prescription medications made easy with TelyRx.

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Medications

What Is Spironolactone? Uses, Side Effects, Dosage & FAQs

by Mariah Powers
written by Mariah Powers
The Wellness Collective

What to Know About Spironolactone

Reviewed by Ashley Robinson, PharmD, Pharmacy Manager for TelyRx

Spironolactone tablets via TelyRx.

Table of Contents

Spironolactone (brand names Aldactone, CaroSpir) is a prescription medication that is used to lower blood pressure (hypertension), treat heart failure, and reduce fluid build up in people with liver disease (cirrhosis) or kidney disease (nephrotic syndrome). It is also prescribed to treat hyperaldosteronism.

Spironolactone comes in oral tablet and liquid forms. Common side effects include breast tenderness, dizziness, and high potassium levels (hyperkalemia).

how does Spironolactone work?

Spironolactone is a diuretic, or “water pill,” that works by blocking a specific hormone in the body called aldosterone. Aldosterone is responsible for making the body retain sodium and water, which can lead to increased blood pressure and fluid buildup. As an aldosterone antagonist, spironolactone blocks this hormone and signals the kidneys to release extra water and sodium through the urine. This can reduce the volume of fluid in blood vessels, lowering blood pressure and reducing the workload on the heart.

Unlike other types of diuretics that cause the body to lose potassium along with fluids, spironolactone is a potassium-sparing diuretic. Even though it makes you urinate more often to remove excess fluid, it helps the body retain potassium in the process, preventing your levels from dropping too low. 

Spironolactone also possesses anti-androgen activity and blocks male sex hormones such as testosterone. It may be prescribed off-label to treat hormonal conditions in women related to higher testosterone levels, such as moderate to severe acne or hirsutism (increased facial and body hair growth) associated with polycystic ovary syndrome (PCOS).

drug facts

Common Brands Aldactone, CaroSpir
Drug Class Potassium-sparing diuretic/Aldosterone antagonist
Generic Status Generic version of Aldactone
Availability Prescription Only

dosing

Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. 

Spironolactone is available in different forms, including oral tablets and oral suspensions (liquids). The tablets are available in dosage strengths of 25 mg, 50 mg, and 100 mg, while the oral suspension comes in a 25 mg/5 mL strength. Spironolactone tablets (Aldactone) and the oral suspension (CaroSpir) are not the same and cannot be substituted for one another.

Spironolactone dosing can depend on the condition it’s prescribed to treat.

  • High Blood Pressure (Hypertension) – The recommended starting dosage range is 25 mg to 100 mg taken daily by mouth. This may be taken as a single dose or divided into separate doses throughout the day. The oral suspension form may have different dosing requirements, typically ranging from 20 mg to 75 mg daily, also in single or divided doses.
  • Heart Failure – The recommended starting dose of 25 mg taken once daily by mouth. Based on your response and potassium levels, your healthcare provider may either increase the dosage to 50 mg daily or change it to 25 mg every other day.
  • Edema (Swelling Related to Liver or Kidney Disease) – The recommended starting dose may be 100 mg taken daily by mouth, which may be in single or divided doses. As needed, the maintenance dose may be adjusted and range from 25 mg to 200 mg daily.
  • Hyperaldosteronism – The recommended dose is 100 mg to 400 mg taken daily by mouth in preparation for surgery.
  • Hormonal Acne and Hirsutism (Off-Label) – Dosing may range from 25 mg to 100 mg taken daily by mouth, in single or divided doses.

FDA-approved uses

Spironolactone is FDA-approved for:

    • Heart Failure
    • High Blood Pressure (Hypertension)
    • Edema (Swelling) Caused by Liver Cirrhosis or Nephrotic Syndrome
    • Primary Hyperaldosteronism

common off-label uses

You may see spironolactone prescribed for uses that are not “FDA-approved.” This is a very common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.

Healthcare providers may prescribe spironolactone off-label to help treat moderate to severe acne in females. Due to its anti-androgen activity, it is not recommended for treating acne in males. Spironolactone may also be prescribed off-label to treat excess facial and body hair growth (hirsutism) in females with PCOS.

side effects

Like all medications, Spironolactone can cause side effects. Common side effects may improve as your body adjusts to the medication, but others may be serious and require medical attention.

Common Side Effects

  • Dizziness
  • Stomach upset
  • Breast pain or tenderness
  • Increased urination
  • Low blood pressure
  • High potassium levels
  • Irregular periods in women
  • Enlarged breast growth (gynecomastia) in males
  • Reduced sex drive in males
  • Headache
  • Drowsiness
  • Nausea 
  • Vomiting
  • Diarrhea
  • Leg or stomach cramps

Serious Side Effects

Serious side effects are rare, but it’s important to know what to look for if they do occur. Stop using spironolactone and call your doctor immediately if you experience: 

  • High Potassium Levels (Hyperkalemia) – If untreated, this can be fatal. Symptoms include muscle weakness, difficulty breathing, slow or irregular heartbeat, nausea, vomiting, and numbness or tingling sensations.
  • Electrolyte Imbalances – Beyond potassium, spironolactone may also cause low sodium, magnesium, calcium, or chloride levels. Symptoms include weakness, muscle cramps, constipation, nausea, vomiting, confusion, difficulty breathing, fainting, seizure, or irregular heartbeats.
  • Low Blood Pressure and Worsening Kidney Function – Fluid loss from spironolactone can lead to dehydration and dangerously low blood pressure. Signs may include feeling faint or dizzy when standing up, decrease in the amount of urine, dark or strong-smelling urine, weakness or fatigue, dry mouth, and headache.
  • Severe Allergic Reactions – Symptoms include swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; severe rash or itching; fever.

Call your doctor immediately if you experience any concerning or prolonged symptoms.
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Spironolactone

Spironolactone may be used to treat moderate to severe acne in females.

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pharmacist tips

  1. Missed Doses – If a dose is missed, take it as soon as you remember, unless it’s almost time for your next dose. In that case, skip the missed dose and take your next dose as usual. Do not double up on doses of spironolactone.
  2. Stay Consistent – You can take spironolactone with or without food, but it is recommended to take it the same way every time (e.g., always with food or always without).
  3. Take It in the Morning or Afternoon – Because spironolactone is a diuretic, it will make you urinate more often. To avoid waking up in the middle of the night to use the restroom, try taking your dose in the morning or afternoon.
  4. Watch Your Potassium Intake – Avoid eating foods high in potassium, such as bananas, nuts, certain leafy greens, and salt substitutes containing potassium. Spironolactone increases potassium levels in the blood, and adding more through your diet can be dangerous.
  5. Manage Dizziness – Spironolactone can cause dizziness and lightheadedness, so it may be recommended to avoid alcohol while taking it. Be careful when getting up from a seated or lying position to avoid falling.
  6. Keep Up With Bloodwork – Your healthcare provider may recommend regular blood testing to ensure the medication is not affecting your kidneys or electrolyte levels.
  7. Liquid Formulations – If you are prescribed the liquid form of spironolactone, shake the bottle well before each use and use the included measuring cup to take an accurate dose.

drug interactions

Spironolactone can interact with other medications, potentially altering their effectiveness or increasing the risk of side effects. For example:

    • NSAIDs Pain Relievers – Nonsteroidal anti-inflammatory drugs like ibuprofen (Advil), acetylsalicylic acid (Aspirin), naproxen (Aleve) can interact with spironolactone and potentially affect kidney function and blood pressure.
    • Blood Pressure & Heart Medications – ACE inhibitors (e.g., lisinopril, benazepril) and Angiotensin Receptor Blockers (ARBs) (e.g., losartan) can increase the risk of high potassium and kidney issues when taken with spironolactone.
    • Potassium Supplements – Taking potassium pills or using salt substitutes containing potassium while on spironolactone can lead to dangerously high potassium levels.
    • Abiraterone – Spironolactone may interact with this hormone medication used for prostate cancer. 
    • Lithium – Spironolactone may interact with lithium, a medication used for depression.
    • Digoxin – Spironolactone may interfere with digoxin, a heart failure medication.
    • Diuretics – Combining spironolactone with other “water pills” can increase dehydration risks.
    • Cholestyramine – Taking spironolactone with this cholesterol medication may raise potassium levels in the blood.

Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.

FAQs

How long does it take for spironolactone to clear hormonal acne? 

While spironolactone is not FDA-approved for acne, when prescribed off-label, it may take anywhere from a few weeks to a few months for skin to become less oily and prone to breakouts. 

Does spironolactone cause you to pee more often? 

Yes. Spironolactone is a diuretic, or “water pill,” meaning it helps your body get rid of extra fluids. This naturally leads to an increased need to urinate.

Is spironolactone used for hair loss or hair growth? 

Spironolactone may be prescribed off-label to limit hair growth in women with hirsutism (excess facial and body hair) since it lowers testosterone levels. However, hair loss has been reported as a potential side effect of spironolactone.

Does spironolactone cause weight loss? 

People taking spironolactone did not report weight gain as a side effect in clinical studies. Because it removes excess fluid from the body, some patients might experience a reduction in water weight, but spironolactone is not a weight loss drug.

Can I drink alcohol while taking spironolactone? 

It is generally recommended to avoid or limit drinking alcohol when taking spironolactone. Alcohol is also a diuretic, which can increase the risk of dehydration and side effects like dizziness.

Is it better to take spironolactone in the morning or at night? 

Providers may recommend taking spironolactone in the morning or afternoon. Taking it too close to bedtime may cause you to wake up frequently to urinate, disrupting your sleep.

Does spironolactone affect my menstrual cycle or cause irregular periods? 

Yes, irregular menstrual cycles or spotting are known side effects of spironolactone. Some women may experience a lack of periods altogether.

Can I take ibuprofen or naproxen with spironolactone? 

You should discuss this with your healthcare provider. NSAIDs like ibuprofen and naproxen can interact with spironolactone, potentially affecting the kidneys and blood pressure levels.

Is spironolactone safe to take during pregnancy? 

Spironolactone is generally not recommended for people who are pregnant, as a limited number of studies suggest it can cause harm to a developing baby. If you are planning to become pregnant, talk with your provider before starting spironolactone.

Can spironolactone help with PCOS (Polycystic Ovary Syndrome) symptoms? 

While spironolactone is not FDA-approved to treat PCOS, it may be prescribed off-label to help with symptoms often associated with the condition, such as hormonal acne and hirsutism (excess body hair) in women.

Is spironolactone a steroid? 

Spironolactone has the chemical structure of a steroid, but it’s classified as a potassium-sparing diuretic (“water pill”) and an aldosterone antagonist.

compare medications

Compared: Spironolactone, Amiloride, Isotretinoin, Doxycycline/Minocycline, Furosemide, or Minoxidil?

There are several medications that your doctor can prescribe in place of spironolactone. Here are a few possible alternatives below.

  • Amiloride – Another potassium-sparing diuretic that treats high blood pressure and heart failure.
  • Furosemide (Lasix) – A diuretic used to treat high blood pressure and swelling (edema) related to heart failure, or liver or kidney problems.
  • Lisinopril – An Angiotensin-Converting Enzyme (ACE) inhibitor that is used to treat high blood pressure and heart failure, and lower the risk of death after a heart attack.
  • Isotretinoin – A prescription medication for severe acne.
  • Doxycycline/Minocycline -T A tetracycline antibiotics that treats a variety of bacterial infections and acne.
  • Minoxidil – An oral medication that treats high blood pressure or a topical that promotes hair regrowth caused by alopecia (male or female pattern baldness)
Disclaimer

Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions.  Learn more about our editorial standards here.

Prescription medications made easy with TelyRx.

Start Your Rx Journey for $22

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Medications

What Is Fluticasone/Salmeterol? Uses, Dosage & FAQs

by Mariah Powers
written by Mariah Powers
The Wellness Collective

What to Know About Fluticasone/Salmeterol Inhalers

Reviewed by Ashley Robinson, PharmD, Pharmacy Manager for TelyRx

Fluticasone/Salmeterol inhaler via TelyRx.

