Carac Cream: Uses, Dosage, Side Effects, Precautions and Alternates

Quick overview

Carac Cream contains fluorouracil, a topical antineoplastic from the antimetabolite class. It is a prescription cream used by adults to treat pre-cancerous actinic (solar) keratosis on the face and front of the scalp, as well as superficial basal cell carcinoma. It is applied once daily directly to the skin and is not intended for use in children or anyone under 18 years old.

What is Carac Cream

Carac Cream is a prescription cream used by adults to treat pre-cancerous skin spots called actinic or solar keratosis on the face and front of the scalp. It is also used for a type of early skin cancer called superficial basal cell carcinoma.

Carac Cream uses

• Treating multiple actinic (solar) keratoses of the face and front of the scalp
• Treating superficial basal cell carcinoma
• Treats actinic keratosis
• Treats solar keratosis
• Targets abnormal sun-damaged skin cells
• Used mainly on the face and anterior scalp

Benefits of Carac Cream

• Can clear pre-cancerous skin lesions after a short course of treatment
• Continuing treatment up to 4 weeks leads to greater clearing of lesions than shorter courses
• Provides once-daily topical treatment
• Targets precancerous sun-damaged cells
• Can treat multiple lesions across an affected area
• Avoids a procedure for some patients

How Carac Cream works

Carac works by interfering with how skin cells make DNA and RNA, which are needed for cells to grow and divide. This effect is strongest on cells that are growing and dividing quickly, such as abnormal skin cells, causing them to die while leaving normal cells less affected.

Carac Cream dosage

Apply Carac only to the skin — do not take it by mouth and do not use it in the eyes, nose, mouth, or on mucous membranes. Clean the treatment area, rinse well, dry with a towel, and wait about 10 minutes before applying the cream. Apply using your fingertips, using just enough to cover the affected area with a thin film, then wash your hands right away after applying. Do not cover the treated skin with a dressing or bandage unless your doctor tells you to.

A moisturizer or sunscreen may be applied about 2 hours after the cream; do not use other skin products, creams, lotions, or cosmetics on the area unless your doctor says it is okay