Table of Contents

The fluticasone and salmeterol dry inhaler is a prescription-only drug combining fluticasone, an inhaled corticosteroid, and salmeterol, a long-acting beta-2 agonist.

The medication comes in the form of a dry powder administered to patients via an inhaler device, normally prescribed to manage asthma or chronic obstructive pulmonary disorder (COPD).

how does a Fluticasone and Salmeterol inhaler work?

The fluticasone and salmeterol inhaler consists of two components, each of which plays a key role in the medication’s mechanisms:

  • Fluticasone Propionate: This is an inhaled synthetic corticosteroid that helps reduce inflammation in the airway and strengthen the lungs to make them less sensitive to allergens, cold air, exercise, and other triggers.
  • Samleterol: This long-acting beta-agonist is a bronchodilator that relaxes the muscles around the bronchial tubes and alleviates tension and swelling in these areas.

By combining these components, the fluticasone and salmeterol inhaler both reduces inflammation and helps maintain an open airway. This dual-action protection has made the inhaler a cornerstone of asthma and COPD management.

drug facts

Common Brands Advair Diskus, Wixela Inhub, AirDuo RespiClick
Drug Class Combination inhaled corticosteroid (ICS), long-acting beta-2 agonist (LABA)
Generic Status Generic version of Advair Diskus
Availability Prescription Only

dosing

Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. 

Most providers follow a standardized dosage when prescribing a fluticasone and salmeterol inhaler, though the medication’s strength – specifically, the amount of fluticasone in the dose – depends on the patient’s severity of symptoms. 

  • Standard Frequency: Standard guidelines suggest one inhalation two times per day, with each session spaced about 12 hours apart.
  • Medication Strength: Using the Diskus format, common concentrations include 100 micrograms of fluticasone to 50 micrograms of salmeterol (100/50 mcg), 250/50 mcg, and 500/50 mcg. 
  • Administration: It is advised to use the inhaler at the same time each day to maintain consistent fluticasone and salmeterol in your lungs at all times.

Always follow your healthcare provider’s instructions for exact dosing.

FDA-approved uses

The fluticasone and salmeterol combination medication is FDA-approved for maintenance treatment of COPD and long-term maintenance treatment of asthma. The generic Wixela earned FDA approval in 2019, and Advair Diskus received the same approval the following year.

common off-label uses

You may see fluticasone and salmeterol prescribed for uses that are not “FDA-approved.” This is a very common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.

Common off-label uses for fluticasone and salmeterol currently found in clinical practice and research include:

  • Post-Infectious Cough: Providers may prescribe a brief fluticasone and salmeterol course for patients with hyperactive airways following a severe viral infection.
  • Exercise-Induced Bronchospasm (EIB): Fluticasone and salmeterol combination medication is not considered a first-line treatment for EIB, but doctors may prescribe it to athletes who need daily maintenance for their asthma.

side effects

Many patients use fluticasone and salmeterol with minimal – if any – issues, but side effects can occur as the body adjusts to the new medication. Common side effects include:

Common Side Effects

  • Sore or hoarse throat, persistent dry cough, and other upper respiratory sensations
  • Mild, transient headache
  • Nausea or vomiting
  • Mild muscle or bone pain
  • Throat irritation or a “scratchy” sensation in the mouth

Serious Side Effects

Serious side effects are rare, but it’s important to know what to look for if they do occur. Serious side effects of taking fluticasone and salmeterol combination medication can include:

  • Candidiasis: Also known as oral thrush, this fungal infection causes white patches in the mouth and throat.
  • Pneumonia: Patients with COPD are at higher risk of developing a lung infection like pneumonia while using an inhaled corticosteroid.
  • Cardiovascular Strain: By acting as a bronchodilator, the salmeterol can increase blood pressure and cause a rapid or irregular heartbeat.
  • Paradoxical Bronchospasm: In rare cases, fluticasone and salmeterol causes the airway to tighten immediately after inhalation.
  • Adrenal Suppression: Long-term use of this medication and other drugs with high-dose steroids can affect how the body produces cortisol. 
  • Ocular Changes: Prolonged use of fluticasone and salmeterol elevates the patient’s risk of glaucoma and cataracts.

Call your doctor immediately if you experience any concerning or prolonged symptoms.
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Fluticasone Propionate/Salmeterol Inhaler

Fluticasone propionate and salmeterol are a combination of an inhaled corticosteroid (ICS) and long-acting beta2-adrenergic agonist (LABA) used as maintenance treatment for asthma.

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pharmacist tips

  1. Rinse and Spit Every Time: After you’ve completed your inhaling session, it is advised to rinse out your mouth with clean drinking water and spit into a sink. This removes lingering powder and residue left behind by the medication, reducing the likelihood of developing thrush.
  2. Wait to Exhale: After inhaling the medication, it is recommended to turn away from the device before exhaling. Breathing onto the inhaler can introduce moisture and cause the dry powder to stick inside the device.
  3. Keep an Eye on the Counter: Diskus has a built-in counter to keep track of the remaining doses. If the number turns red, this means five or fewer doses are remaining and it’s time for a refill.
  4. Spot Clean Only: It is not recommended to ever clean the inhaler with water. Wiping the device’s surfaces with a dry tissue or cloth should suffice.
  5. Don’t Shake the Diskus: If you use the Advair Diskus Inhaler, it is not recommended to shake before using like you would with a standard “puff” asthma inhaler. This can disperse the medication incorrectly within the device.

drug interactions

  • Since the fluticasone and salmeterol combination medication contains a steroid and bronchodilator, it can interact with a wide range of other drug types. Notable interactions for fluticasone and salmeterol include:
  • Beta Blockers: Primarily used to treat high blood pressure and heart conditions, beta blockers can counteract the effects of salmeterol and cause the airway to become narrow. 
  • Antifungals and Antiretrovirals: Some antifungal medications, including ketoconazole, and antiretrovirals like ritonavir can increase the level of fluticasone in your blood. If you take these drugs with a fluticasone and salmeterol inhaler, it can exacerbate the steroid’s potential side effects.
  • Monoamine Oxidase Inhibitors (MAOIs) and Tricyclic Antidepressants: These antidepressant medications may enhance the effects of salmeterol and lead to heart palpitations.
  • Diuretics: Using a fluticasone and salmeterol inhaler while taking water pill diuretics can cause potassium levels to decrease.

Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.

 

FAQs

What is the difference between fluticasone-salmeterol Diskus and HFA?

Hydrofluoroalkane (HFA) is an aerosol spray “puffer” medication that uses a propellant to deliver the medication. This differs from the Diskus, which consists of a dry powder inhaler that requires a forceful inhalation to force the medication into the lungs.

Is fluticasone-salmeterol a rescue inhaler?

No, fluticasone-salmeterol is a controlled or maintenance inhaler. It is designed to manage daily symptoms, and does not work fast enough to prevent a sudden asthma attack.

Why do I need to rinse my mouth after using this inhaler?

Rinsing your mouth with water after inhaling fluticasone-salmeterol is recommended for flushing out lingering powder and residue. If powder and residue are not rinsed out, this can lead to yeast growth and oral thrush.

How long does it take for fluticasone-salmeterol to improve breathing?

Patients may begin to notice the effects of fluticasone-salmeterol within 30 to 60 minutes of their inhalation session. However, the medication may need up to two weeks to take full effect.

Can I use this inhaler for a sudden asthma attack?

No, it is not advised to use the fluticasone-salmeterol inhaler during a sudden asthma attack because the device does not work quickly enough. It is strongly recommended for people with asthma to keep a rescue albuterol inhaler instead.

Is Wixela Inhub the same thing as Advair Diskus?

Yes, Wixela Inhub is the generic version of the brand-name Advair Diskus. Both contain the same active ingredients and use the same type of inhaler device.

Does fluticasone-salmeterol contain steroids?

Yes, fluticasone is in the inhaled corticosteroid drug class of medications used to reduce inflammation.

Can I use a spacer with the Diskus inhaler?

No, spacers – or holding chambers – are only designed for use with HFA aerosol inhalers. The Diskus and other dry powder inhalers require users to inhale deeply directly from the device’s mouthpiece.

What should I do if I accidentally breathe out into the device?

Breathing out into the fluticasone-salmeterol inhaler can introduce moisture to the device and cause the dry powder medication to clump or stick to the side walls. If this happens, it is recommended to consult your pharmacist or simply empty the inhaler and load a new dose.

Does this medication cause weight gain?

Since fluticasone-salmeterol and other inhaled steroids target the lungs, and not the entire body, significant weight gain is not associated with taking this medication. That said, systemic absorption may occur with high-dose treatments.

Can fluticasone-salmeterol cause thrush (yeast infection in the mouth)?

Yes, oral thrush is a known side effect of fluticasone-salmeterol. Thrush is a fungal infection that appears as white patches in the mouth and throat. Thoroughly rinsing and spitting after inhaling the medication should help prevent oral thrush.

Is it safe to stop taking this inhaler if my asthma or COPD feels better?

It is not advised to stop fluticasone-salmeterol treatment without first consulting your doctor – even if your symptoms subside. This medication is meant to control asthma and COPD, so not taking it can cause inflammation and asthma attacks to return.

Does this medication affect my voice or cause hoarseness?

Yes, some people who take fluticasone-salmeterol experience a hoarse voice. Thorough rinsing and spitting after inhaling the powder can help mitigate this issue.

Can I take fluticasone-salmeterol while pregnant?

Each pregnant patient should discuss options with their provider, who can make recommendations based on unique medical history. However, providers generally agree that controlling and maintaining asthma while pregnant is vital to both maternal and fetal health. 

How do I know when the Diskus is empty?

Diskus inhalers feature an indicator window near the top. When the counter reaches 5, the number turns red as a warning to replenish your supply soon. A “0” indicates the inhaler is completely empty.

Does salmeterol increase the risk of asthma-related complications?

LABAs like salmeterol can increase the risk of asthma-related complications without the presence of an inhaled corticosteroid like fluticasone. Combination devices like the Diskus help ensure users get the treatment they need without an added risk of asthma-related complications. 

Can I take over-the-counter cold medicines while using this inhaler?

Yes, most over-the-counter cold medicines are safe to take while using the fluticasone-salmeterol inhaler. However, some decongestants increase heart rate and blood pressure, and this can compound salmeterol’s effects. Talk to your doctor or pharmacist before mixing fluticasone-salmeterol and cold medicine.

Does fluticasone-salmeterol raise blood pressure or heart rate?

For some patients, fluticasone-salmeterol can temporarily increase heart rate and blood pressure. It is advised to speak with your doctor if this occurs.

What are the long-term side effects of inhaled corticosteroids?

Long-term fluticasone-salmeterol use in high doses can lead to complications like reduced bone density, increased eye pressure, and slowed growth in children. Providers monitor these and other potential long-term side effects during checkup appointments.

Should I wash the Diskus device with water?

No, you should never wash the Diskus device with water. Exposure to water and moisture can ruin the dry powder and cause you to waste doses.

compare medications

Compared: Albuterol, Xopenex, Fluticasone, or Symbicort? 

Here’s how albuterol compares to other common respiratory inhalers. 

  • Albuterol (ProAir HFA, Proventil HFA, Ventolin HFA) 
    • Type – “Rescue” Inhaler (Short-Acting Beta-Agonist, SABA). 
    • Use – Taken “as-needed” to provide rapid, short-term relief from sudden symptoms (wheezing, shortness of breath). It works by relaxing airway muscles. 
  • Levalbuterol (Xopenex) 
    • Type – “Rescue” Inhaler (SABA). 
    • Use – This is a direct alternative to albuterol. It works in the exact same way but contains only one isomer of the drug. It is sometimes prescribed for patients who are very sensitive to albuterol’s side effects (like shakiness). 
  • Inhaled Corticosteroids (Flovent/Fluticasone, Pulmicort/Budesonide) 
    • Type – “Controller” Inhaler. 
    • Use – This is a different class of medication. It does not provide rescue. It’s taken every day (even when you feel well) to reduce the underlying inflammation in your lungs and prevent symptoms from happening. 
  • Combination Inhalers (Advair, Symbicort, Dulera) 
    • Type – “Controller” Inhaler. 
    • Use – This is also a daily controller medication. It combines an inflammation-reducing steroid (ICS) with a Long-Acting Beta-Agonist (LABA) that keeps airways open for 12-24 hours. It is not used for sudden rescue.
Disclaimer

Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions.  Learn more about our editorial standards here.

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Medications

What Is Propranolol? Uses, Side Effects, Dosage & FAQs

by Mariah Powers
written by Mariah Powers
The Wellness Collective

What to Know About Propranolol

Reviewed by Ashley Robinson, PharmD, Pharmacy Manager for TelyRx

Propranolol via TelyRx.

Table of Contents

Propranolol is a prescription medication in the beta blocker drug class. Originally developed to manage high blood pressure and angina-related chest pain, propranolol is now used to treat a wide range of medical and psychological conditions, including migraines and performance anxiety.

Because propranolol slows down the body’s natural processes, mild side effects are common during the first few weeks of usage. It is available in multiple forms, most commonly as an immediate-release or extended-release oral tablet or liquid solution.

how does Propranolol work?

Propranolol forms a shield around beta receptors in the heart and blood vessels. During moments of physical or emotional stress, hormones like adrenaline (epinephrine) and noradrenaline bind to these beta receptors as part of your body’s “fight or flight” response. 

When adrenaline and noradrenaline cannot bind to beta receptors, the result is often a slower and more regular heart rate, improved blood flow, lower blood pressure, and less severe shaking or tremors. Similarly, propranolol can alleviate headaches by relaxing blood vessels in the brain and reducing the excitability of nerve cells that contribute to migraines.

drug facts

Common Brands Inderal LA, Inderal XL, Innopran XL, Hemangeol
Drug Class Non-selective beta-adrenergic receptor blocker
Generic Status Generic version of Inderal LA, Inderal XL, Innopran XL
Availability Prescription Only

dosing

Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. 

Each patient is prescribed an individualized dose of propranolol. The drug can affect heart rate and blood pressure, so providers often start patients at a lower dose and titrate – or increase the dose slowly over time – based on that person’s clinical response and heart rate. Specific dosage and form of medication usually depend on the condition being treated, which may include:

  • Performance Anxiety: Standard dosing guidelines for people taking propranolol for performance anxiety recommend a dose of 10 milligrams (mg) to 40 mg about 30 to 60 minutes before the speech or performance. Providers may advise taking the drug on an empty stomach to expedite the absorption process.
  • Hypertension: A standard propranolol dosage for hypertension, or high blood pressure, is typically 40 mg twice a day with immediate-release tablets or 80 mg once a day with extended-release tablets.
  • Migraine Prevention: Many people with migraines start their propranolol treatment at 80 mg daily, which may be divided into subdoses or taken all at once with an extended-release tablet. Daily doses may be increased up to 240 mg based on provider recommendations.
  • Essential Tremor: To treat essential tremor – a neurological condition characterized by involuntary shaking in the head, voice, limbs, and trunk – doctors typically prescribe a dose of propranolol 40 mg taken twice daily.

Always follow your healthcare provider’s instructions for exact dosing.

FDA-approved uses

Propranolol is FDA-approved for a wide range of clinical uses, including:

  • Managing high blood pressure to reduce the risk of heart attack and stroke
  • Managing long-term angina pectoris, or chest pain caused by heart disease
  • Regulating heart rate for patients with atrial fibrillation (irregular heartbeat)
  • Reducing the involuntary shakes that can occur with essential tumor
  • Acting as a migraine prophylaxis by decreasing the frequency and severity of episodes
  • Improving survival rates for people who have recently had a myocardial infarction (heart attack)
  • Improving blood flow and alleviating symptoms related to the condition known as hypertrophic subaortic stenosis
  • Managing blood pressure for people with pheochromocytoma, a rare type of adrenal gland tumor

This is not an exhaustive list of FDA-approved uses, and propranolol also has several off-label uses (see list below).

common off-label uses

You may see propranolol prescribed for uses that are not “FDA-approved.” This is a very common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.

Off-label uses for propranolol currently found in clinical practice and research include the following:

  • Performance Anxiety: Propranolol can help mitigate “stage fright” symptoms that appear due to stress over an upcoming presentation, speech, or performance.
  • Overactive Thyroid: Propranolol can reduce and control heart rate for people with thyroid storm, hyperthyroidism, and other conditions that cause an overactive thyroid.
  • Portal Hypertension: For people with cirrhosis of the liver, propranolol can help prevent bleeding caused by esophageal varices.
  • Akathisia: Akathisia, or physical restlessness that occurs after taking antipsychotic medication, can be managed with a propranolol treatment plan.

side effects

Side effects from taking propranolol are common, and many are linked to the drug taking effect and slowing down different systems in the body. Many patients experience mild side effects during the first few weeks of treatment that gradually diminish over time. These include:

Common Side Effects

  • Dizziness or lightheadedness
  • Fatigue, tiredness, and weakness in the limbs
  • Cold or numb extremities
  • Diarrhea, constipation, and mild nausea
  • Vivid dreams or difficulty falling asleep

Serious Side Effects

Serious side effects are rare, but it’s important to know what to look for if they do occur.

Serious side effects that can occur after taking propranolol include:

  • Bradycardia: Bradycardia, or a slow heart rate, can occur after taking propranolol with symptoms such as fainting, confusion, and extreme weakness.
  • Bronchospasm: People with underlying lung conditions who take propranolol may experience bronchospasm, which causes wheezing and difficulty breathing.
  • Worsening Heart Failure: Taking propranolol can worsen the symptoms of heart failure, leading to symptoms like sudden weight gain, swelling of the ankles and feet, and shortness of breath. 
  • Severe Skin Reaction: Taking propranolol can lead to a severe skin reaction with painful blisters or peeling.
  • Raynaud’s Phenomenon: Propranolol can bring on symptoms of Raynaud’s, which include extreme sensitivity to the cold in the fingers and toes.
  • Mental Health Changes: Propranolol may cause new symptoms of depression or hallucinations, or worsen existing issues.

Call your doctor immediately if you experience any concerning or prolonged symptoms.
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Propranolol

Propranolol is used for the treatment of performance anxiety and public speaking. It can also be used for high blood pressure, migraine prevention, and heart conditions.

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pharmacist tips

  1. Stand up Slowly: Since propranolol can cause dizziness, it is recommended to exercise caution when rising to your feet. 
  2. Regulate Alcohol Intake: Alcohol can increase the levels of propranolol in your blood, which in turn can lead to dangerously low blood pressure. For this reason, many providers recommend limiting or cutting out drinking.
  3. Ease off the Drug: Quitting propranolol “cold turkey” can cause sharp spikes in blood pressure and, in some cases, lead to a heart attack. It is recommended to follow your doctor’s instructions when tapering off the drug’s dosage.
  4. Consider Quitting Smoking: Smoking can negatively affect how your liver processes the medication. Your doctor may advise you to quit smoking and provide information about tobacco cessation programs.
  5. Monitor Your Blood Sugar: If you have diabetes and take propranolol, keep an eye on your blood sugar levels – the drug can mask the symptoms of hypoglycemia, or low blood sugar.
  6. Take Caution With Asthma: As a beta blocker, propranolol can cause the airways to constrict. This can cause complications for people with asthma and chronic obstructive pulmonary disease (COPD).

drug interactions

Propranolol interacts with a wide array of medication types. Your doctor may adjust the dose or increase monitoring based on how you respond to the initial doses. Known interactions with propranolol include:

  • Heart and Blood Pressure Medication: Digoxin, a heart medication derived from foxglove, and calcium channel blockers like Verapamil or Diltiazem can cause the heart rate to slow excessively if taken with propranolol.
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs): Common NSAIDs like ibuprofen and naproxen can interfere with propranolol’s ability to lower blood pressure.
  • Warfarin: Propranolol can increase the levels of warfarin – a common blood thinner – in your bloodstream.
  • Epinephrine: Taking propranolol can interfere with epinephrine administered into the body with an injectable EpiPen.
  • Clonidine: People who take both propranolol and clonidine may experience a severe spike in blood pressure if they abruptly stop taking clonidine.
  • Cimetidine: Cimetidine, a heartburn medication, may increase the level of propranolol in your body. Taking propranolol with cimetidine can lead to associated health complications.

Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.

FAQs

Does propranolol help with performance anxiety?

Yes, propranolol can help treat performance anxiety – this is one of the drug’s most common off-label uses. Propranolol may not reduce the mental stress of performance anxiety, but it can help alleviate physical symptoms.

How quickly does propranolol start working for physical anxiety symptoms?

Immediate-release propranolol tablets typically start taking effect within 30 to 60 minutes of dosing. Per standard guidelines for peak effectiveness, it is advised to take the drug about an hour before the performance. As their name implies, extended-release tablets require more time to take effect.

Can I take propranolol if I have asthma or COPD?

No, most people with asthma or COPD do not take propranolol because it is a non-selective beta blocker. This means the medication can block all beta receptors, including beta-2 receptors in the lungs that help regulate healthy breathing, and cause the airways to constrict.

Does propranolol cause weight gain?

Some people who take propranolol experience mild to moderate weight gain up to 5 pounds. Sudden or rapid weight gain should be reported to your healthcare provider, as this may indicate an adverse reaction to the medication or an underlying medical condition.

Does propranolol make you feel sleepy?

Yes, propranolol can cause sleepiness – dizziness and fatigue are two of the drug’s most common side effects. Feelings of sluggishness can occur because the drug slows heart rate and decreases blood pressure. People often feel sleepy when first taking propranolol, but this side effect diminishes over time.

Can propranolol cause nightmares?

Yes, some people who take propranolol report vivid dreams or nightmares. The exact reasons for this are unknown, but some experts believe propranolol is a “lipophilic” medication that can cross the blood-brain barrier more easily than other drugs.

Does propranolol lower blood pressure and heart rate?

Yes, lowering blood pressure and heart rate are primary functions of propranolol. Reducing blood pressure and heart rate helps lower the patient’s overall systemic blood pressure. 

Why do my hands and feet feel cold while taking propranolol?

Propranolol can cause mild vasoconstriction in the extremities and reduce heart output, reducing blood flow to the finger and toes and causing the hands and feet to feel very sensitive to cold. 

Is propranolol addictive or a controlled substance?

No, propranolol is not a narcotic with higher potential for addiction and abuse or a controlled substance. However, a prescription is required to obtain propranolol. 

Does propranolol cause hair loss?

Alopecia, or hair loss, is very rare but has been observed in some people who take propranolol and other beta blockers. The hair loss may be reversible when the patient stops taking this medication.

Does propranolol affect my ability to exercise?

Yes, propranolol can affect your ability to exercise by preventing the heart rate from increasing in response to adrenaline. This can make you feel fatigued more easily when exercising.

How long does propranolol last?

Immediate-release propranolol tablets typically last six to eight hours, necessitating multiple doses per day. Extended-release tablets taken once per day are designed to last up to 24 hours.

compare medications

Compared: Propranolol, Nadolol, Metoprolol, Clonidine, or Ativan?

Propranolol is a prescription-only beta blocker used to treat a wide range of medical conditions. It is widely available, but not the only option for patients. Common propranolol alternatives include the following:

  • Nadolol: Like propranolol, nadolol is a non-selective beta blocker. The key difference between these drugs is half-life, with nadolol’s effects lasting much longer. For this reason, nadolol is almost always prescribed as a once-daily, extended-release dose, while propranolol is often preferred for situational anxiety that requires a short-term fix.
  • Metoprolol: Metoprolol is a cardioselective beta blocker, meaning it primarily targets the heart and does not affect the lungs as much. Metoprolol is a safer option for patients with preexisting and mild respiratory problems, while propranolol may be preferred for “systemic” effects to curb issues like tremors and performance anxiety.
  • Clonidine: Clonidine is an alpha-agonist intended to decrease nerve signals that constrict blood vessels. This mechanism differs from that of propranolol, which targets the blood vessels directly. Side effects of clonidine tend to be more pronounced, especially dry mouth, and the drug has more sedating effects.
  • Ativan: Ativan, a benzodiazepine often sold under the brand name Lorazepam, sedates the central nervous system to quell anxiety. This is a controlled substance and may be habit-forming. Propranolol treats physical symptoms of anxiety without sedating the patient or increasing their risk of addiction.
Disclaimer

Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions.  Learn more about our editorial standards here.

Prescription medications made easy with TelyRx.

Start Your Rx Journey for $22

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Medications

What Is Losartan? Uses, Side Effects, Dosage & FAQs

by Mariah Powers
written by Mariah Powers
The Wellness Collective

What to Know About Losartan

Reviewed by Ashley Robinson, PharmD, Pharmacy Manager for TelyRx

Losartan tablets via TelyRx.

Table of Contents

Losartan (brand name Cozaar) is an oral prescription medication used to treat high blood pressure (hypertension). It belongs to a class of drugs known as angiotensin II receptor blockers (ARBs).

Beyond managing blood pressure, losartan is used to reduce the risk of stroke in people who have both high blood pressure and a heart condition known as left ventricular hypertrophy. Losartan is also prescribed to protect kidney function in people with type 2 diabetes who have diabetic nephropathy, a form of kidney disease.

how does Losartan work?

As an angiotensin II receptor blocker, losartan works by blocking a hormone called angiotensin II. Angiotensin II binds to receptors in the blood vessels, causing them to narrow and triggering the release of another hormone, aldosterone, which causes the body to retain salt and water. 

By blocking these receptors, losartan has three main effects:

  1. It allows the blood vessels to relax and widen, helping blood to flow more easily and lowering blood pressure.
  2. It decreases the workload on the heart.
  3. It prevents the kidneys from reabsorbing too much sodium and water into the body.

drug facts

Common Brands Cozaar
Drug Class Angiotensin II receptor blocker (ARB)
Generic Status Generic version of Cozaar
Availability Prescription Only

dosing

Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. 

Losartan comes in three dosage strengths: 25 mg, 50 mg, and 100 mg.

The recommended starting dose for adults is usually 25 mg or 50 mg taken by mouth once daily. Depending on how blood pressure responds, a provider may increase the dose to a maximum of 100 mg once daily.

Always follow your healthcare provider’s instructions for exact dosing.

FDA-approved uses

Losartan is FDA-approved to:

  • Lower high blood pressure (hypertension)
  • Reduce the risk of stroke in people with high blood pressure and left ventricular hypertrophy (Note: Studies suggest this benefit may not apply to Black people with these conditions.)
  • Slow the progression of kidney damage in people with type 2 diabetes and nephropathy, a type of kidney disease

common off-label uses

You may see losartan prescribed for uses that are not “FDA-approved.” This is a very common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.

While losartan is FDA-approved for blood pressure and angina, healthcare providers may prescribe it for other heart conditions, such as acute coronary syndrome and stable coronary artery disease.

side effects

Like all medications, losartan can cause side effects. Common side effects may improve as your body adjusts to the medication, but others may be serious and require medical attention.

Common Side Effects

  • Dizziness
  • Common cold
  • Nasal congestion
  • Back pain

Serious Side Effects

Serious side effects are rare, but it’s important to know what to look for if they do occur. Stop using losartan and call your doctor immediately if you experience: 

  • Low Blood Pressure (Hypotension) – This can cause severe dizziness, fainting, lightheadedness, or confusion, especially when standing up or dehydrated.
  • Kidney Damage – Signs include urinating less than usual; swelling in the feet, ankles, or legs; unexplained weight gain; weakness; confusion; nausea; and chest pain or pressure.
  • High Potassium Levels (Hyperkalemia) – Symptoms include muscle weakness, unusual tiredness, slow or irregular heartbeat, nausea, vomiting, or difficulty breathing.
  • Severe Allergic Reactions – Swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; severe rash or itching; fever.
  • Pregnancy – Losartan can cause injury or death to an unborn fetus. It should not be used during pregnancy.

Call your doctor immediately if you experience any concerning or prolonged symptoms.
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Losartan

Losartan is a medication used to help lower blood pressure.

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pharmacist tips

  1. Be Consistent – Take losartan at the same time each day.
  2. Avoid NSAIDs – Do not take nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin) or naproxen (Aleve) for headache or pain relief, without checking with your doctor, as combining them with losartan can increase the risk of kidney damage.
  3. Watch Potassium Intake – Losartan can increase potassium levels in your body. Avoid using salt substitutes that contain potassium or eating thigh-potassium foods like bananas.
  4. Follow a Low-Salt Diet – Your healthcare provider may recommend a low-sodium diet when taking losartan to help lower blood pressure.
  5. Avoid or Limit Alcohol – While alcohol is not known to directly interact with losartan, it can lower blood pressure and increase side effects like dizziness.
  6. Missed Dose – If you miss a dose, take it as soon as you remember. If it is almost time for the next dose, skip the missed one and take your next dose as usual. Do not take two doses at once.
  7. Pregnancy Warning – If you are pregnant or plan to become pregnant, tell your doctor immediately and stop taking losartan.
  8. Monitor Blood Pressure – Keep checking your blood pressure at home and maintain a log to help your doctor determine if the medication is working effectively for you.

drug interactions

Losartan can interact with other medications, potentially altering their effectiveness or increasing side effects. For example:

  • Lithium – Losartan may interact with lithium, a medication used for depression, potentially increasing lithium levels in the body.
  • Nonsteroidal Anti-Inflammatory Drugs (NSAIDs) – Pain relievers like ibuprofen, naproxen, and celecoxib can increase the risk of kidney problems when taken with losartan.
  • Potassium Supplements – Taking potassium pills or using potassium-containing salt substitutes can lead to dangerously high potassium levels (hyperkalemia).
  • ACE Inhibitors – Taking losartan with drugs like lisinopril or enalapril can increase the risk of low blood pressure and kidney issues.
  • Aliskiren – This blood pressure medicine should not be used with losartan, especially in patients with diabetes.
  • Diuretics – “Water pills” can increase the risk of low blood pressure and electrolyte imbalances when taken with losartan.

Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.

FAQs

Why is losartan preferred over lisinopril for some patients? 

As an ACE inhibitor, lisinopril can cause a dry, hacking cough as a side effect. Because losartan is an ARB, a different kind of medication, it works similarly to treat high blood pressure but is less likely to cause this cough, making it a preferred alternative for some people.

Can I eat bananas while taking losartan? 

It’s best to be cautious. Bananas are high in potassium, and losartan can raise potassium levels in your body. While an occasional banana may be fine, eating bananas regularly or eating them with other potassium sources could lead to a condition called hyperkalemia (dangerously high levels of potassium). Ask your doctor what they recommend based on your level of risk.

Does losartan cause a dry cough? 

It is unlikely. While a cough can happen, losartan is specifically noted for having fewer side effects like cough compared to ACE inhibitors like lisinopril.

Is it better to take losartan in the morning or at night? 

The best time to take losartan is whatever time works best for you, as long as you are consistent. Some providers may suggest a specific time or even splitting the dose to twice a day for certain patients, so follow your healthcare provider’s instructions.

How long does it take for losartan to work? 

Losartan starts working within several hours, but it typically takes about a week to see a drop in blood pressure. It may take several weeks to see the full benefits of the medication.

Can losartan cause sudden weight gain or swelling? 

Sudden weight gain or swelling in the feet and ankles can be a sign of kidney damage or heart failure, which are serious conditions. If you experience unexplained weight gain on losartan, contact your provider.

Can I drink alcohol while taking losartan? 

Alcohol is not known to directly interact with losartan, but drinking can lower blood pressure and increase the risk of side effects like dizziness and fainting. Your healthcare provider may recommend limiting or avoiding alcohol while taking losartan.

Does losartan cause hair loss? 

Hair loss is not listed as a common side effect for losartan. If you experience hair loss on losartan, contact your doctor to understand what may be causing it.

Can losartan cause erectile dysfunction? 

Erectile dysfunction (inability to have or keep an erection) is not listed as a common side effect of the medication. There are several possible causes for erectile dysfunction. If you experience ED on losartan, make an appointment with your healthcare provider.

Does losartan cause constipation? 

Constipation, or difficulty having a bowel movement, has been reported as a less common side effect of losartan.

Does losartan make you sleepy? 

It can. Tiredness and sleepiness are common side effects of losartan.

Is losartan a beta blocker? 

No, losartan is not a beta blocker. It is an angiotensin II receptor blocker (ARB).

compare medications

Compared: Losartan, Valsartan, Lisinopril, Ramipril, Losartan-Hydrochlorothiazide, or Amlodipine?

There are several medications that your doctor can prescribe in place of losartan. Here are a few possible alternatives below.

  • Valsartan – Another angiotensin II receptor blockers (ARB) like losartan that is used to treat high blood pressure, heart failure, and left-sided heart failure after a heart attack.
  • Lisinopril – An ACE inhibitor that is used to treat high blood pressure or heart failure, but may cause cough as a side effect.
  • Ramipril – Another ACE inhibitor that is used to treat high blood pressure and heart failure, and may cause cough as a side effect. 
  • Losartan-Hydrochlorothiazide – A combination pill that contains both losartan and a diuretic (water pill) called hydrochlorothiazide, which may be used when losartan alone is not enough to lower blood pressure.
  • Amlodipine – A calcium channel blocker  that is used to treat high blood pressure and chest pain (angina).
Disclaimer

Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions.  Learn more about our editorial standards here.

Prescription medications made easy with TelyRx.

Start Your Rx Journey for $22

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Medications

What Is Amlodipine? Uses, Side Effects, Dosage & FAQs

by Mariah Powers
written by Mariah Powers
The Wellness Collective

What to Know About Amlodipine

Reviewed by Ashley Robinson, PharmD, Pharmacy Manager for TelyRx

Amlodipine via TelyRx.

Table of Contents

Amlodipine (brand name Norvasc) is an oral prescription medication used to treat high blood pressure (hypertension). It is also used to manage coronary artery disease and prevent chronic chest pain (angina).

Amlodipine is designed for long-term use and can be prescribed alone or in combination with other heart medications. Common side effects include fatigue, nausea, abdominal pain, and swelling in the hands and feet.

how does Amlodipine work?

As a calcium channel blocker, amlodipine works by relaxing the blood vessels. This lowers blood pressure and makes it easier for oxygen to reach the heart, helping to prevent chest pain.

drug facts

Common Brands Norvasc
Drug Class Calcium channel blocker
Generic Status Generic version of Norvasc
Availability Prescription Only

dosing

Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. 

Amlodipine comes in three dosage strengths: 2.5 mg, 5 mg, and 10 mg. The recommended dose of amlodipine for adults is usually 5 mg daily taken by mouth. Your provider may increase the dose depending on how your blood pressure responds. The maximum dose is 10 mg daily.

A lower starting dose of 2.5 mg daily is recommended for small, fragile, or older adults, as well as adults with liver problems.

Always follow your healthcare provider’s instructions for exact dosing.

FDA-approved uses

Amlodipine is FDA-approved to treat cardiovascular conditions such as:

  • High blood pressure (hypertension)
  • Coronary artery disease, including chest pain (angina)

common off-label uses

You may see amlodipine prescribed for uses that are not “FDA-approved.” This is a very common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.

While amlodipine is FDA-approved for blood pressure and angina, healthcare providers may prescribe it for other circulatory conditions such as Raynaud’s phenomenon, a condition where fingers and toes feel numb or cold in response to temperature changes.

side effects

Like all medications, amlodipine can cause side effects. Common side effects may improve as your body adjusts to the medication, but others may be serious and require medical attention.

Common Side Effects

  • Swelling of the ankles, feet, or hands
  • Fatigue
  • Tiredness or sleepiness
  • Dizziness
  • Redness or warmth in the face
  • Heart palpitations
  • Nausea
  • Abdominal pain

Serious Side Effects

Serious side effects are rare, but it’s important to know what to look for if they do occur. Stop using amlodipine and call your doctor immediately if you experience: 

  • Severe Allergic Reactions – Swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; severe rash or itching; fever.
  • Low Blood Pressure (Hypotension) – Severe dizziness or lightheadedness, especially when standing up. The risk of this side effect is higher in people with aortic stenosis (narrow heart valves) or when starting or increasing the dose.
  • Worsening Chest Pain or Heart Attack – Chest pain or tightness, sweating, shortness of breath. The risk of this side effect is higher in people with coronary artery disease or when starting or increasing the dose.
  • Liver Issues – Yellowing of the skin or eyes (jaundice), dark urine, pale stool, weakness, nausea, or severe upper stomach pain. 

Call your doctor immediately if you experience any concerning or prolonged symptoms.
Starting at $24.99

Amlodipine

Amlodipine is a medication used to lower blood pressure.

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pharmacist tips

  1. Take with Food – Amlodipine can be taken with or without food. If you find it upsets your stomach, try taking it with a meal.
  2. Stick to a Schedule – It’s recommended to take amlodipine at the same time each day. 
  3. Manage Swelling – If you experience minor swelling in your legs or ankles, elevating your legs when sitting or wearing compression socks may help. If swelling becomes bothersome, consult your provider.
  4. Avoid Grapefruit – It is generally recommended to avoid consuming grapefruit or grapefruit juice while on amlodipine, as it can affect how the drug works.
  5. Limit or Avoid Alcohol – While alcohol is not known to directly interact with amlodipine, it can lower blood pressure and increase side effects like dizziness and sleepiness.
  6. Missed Doses – If a dose is missed, take it as soon as you remember as long as it’s been less than 12 hours since your last dose. Otherwise, skip the missed dose and take the next dose at the regular time. Don’t take two doses at once to make up for a missed dose.
  7. Monitor Blood Pressure – Checking your blood pressure at home and keeping a log can help your doctor determine if the medication is working effectively for you.

drug interactions

Amlodipine can interact with other medications, potentially altering their effectiveness or increasing side effects. For example:

  • Simvastatin – Taking amlodipine with this cholesterol medication may require a dose adjustment of the simvastatin to prevent side effects.
  • Cyclosporine & Tacrolimus – These immunosuppressant medications can interact with amlodipine. A dose adjustment may be needed.
  • Clarithromycin – This antibiotic may affect how your body processes amlodipine.
  • Itraconazole – This antifungal medication can interact with calcium channel blockers like amlodipine.
  • Diltiazem – This calcium channel blocker may affect how the body processes amlodipine in older people.

Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.

FAQs

Why does amlodipine cause swelling? 

Amlodipine works by relaxing and widening blood vessels. This relaxation can sometimes cause fluid to leak from the small blood vessels into the surrounding tissues, leading to swelling (edema), particularly in the ankles, hands, and feet.

Is it better to take amlodipine in the morning or at night? 

You can take amlodipine at any time of day, with or without food. However, it is recommended to take it at the same time every day.

How quickly does amlodipine lower blood pressure? 

Amlodipine may start to lower blood pressure within a few hours of the first dose, but it typically takes a few weeks of consistent daily use to see the full effects.

Does amlodipine cause weight gain? 

Weight gain is not a common side effect of the drug itself. However, because amlodipine can cause fluid retention (swelling), some people may notice a slight increase in weight due to water retention.

Is amlodipine safe for kidneys? 

Yes, amlodipine is generally considered safe for the kidneys. It is processed primarily by the liver, so dose adjustments are typically not needed for kidney disease.

Can I stop taking amlodipine if my blood pressure is normal? 

You should keep taking the medication as prescribed unless your doctor tells you to stop. High blood pressure can be a chronic condition, and the medication can help keep your levels normal.

Does amlodipine interact with other blood pressure medications? 

Amlodipine may be prescribed with other blood pressure medications. However, taking multiple drugs that lower blood pressure can sometimes cause it to drop too low (hypotension). Your doctor may recommend extra monitoring to prevent this from happening.

What are the most common side effects of amlodipine? 

The most common side effects of amlodipine are swelling of the hands or feet, tiredness, dizziness, nausea, abdominal pain, heart palpitations, and flushing of the face.

Does amlodipine cause erectile dysfunction? 

It is rare, but some men have reported erectile dysfunction (ED) while taking amlodipine. However, high blood pressure itself is also a common cause of ED. If you experience ED, speak with your provider for treatment options.

compare medications

Compared: Amlodipine, Nifedipine, Lisinopril, Losartan, Amlodipine/Valsartan, or Amlodipine/Olmesartan?

There are several medications that your doctor can prescribe in place of amlodipine. Here are a few possible alternatives below.

  • Nifedipine – A calcium channel blocker that is used to treat high blood pressure and chest pain (angina). 
  • Lisinopril – An angiotensin-converting enzyme (ACE) inhibitor that is used to treat high blood pressure.
  • Losartan – An angiotensin II receptor blocker (ARB) that is prescribed to treat high blood pressure, and to prevent stroke or kidney damage in people with certain health conditions.
  • Amlodipine/Valsartan – A combination medication that is used to treat high blood pressure.
  • Amlodipine/Olmesartan – A combination medication that is used to treat high blood pressure.
Disclaimer

Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions.  Learn more about our editorial standards here.

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Medications

What Are Progesterone Capsules? Uses, Side Effects, & FAQs

by Mariah Powers
written by Mariah Powers
The Wellness Collective

What to Know About Progesterone Capsules

Reviewed by Ashley Robinson, PharmD, Pharmacy Manager for TelyRx

Progesterone capsules via TelyRx.

Table of Contents

Progesterone capsules (brand name Prometrium) are prescription bioidentical hormones, meaning their chemical structure is identical to the progesterone naturally produced by the ovaries. 

For postmenopausal women receiving estrogen therapy, the medication is used to prevent a precancerous thickening of the uterine lining, a condition known as endometrial hyperplasia. It may also be prescribed to women experiencing irregular menstrual cycles or amenorrhea (the absence of periods) due to hormonal imbalances. Common side effects include headache, breast tenderness, and mood changes.

how does Progesterone work?

Progesterone works by acting as a direct replacement or supplement for the progesterone hormone that naturally occurs in the body.

For women undergoing estrogen therapy, estrogen can cause the lining of the uterus to grow excessively. Without progesterone to counterbalance this growth, the lining can become precancerous, a condition called endometrial hyperplasia. Progesterone capsules are used to get the uterine lining to stop growing and shed, helping prevent irregular thickening and reducing the risk of endometrial cancer.

When used for amenorrhea (lack of periods), progesterone capsules help regulate the menstrual cycle. By taking the progesterone for a set number of days and then stopping, it mimics the natural hormonal drop of a menstrual cycle and triggers a period to start.

drug facts

Common Brands Prometrium
Drug Class Progestins
Generic Status Generic version of Prometrium
Availability Prescription Only

dosing

Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. 

The dosing of progesterone capsules depends on what you’re taking it for. 

  • Preventing Endometrial Hyperplasia – For postmenopausal women receiving estrogen therapy, the recommended dose is 200 mg taken by mouth at bedtime for 12 days per 28-day cycle. Alternatively, your healthcare provider may also describe a continuous daily dose.
  • Treating Secondary Amenorrhea – For premenopausal women experiencing irregular or missed periods, the recommended dose is 400 mg taken by mouth at bedtime for 10 days. A withdrawal bleed (period) usually occurs within a few days after the last dose is taken.

Always follow your healthcare provider’s instructions for exact dosing.

FDA-approved uses

Progesterone capsules are FDA-approved to prevent endometrial hyperplasia in postmenopausal women receiving estrogen therapy and to treat secondary amenorrhea (irregular or missed periods).

common off-label uses

Progesterone capsules do not have any common off-label uses at this time.

side effects

Like all medications, progesterone capsules can cause side effects. Common side effects may improve as your body adjusts to the medication, but others may be serious and require medical attention.

Common Side Effects

  • Headache
  • Breast pain or tenderness
  • Joint or muscle pain
  • Depression
  • Dizziness
  • Abdominal pain or bloating
  • Hot flashes
  • Urinary problems
  • Vaginal discharge or dryness
  • Nausea
  • Vomiting
  • Worry
  • Chest pain
  • Diarrhea
  • Night sweats
  • Swelling of hands and feet
  • Constipation 
  • Fatigue

Serious Side Effects

Serious side effects are rare, but it’s important to know what to look for if they do occur. Stop using progesterone capsules and call your doctor immediately if you experience: 

  • Severe Allergic Reactions – Swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; severe rash or itching; fever.
  • Blood Clots in the Lungs – Leg or arm pain, difficulty breathing, severe headache, or chest pain.
  • Blood Clot in the Eyes (Retinal Thrombosis) – Sudden partial or complete loss of vision, bulging eyes, or double vision.
  • Stroke – Sudden numbness on one side of the body, confusion, difficulty speaking or walking, or severe headache.
  • Heart Attack – Chest pain or tightness, sweating, difficulty breathing, or pain in the shoulder, neck, arm, or jaw.
  • Liver Issues – Yellowing of the skin or eyes (jaundice), dark urine, pale stool, weakness, nausea, or severe upper stomach pain.
  • Pneumonia – Fever, night sweats, cough, fatigue, difficulty breathing.
  • Breast Lumps – Breast pain, soreness, swelling, rash, dimpling of the skin, or nipple discharge.

Call your doctor immediately if you experience any concerning or prolonged symptoms.
Starting at $34.99

Progesterone Capsules

Progesterone is a female hormone used to help prevent endometrial hyperplasia associated with estrogen therapy.

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pharmacist tips

  • Take Your Dose Before Bed – Because progesterone can cause significant drowsiness or dizziness, it is recommended to take your dose at bedtime.
  • Swallow with Water – Progesterone capsules should be swallowed whole with a full glass of water.
  • Be Careful Driving – Progesterone capsules can cause dizziness, so it’s recommended to avoid driving, operating heavy machinery, or performing dangerous activities until you know how this medication affects you.
  • Check for Allergies – Many progesterone capsules contain peanut oil. If you have a peanut allergy, alert your pharmacist immediately to verify the ingredients of the specific manufacturer.

drug interactions

Progesterone capsules can interact with other medications, potentially altering their effectiveness or increasing side effects. For example:

  • Antifungal Medications – Medications like ketoconzaole can affect how the body metabolizes progesterone.
  • Antibiotics – Drugs such as Rifampin may interact with progesterone.
  • Seizure Medications – Carbamazepine, phenytoin, and barbiturates can interact with progesterone.
  • Estrogens – While often prescribed together, progesterone can alter the effects of estrogen, sometimes decreasing its beneficial impact or increasing breast tenderness.

Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.

FAQs

Why should I take progesterone capsules at bedtime?

Progesterone can cause extreme dizziness or drowsiness. Taking it at bedtime helps prevent these issues during the day and may assist with sleep.

Does progesterone cause weight gain?

Some people experience weight changes on progesterone due to fluid retention (bloating) or increased appetite. However, others report weight loss. If you notice rapid weight gain or swelling, contact your healthcare provider.

What is the difference between progesterone and progestin?

“Progesterone” typically refers to a bioidentical hormone medication that is chemically identical to the progesterone the ovaries produce. “Progestin” is a broad term for synthetic hormones that mimic progesterone’s effects but have a slightly different chemical structure. Progesterone capsules (Prometrium) are bioidentical, whereas medications like norethindrone are synthetic progestins.

Is it safe to take progesterone capsules during pregnancy?

Progesterone may be safe to take in certain situations during pregnancy, such as to prevent preterm labor. However, it is generally considered unsafe to use during pregnancy for other purposes unless directed by a specialist. It’s best to consult your OB/GYN before taking progesterone capsules during pregnancy.

Do progesterone capsules contain peanuts?

Yes, progesterone capsules, as well as brand name Prometrium, contain peanut oil. If you have a peanut allergy, contact your pharmacist before taking progesterone capsules to verify the ingredients and see if you need to take an alternative instead.

Does progesterone help with anxiety or sleep?

While not FDA-approved as a sleeping pill or anti-anxiety medication, progesterone can cause drowsiness which may help some people sleep. 

Will progesterone capsules stop my period?

If taken cyclically (e.g., for 10-12 days a month), progesterone is designed to regulate the period, not stop it. It’s typical to experience a “withdrawal bleed” (period) within 2 to 3 days after finishing your course of progesterone. 

Can progesterone cause dizziness or “drunk” feelings?

Yes, progesterone can cause significant dizziness and lightheadedness. This is why driving or operating machinery after taking a dose is discouraged.

Is bioidentical progesterone safer than synthetic progestins?

Providers and patients may prefer bioidentical progesterone because it replicates the body’s natural hormone structure. Some research suggests it may carry a lower risk profile regarding breast cancer and cardiovascular issues compared to certain synthetic progestins, but all hormone therapy carries some risk.

How does progesterone protect the uterus during hormone replacement therapy (HRT)?

Estrogen stimulates the thickening of the uterine lining. Without a counter-balance, this lining can grow uncontrollably and become precancerous (endometrial hyperplasia). Progesterone acts as the “brakes,” stopping the growth and helping the lining mature and shed properly.

What is the difference between oral and vaginal progesterone?

Oral progesterone capsules are taken by mouth and processed through the liver (systemic absorption). Vaginal progesterone delivers the hormone directly to the uterus, which can result in fewer systemic side effects like drowsiness but may be messier to administer.

compare medications

Compared: Progesterone Capsules, Endometrin, Norethindrone, Climara, or Activella?

There are several medications that your doctor can prescribe in place of progesterone capsules. Here are a few possible alternatives below.

  • Endometrin – A brand of progesterone designed as a vaginal insert that is used in fertility treatment.
  • Norethindrone – A synthetic form of progesterone that may be used as a birth control pill or to treat endometriosis. 
  • Climara – A patch that delivers estrogen (estradiol) through the skin to treat menopausal symptoms like hot flashes.
  • Activella – A combination HRT tablet that contains both estradiol (estrogen) and norethindrone (synthetic progestin) in a single pill.
Disclaimer

Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions.  Learn more about our editorial standards here.

Prescription medications made easy with TelyRx.

Start Your Rx Journey for $22

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Medications

What Is Amoxicillin-Clavulanate? Uses, How it Works, & FAQs

by Mariah Powers
written by Mariah Powers
The Wellness Collective

What to Know About Amoxicillin-Clavulanate

Reviewed by Ashley Robinson, PharmD, Pharmacy Manager for TelyRx

Amoxicillin-Clavulanate via TelyRx.

Table of Contents

Amoxicillin-clavulanate (brand name Augmentin) is a combination antibiotic that is prescribed for a number of bacterial infections that affect the ears, sinuses, skin, lower respiratory tract, and urinary tract.

Amoxicillin-clavulanate treats bacterial infections. It does not treat infections caused by viruses, such as the common cold or flu. It’s available in several forms, including immediate-release tablets, extended-release tablets, chewable tablets, and liquid oral suspensions. Common side effects include diarrhea, nausea, skin rashes, and hives.

how does Amoxicillin-clavulanate work?

Amoxicillin-clavulanate is a combination antibiotic with two active ingredients: amoxicillin and clavulanate potassium (also known as clavulanic acid). These work together by preventing the bacteria from growing and from forming a resistance to the antibiotic.

Amoxicillin functions as a penicillin-type antibiotic. It prevents the bacteria from forming a protective cell wall that allows it to grow and spread. Clavulanate acts as a beta-lactamase inhibitor. It works by blocking the beta-lactamase enzymes that bacteria use to shield themselves against antibiotics like amoxicillin.

The combination of the two active ingredients allows the amoxicillin to remain active against bacteria that would otherwise be resistant to amoxicillin alone.

drug facts

Common Brands Augmentin, Augmentin ES, Augmentin XR
Drug Class Penicillin antibiotic/Beta-lactamase inhibitor
Generic Status Generic version of Augmentin
Availability Prescription Only

dosing

Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. 

Dosage for amoxicillin-clavulanate varies depending on the severity of their infection and is based on the dosage of amoxicillin.

  • Severe Infections or Respiratory Tract Infections – Providers typically recommend 875 mg taken by mouth with food every 12 hours, or 500 mg every 8 hours.
  • Less Severe Infections – The recommended dose is 500 mg taken by mouth with food every 12 hours, or 250 mg every 8 hours.

Amoxicillin comes in the following dosage forms and strengths:

Tablets

    • 500 mg amoxicillin/125 mg clavulanate
    • 875 mg amoxicillin/125 mg clavulanate

Oral suspension

      • 200 mg amoxicillin/28.5 mg clavulanate per 5 ml
      • 400 mg amoxicillin/57 mg clavulanate per 5 ml

Chewable tablets

    • 200 mg amoxicillin/28.5 mg clavulanate
    • 400 mg amoxicillin/57 mg clavulanate

Always follow your healthcare provider’s instructions for exact dosing.

FDA-approved uses

Amoxicillin-Clavulanate is FDA-approved to treat bacterial infections such as:

  • Lower respiratory tract infections
  • Ear infections
  • Sinus infections
  • Skin infections
  • Urinary tract infections (UTIs)

common off-label uses

You may see amoxicillin-clavulanate prescribed for uses that are not “FDA-approved.” This is a very common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.

Amoxicillin-Clavulanate may be prescribed “off-label” for strep throat and other bacterial infections.

side effects

Like all medications, amoxicillin-clavulanate can cause side effects. Common side effects may improve as your body adjusts to the medication, but others may be serious and require medical attention.

Common Side Effects

  • Diarrhea
  • Nausea
  • Skin rash or hives
  • Vomiting
  • Vaginal yeast infections

Serious Side Effects

Serious side effects are rare, but it’s important to know what to look for if they do occur. Stop using amoxicillin-clavulanate and call your doctor immediately if you experience: 

  • Severe Allergic Reactions – Swelling of the face, lips, tongue, or throat; difficulty breathing or swallowing; severe rash or itching; fever.
  • Severe Skin Reactions – Rare conditions such as Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN), or acute generalized exanthematous pustulosis (AGEP) can manifest as painful red or purple skin that peels, blisters, or develops pustules (fluid-filled bumps). This side effect can be more common in people with a current mononucleosis infection (“mono” or the “kissing disease”). Amoxicillin-clavulanate should not be used by people who currently have mononucleosis.
  • Liver Damage (Hepatic Dysfunction) – Signs may include yellowing of the skin or eyes (jaundice), dark urine, light-colored stool, stomach pain, fatigue, fever, and severe nausea.
  • Antibiotic-Associated Diarrhea (C. diff) – An overgrowth of Clostridioides difficile (C. diff) bacteria can cause severe, watery, or bloody diarrhea, fever, and severe stomach cramps. These symptoms can occur up to two months after stopping the medication.
  • Drug-Induced Enterocolitis Syndrome (DIES) – This rare reaction in the GI tract causes symptoms such as severe vomiting, severe diarrhea, extreme tiredness, pale skin, low blood pressure, dizziness, and confusion. If DIES occurs, it usually happens within a day of taking amoxicillin-clavulanate.

Call your doctor immediately if you experience any concerning or prolonged symptoms.
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Amoxicillin-Clavulanate

Augmentin is a combination antibiotic used to treat a wide range of bacterial infections, including respiratory tract infections, ear infections, urinary tract infections, and skin infections.

View

pharmacist tips

  • Take with Food – To reduce the likelihood of stomach upset, it is recommended to take your dose  with a meal or snack. For the extended-release tablets, a low-fat meal is recommended to improve absorption.
  • Stay Hydrated – If you experience diarrhea, it is helpful to drink plenty of fluids to stay hydrated.
  • Avoid Alcohol – While alcohol is not known to interact with amoxicillin-clavulanate, avoiding alcohol is recommended because it can worsen side effects like nausea and diarrhea.
  • Do Not Crush Extended-Release Tablets – The immediate-release and extended-release tablets have a special coating and should generally not be crushed. The chewable tablets may be crushed or chewed.
  • Measure and Store Oral Liquid Properly – If you are prescribed the liquid form of amoxicillin-clavulanate, it must be stored in the refrigerator. Shake the bottle well before every dose to ensure the medication is mixed evenly. Use the included cup or syringe to measure your dose, not a household spoon. Discard any remaining liquid after 10 days.
  • Finish the Course – Even if you feel better after a few days, finishing the entire prescribed course is important to prevent future resistance to amoxicillin-clavulanate or similar antibiotic medications.

drug interactions

Amoxicillin-clavulanate can interact with other medications, potentially altering their effectiveness or increasing side effects. For example:

  • Allopurinol – A gout medication. Taking it with amoxicillin-clavulanate may increase the risk of rash.
  • Probenecid – A gout medication. It should not be used at the same time as amoxicillin-clavulanate.
  • Blood Thinners – Anticoagulants, such as warfarin, may interact with amoxicillin-clavulanate, potentially affecting blood clotting.
  • Birth Control – Antibiotics may decrease the effectiveness of oral contraceptives (birth control pills). It is often suggested to use an additional form of birth control during treatment.
  • Tetracyclines – Other antibiotics like doxycycline and tetracycline are generally not recommended to be used at the same time as amoxicillin-clavulanate.

Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.

FAQs

What is amoxicillin-clavulanate used to treat? 

Amoxicillin-clavulanate is a combination antibiotic used to treat a wide range of bacterial infections, including those affecting the ears, sinuses, skin, urinary tract, and lower respiratory tract.

Why is clavulanate added to amoxicillin? 

Amoxicillin kills bacteria, but some bacteria produce an enzyme called beta-lactamase to destroy amoxicillin and resist treatment. Clavulanate is added to block this enzyme, protecting the amoxicillin and allowing it to kill the bacteria.

Should I take amoxicillin-clavulanate with food? 

Yes. It is generally recommended to take amoxicillin-clavulanate with a meal or snack to help minimize stomach upset and nausea.

Does amoxicillin-clavulanate cause yeast infections?

Yes, it can. Vaginal yeast infections are a reported side effect of amoxicillin-clavulanate, occurring in a small percentage of users. Antibiotics can disrupt the natural balance of bacteria in the body, allowing yeast to overgrow.

What happens if I miss a dose of amoxicillin-clavulanate? 

If a dose is missed, it should be taken as soon as you remember. However, if it is almost time for the next scheduled dose, skip the missed dose and resume the regular schedule. Do not take double doses to make up for the missed one.

Is amoxicillin-clavulanate safe to take during pregnancy or breastfeeding? 

It is not known if amoxicillin-clavulanate harms an unborn baby, but the drug does pass into breast milk. If you are pregnant or breastfeeding, tell your healthcare provider so they can advise whether amoxicillin-clavulanate is safe for you to take. 

What is the difference between amoxicillin and amoxicillin-clavulanate? 

Amoxicillin is a single antibiotic. Amoxicillin-clavulanate (Augmentin) is a combination antibiotic that contains amoxicillin plus clavulanate. The addition of clavulanate helps the medication fight bacteria that can become resistant to amoxicillin alone.

Does Augmentin affect birth control pills? 

It is possible. This antibiotic may make birth control pills less effective. Providers often recommend using a backup method of contraception while taking Augmentin.

Can I crush an amoxicillin-clavulanate tablet? 

It depends. Standard immediate-release and extended-release tablets should typically not be crushed due to their coating. However, chewable tablets can be chewed or crushed. Extended-release tablets often have a score line allowing them to be split in half.

Does Amoxicillin-Clavulanate cause rashes? 

Yes, skin rashes are a common side effect of amoxicillin-clavulanate. While mostly mild, rashes can sometimes indicate a more serious allergic reaction or interaction, such as when they are severe or accompanied by swelling, itching, blisters, peeling, or painful red or purple skin.

compare medications

Compared: Amoxicillin-Clavulanate, Amoxicillin, Cephalexin, Azithromycin, Doxycycline, or Sulfamethoxazole-Trimethoprim?

There are several medications that your doctor can prescribe in place of amoxicillin-clavulanate. Here are a few possible alternatives below.

  • Amoxicillin – A penicillin antibiotic that contains only amoxicillin and is prescribed to treat bacterial infections.
  • Cephalexin – A cephalosporin antibiotic, that is prescribed to treat bacterial infections such as pneumonia and respiratory tract infections.
  • Azithromycin – A macrolide antibiotic that may be prescribed when people have a penicillin allergy.
  • Doxycycline – A tetracycline antibiotic that may be prescribed for acne as well as bacterial infections and can be used when someone has an allergy to penicillin.
  • Sulfamethoxazole-Trimethoprim – A combination antibiotic that is prescribed to treat bacterial infections such as UTIs and ear infections.
Disclaimer

Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions.  Learn more about our editorial standards here.

Prescription medications made easy with TelyRx.

Start Your Rx Journey for $22

You may also like

What to Know About Ozempic (Semaglutide)

What to Know About Mounjaro (Tirzepatide)

What Is Wegovy? Uses, Side Effects, Dosage &...

What Is Vardenafil?

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Medications

What Is Ondansetron? Uses, How it Works, Dosage & FAQs

by Mariah Powers
written by Mariah Powers
The Wellness Collective

What to Know About Ondansetron

Reviewed by Ashley Robinson, PharmD, Pharmacy Manager for TelyRx

Ondansetron via TelyRx.

Table of Contents

Ondansetron is a prescription antiemetic medication primarily used to treat nausea and vomiting. Ondansetron may be administered as a pill, liquid solution, or injection. 

Common side effects include headaches, constipation, fatigue or malaise, dizziness, and diarrhea.

how does Ondansetron work?

Ondansetron essentially runs interference on the body’s natural response to nausea. When a person’s body is exposed to chemotherapy drugs and other situations that induce nausea, cells in the small intestine release serotonin that binds to 5-HT3 receptors in the vagus nerve connecting the brain and gut. After these receptors become active, the “vomiting reflex” is triggered within the body.

Ondansetron works by binding to the 5-HT3 receptors, leaving nowhere for the serotonin to bind. This cuts off communication between the brain and gut, minimizing the vomiting reflex in the process.

drug facts

Common Brands Zofran ODT, Zuplenz, Zofran
Drug Class Selective 5-HT3 Receptor Antagonist
Generic Status Generic version of Zofran
Availability Prescription Only

dosing

Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. 

A patient’s overall health, and their liver function in particular, is used to determine their ondansetron dose. Typical prescriptions for ondansetron include:

  • Chemotherapy-Induced Nausea: For adults taking high-risk trigger medication for chemotherapy who experience nausea, a dose of 24 milligrams (mg) taken half an hour before treatment is standard. Patients taking moderate-risk trigger medication are often prescribed an 8-mg dose taken before their chemotherapy, and another 8-mg dose taken eight hours later. Subsequent doses of 8 to 12 mg may be prescribed every 12 hours for the next one to two days. 
  • Radiation Therapy: Most providers recommend an ondansetron dose of 8 mg taken one to two hours before the radiation therapy session.
  • Post-Operative Nausea: For patients undergoing an operation, providers frequently prescribe a dose of 16 mg of ondansetron taken one hour before anesthesia is induced.

Ondansetron is also frequently prescribed to treat general nausea as an off-label use (see more information below). 

Always follow your healthcare provider’s instructions for exact dosing.

FDA-approved uses

Ondansetron is FDA-approved to prevent chemotherapy-induced, radiation-induced, and postoperative nausea and vomiting. In chemotherapy cases, ondansetron can be used as a nausea preventative during initial and repeat cancer treatment courses.

common off-label uses

You may see Ondansetron prescribed for uses that are not “FDA-approved.” This is a very common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.

Common off-label uses for ondansetron currently found in medical research and practice include:

  • Hyperemesis Gravidarum: Ondansetron can treat dehydration and malnutrition brought on by hyperemesis gravidarum, commonly called extreme morning sickness, in cases where first-line medications have not been effective or cannot be used.
  • Gastroenteritis: Ondansetron can help keep fluids down to assist with IV hydration for people with gastroenteritis, or stomach flu. This off-label use is frequently employed in emergency rooms and urgent care centers.
  • Cyclic Vomiting Syndrome: This condition – characterized by repeated attacks of severe nausea and vomiting – can be treated with ondansetron.
  • Migraine-Associated Nausea: Headache specialists may prescribe ondansetron to alleviate migraine-associated nausea.

side effects

Most patients tolerate ondansetron well. Side effects are typically mild, and will resolve when the medication course is completed. These common side effects include:

Common Side Effects

  • Headache
  • Constipation
  • Fatigue or malaise
  • Dizziness
  • Diarrhea

Serious Side Effects

Serious side effects are rare, but it’s important to know what to look for if they do occur.

Serious, less common side effects from taking ondansetron can include:

  • QT Prolongation: This rare condition causes the heart to take longer to recharge between beats. If untreated, QT prolongation can lead to fainting or a dangerously fast heartbeat.
  • Serotonin Syndrome: If ondansetron is taken with medications meant to boost serotonin levels, this can increase the risk of a condition called serotonin syndrome. Symptoms include confusion, a rapid heart rate, muscle stiffness, and tremors.
  • Severe Allergic Reaction: As with many medications, ondansetron can cause a severe allergic reaction in some people with symptoms including hives, a rash, and swelling of the face, lips, tongue, and throat.
  • Bowel Blockage: Ondansetron’s constipating effects can, in rare cases, cause a serious bowel blockage. This is especially common in people who have recently undergone abdominal surgery.
  • Myocardial Ischemia: Ondansetron may cause blood flow to decrease. This can lead to symptoms like chest pain.

Call your doctor immediately if you experience any concerning or prolonged symptoms.
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Ondansetron

Ondansetron is used to treat or prevent acute, severe nausea and vomiting from occurring, especially around chemotherapy, radiation, or surgery.

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pharmacist tips

  1. Plan Ahead for Nausea: For many people, ondansetron works best as a preventative measure for nausea. This is why providers typically recommend taking ondansetron prior to chemotherapy or radiation sessions.
  2. Stay Hydrated: Ondansetron minimizes the urge to vomit, but it does not replenish lost fluids. Sipping electrolyte-rich fluids during the day while taking ondansetron is the best way to stay hydrated.
  3. Watch Your Regularity: Constipation can occur when taking ondansetron, especially if multi-day course treatments are involved. Keep an eye on your bowel movements and, if you become constipated, talk to your doctor about options like a stool softener.
  4. Handle Your Dose With Care: Many ondansetron tablets come in foil packets, and they can easily break or disintegrate if you try to force them out of their packaging. For liquid doses, use the medication syringe or dose cup to ensure the right amount of medication (common spoons are not reliable measurement tools).
  5. Watch out for Dizzy Spells: Ondansetron does not cause too much sedation, but it can induce dizziness. Avoid driving or operating heavy machinery after dosing until you have a good idea of how the medication affects your motor skills.

drug interactions

Numerous interactions between ondansetron and other drugs have been documented. The most common interactions include:

  • Apomorphine: This drug, which is commonly used to treat Parkinson’s disease, should never be taken with ondansetron. Doing so can cause a severe drop in blood pressure and lead to loss of consciousness.
  • Serotonergic Drugs: When taken with ondansetron, drugs heavy in serotonin can increase the risk of serotonin syndrome. These drugs include selective serotonin reuptake inhibitors like Prozac and Zoloft, selective serotonin-norepinephrine reuptake inhibitors like Effexor, and triptans used to treat migraines.
  • QT-Prolonging Drugs: This broad class of drugs includes antibiotics such as ciprofloxacin and anti-arrhythmics such as amiodarone, which affect heart rhythm. Taking these medications with ondansetron can increase the risk of heart rhythm problems.
  • St. John’s Wort: This common herbal supplement reduces the amount of ondansetron in your bloodstream, making ondansetron  less effective.

Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.

FAQs

How long does it take for ondansetron to start working?

Most people notice the effects of oral ondansetron within 30 to 60 minutes of taking their dose. The drug takes about two hours to reach its full effects.

Does ondansetron make you sleepy?

Although its common side effects include fatigue and dizziness, ondansetron is not considered as likely to induce significant drowsiness as many other anti-nausea drugs. Excessive sleepiness while taking ondansetron may be due to an underlying condition.

Can you take ondansetron on an empty stomach?

Yes, you can take ondansetron on an empty stomach. However, taking your ondansetron dose with food may be the best way to alleviate existing nausea symptoms.

Is ondansetron safe to take during pregnancy?

Ondanetron is commonly prescribed to prevent and treat morning sickness. However, it is advised to speak with your provider, as some studies have linked ondansetron to a slightly increased risk of cleft palate if the drug is taken during the first trimester.

Does ondansetron help with motion sickness?

Standard guidelines suggest ondansetron is not effective at treating common motion sickness. For many people, motion sickness originates in the inner ear and vestibular system, which do not use the 5-HT3 receptors that ondansetron binds to.

Does ondansetron cause constipation?

Yes, ondansetron can cause constipation and this is listed as one of the drug’s most common side effects. This occurs because blocking serotonin can slow down how quickly stool moves through the body.

Can I take ondansetron with ibuprofen or Tylenol?

It is recommended to speak with your doctor before taking ibuprofen or Tylenol if you’re already taking ondansetron. That said, there are no known drug interactions between ondansetron and ibuprofen or Tylenol. 

Is ondansetron a narcotic or controlled substance?

No, ondansetron is not a narcotic with potential for addiction and abuse, and has not been classified as a controlled substance. However, you still need a doctor’s prescription to obtain ondansetron.

What is the difference between ondansetron and Zofran?

There is no therapeutic difference between ondansetron and Zofran – the latter was the original brand name version of the former generic. Zofran has largely been discontinued in the U.S. and ondansetron is sold under other names.

compare medications

Compared: Ondansetron, Dolasetron, Promethazine, Scopolamine, or Diphenhydramine?

Ondansetron is a commonly prescribed medication used to prevent nausea and vomiting before it occurs. It is similar to other drugs available, including the following ondansetron alternatives:

  • Dolasetron: Like ondansetron, dolasetron is in the 5-HT3 agonist drug class and used to prevent nausea. However, it is prescribed less frequently due to its higher risk of inducing heart rhythm changes compared to ondansetron.
  • Promethazine: Promethazine is an antihistamine with heavy sedating effects, including significant “brain fog.” Ondansetron is usually preferred for patients who need to remain alert while taking their medication, but promethazine may be more effective for motion sickness or nausea originating in the inner ear.
  • Scopolamine: Scopolamine is frequently prescribed as a “skin patch” for treating sea sickness. This makes it more effective at treating motion-related nausea, whereas ondansetron is considered a front line option for nausea originating from chemotherapy or radiation.
  • Diphenhydramine: Commonly sold under the brand name Benadryl, diphenhydramine has antihistamine properties that make it effective for treating mild nausea or vomiting. It can cause heavy sedation. Ondansetron is more potent and effective for targeting nausea without the sedating effects.
Disclaimer

Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions.  Learn more about our editorial standards here.

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Medications

What Is Imiquod Cream? Uses, Side Effects, Dosage & FAQs

by Mariah Powers
written by Mariah Powers
The Wellness Collective

What to Know About Imiquimod Cream

Reviewed by Ashley Robinson, PharmD, Pharmacy Manager for TelyRx

Imiquimod cream via TelyRx.

Table of Contents

Imiquimod is a topical cream in the immune response modifier drug class. It is primarily used to treat three conditions: actinic keratosis (AK), superficial basal cell carcinoma (sBCC), and external genital or perianal warts (EGW) caused by human papillomavirus (HPV). 

Unlike many topicals, which provide antiviral or anti-tumor treatment, imiquimod essentially flags abnormal skin cells and the body eliminates them through natural processes. Many of the most common side effects involve local skin reactions, but serious side effects are rare.

how does Imiquimod cream work?

Imiquimod is thought to work as an agonist for Toll-like receptor 7 (TLR7), a group of sensors concentrated in the immune system. Imiquimod binding to TLR7 receptors triggers the release of cytokines, messengers for the immune system that act as a signaling device for white blood cells. 

After receiving the signal, white blood cells converge on the site of application and work to eradicate abnormal cells. This can cause skin around the application to become red, swollen, or crusty – these are signs the medication is working as intended.

drug facts

Common Brands Aldara, Zyclara
Drug Class Immune Response Modifier
Generic Status Generic version of Zyclara
Availability Prescription Only

dosing

Note: Dosing information below is educational only. Your prescribing physician will determine your specific dose based on your individual health needs. 

Imiquimod is a topical cream applied directly to the affected skin. Dosage and application schedule depends on the condition being treated, as well as patient factors like age and severity of symptoms. The most common prescribed forms of imiquimod include 5%, 2.5% and 3.75%.

  • Actinic Keratosis (AK): This condition, characterized as rough or scaly patches of skin brought on by overexposure to the sun, is often treated with two weekly applications of Aldara 5% for a 16-week course. Zyclara 3.75% may be prescribed once daily with an intermittent “two weeks on, two weeks off” schedule to help the body rest.
  • External Genital and Perianal Warts: To treat external genital and perianal warts brought on by human papillomavirus (HPV), doctors may prescribe Aldara 5% three times per week for up to 16 weeks or whenever the warts have fully cleared. Alternatively, providers may prescribe a daily application of Zyclara 3.75% for up to eight weeks.
  • Superficial Basal Cell Carcinoma (sBCC): To treat sBCC, providers frequently prescribe a six-week Aldara 5% course consisting of five applications per week. 

Always follow your healthcare provider’s instructions for exact dosing.

FDA-approved uses

Imiquimod topical cream is FDA-approved to treat typical, nonhypertrophic actinic keratosis on the face or scalp of immunocompetent adults. It is also FDA-approved to treat external genital and perianal warts from HPV, and to treat biopsy-confirmed sBCC on the trunk, neck, and extremities for people who are not good candidates for surgical procedures. 

common off-label uses

You may see Imiquimod prescribed for uses that are not “FDA-approved.” This is a very common and legal practice called “off-label” prescribing, where a doctor uses their clinical judgment to prescribe a drug for a different (but well-researched) purpose.

Common off-label uses for imiquimod topical cream found in clinical practice and research include:

  • Molluscum Contagiosum: Providers may prescribe imiquimod for adults with this condition, which is characterized by small, viral bumps on the skin.
  • Bowen’s Disease: This early-stage form of skin cancer may be treated with imiquimod if surgery is not an option.
  • Common Warts: Imiquimod can treat stubborn warts on the hands and feet that have not responded to freezing or salicylic acid.
  • Lentigo Maligna: Imiquimod may be used to treat lentigo maligna, an early melanoma that may occur in a location that is not convenient for surgery.

side effects

Local skin response side effects are common when taking imiquimod – so common, in fact, that they’ve been dubbed the “imiquimod reaction” due to their frequency. Imiquimod reaction side effects around the application site include:

Common Side Effects

  • Redness and swelling
  • Itching and burning
  • Crusting and scabbing

Other side effects can include headache and flu-like symptoms such as fever, fatigue, and muscle aches.

Serious Side Effects

Serious side effects are rare, but it’s important to know what to look for if they do occur.

Serious side effects of using imiquimod topical cream include:

  • Severe Local Inflammation: Imiquimod reaction is common, but it is advised to contact a provider if you experience deep skin ulcers, significant bleeding, or severe pain around the application site.
  • Difficulty Urinating: Swelling of the vulva and urinary opening can lead to pain and difficulty during urination.
  • Flu Symptoms: People who use imiquimod may experience a “flu response” with high fever, chills, and body aches.
  • Skin Color Changes: Imiquimod can cause permanent lightening or darkening of skin around the application site.
  • Severe Allergic Reaction: As with many types of medication, imiquimod can trigger a severe allergic reaction in some people. Hives, itchy skin, and swelling of the face, lips, tongue, and throat are among the most common symptoms of this rare reaction.

Call your doctor immediately if you experience any concerning or prolonged symptoms.
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Imiquimod Cream

Imiquimod is topical prescription indicated for the treatment of genital and perianal warts. 

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pharmacist tips

  • Take Pre-Application Measures: It is recommended to only apply imiquimod to dry skin, as damp skin can cause irritation. Before applying the cream, it is advised to wash and dry both the application area and both hands. 
  • A Little Goes a Long Way: You only need a thin layer of cream for the imiquimod to be effective. Simply rub the cream into your skin until it is no longer visible. For genital and perianal warts, providers generally recommend rubbing cream into the wart without doing so on the surrounding skin.
  • Avoid Bandages: It is not advised to cover the application site with a bandage, even if a local skin response occurs. Bandages can trap medication and cause severe burns. Loose gauze is generally seen as the most acceptable covering.
  • Stay Hygienic: Wash your hands thoroughly after each application. This helps ensure the cream never enters your eyes, nose, or mouth. 
  • Practice Sun Protection: Since imiquimod can cause sun sensitivity, protective layers and high-SPF sunscreen on the treated area are advised when you go outside.
  • Discard Cream Packets: Throw away used imiquimod packets. Some cream may remain inside the packet, but it will quickly lose its preservatives and effectiveness. It is recommended to open a new packet for each application.

drug interactions

  • Barrier Contraceptives: Imiquimod can weaken the effectiveness of condoms, diaphragms, and other types of barrier contraceptives. This can increase the risk of both pregnancy and transmission of genital warts.

The body quickly absorbs imiquimod, so “pill-to-pill” interactions are not common, but local interactions may still occur. 

  • Immunosuppressants: Oral steroids, chemotherapy, and other immunosuppressant drugs that lower the immune system may decrease the effectiveness of imiquimod.
  • Other Topicals: Medical creams and exfoliants can worsen irritation – sometimes to dangerous levels – if applied to the same spot where imiquimod has been used.

Always give your doctor and pharmacist a complete list of all your medications, vitamins, and supplements to check for potential interactions.

FAQs

Why does my skin look worse after starting imiquimod?

Imiquimod triggers an immune response that causes inflammation around the application site. This is a sign the medication is working properly, but the inflammation can cause reddening, scabbing, and crusting.

How long should I leave imiquimod on my skin before washing it off?

Standard guidelines for using imiquimod recommend leaving the cream on for about eight hours before washing it off. Many people apply the cream at bedtime and leave it on overnight. If treating genital warts, providers may recommend leaving the cream on for six to 10 hours. Leaving the cream on longer than prescribed can cause the skin to break down without treating the condition.

Can I have sex while using imiquimod?

Most providers recommend abstaining from sex while the cream is on the skin. This not only prevents the partner’s skin from becoming irritated, but also because imiquimod compromises the effectiveness of barrier contraceptives like condoms and diaphragms. It is generally advised to avoid sexual contact until the cream has been removed.

Does imiquimod kill the virus (HPV) or just the warts?

Imiquimod does not directly kill viruses. Rather, the medication signals to your body that abnormal cells are present in the skin and natural processes in the immune system are used to eradicate the abnormal cells. HPV may continue to reside in skin peripheral to the original application site, so new warts may appear during treatment.

Is it normal to have a fever while using imiquimod?

Many people experience a flu response after taking imiquimod, with a fever being one of the most common flu response symptoms. If the fever exceeds 101 degrees or is accompanied by chills, it is advised to contact your doctor immediately. 

Can I use imiquimod on my face for actinic keratosis?

Yes, imiquimod is FDA-approved to treat actinic keratosis (AK) on the face and is one of the most frequently prescribed medications for doing so. Use the topical cream to treat AKs as directed by your healthcare provider. 

Is imiquimod safe to use during pregnancy?

Research is limited on whether imiquimod is safe to use during pregnancy, but many providers encourage pregnant patients to explore other medication options first.  

Does imiquimod weaken condoms or diaphragms?

Yes, chemicals in imiquimod topical cream can weaken and destabilize the latex used in condoms and diaphragms. This makes the barrier contraceptives prone to tearing and increases the risk of pregnancy and STD transmission.

Can I go out in the sun while using imiquimod?

Yes, you can go out in the sun while using imiquimod, but the medication causes sunlight sensitivity and extra precautions are strongly recommended. Protective clothing and high-SPF sunscreen can be effective guardrails. If you apply imiquimod to your scalp or face, a wide-brimmed hat is also advised.

Should I cover the treated area with a bandage?

No, it is not recommended to use a bandage to cover an area treated with imiquimod topical cream. Covering can increase how much of the drug is absorbed in the bloodstream and exacerbate swelling and other local skin reactions. Most doctors recommend leaving the area uncovered after applying the topical cream.

Can you put makeup over Imiquimod?

No, it is not advised to wear makeup over imiquimod that has been recently applied and is still actively “working.” Makeup can interfere with the cream’s effectiveness. It is recommended to only put on makeup after the cream has been applied, worn for about eight hours, and washed off.

compare medications

Compared: Imiquimod, Podophyllotoxin, or Diclofenac?

Imiquimod topical cream is an immune response modifier that helps the body identify and eliminate abnormal skin cells. Below, we’ll look at two imiquimod alternatives:

  • Podophyllotoxin: Podophyllotoxin is used to treat genital warts by acting as a cytotoxic agent that kills warts directly. It acts quickly and can clear warts in a matter of weeks, but imiquimod has a lower recurrence rate because it helps the body identify abnormal skin cells.
  • Diclofenac: Diclofenac is a topical nonsteroidal anti-inflammatory drug (NSAID) used to treat actinic keratosis. Its side effects are mild compared to imiquimod’s and generally do not produce as much redness or crusting. However, diclofenac schedules tend to be significantly longer and the drug may not be as effective as imiquimod for treating advanced or stubborn precancerous lesions.
Disclaimer

Important: Information on this page is for educational purposes only. Prescribing decisions are made by independent, licensed providers. TelyRx operates technology-enabled pharmacies and a telehealth platform that connects patients with board-certified licensed providers. Prescriptions, when provider-approved and issued, are filled and shipped by TelyRx-affiliated pharmacies. We do not employ physicians or make prescribing decisions.  Learn more about our editorial standards here.

Prescription medications made easy with TelyRx.

Start Your Rx Journey for $22

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What to Know About Ozempic (Semaglutide)

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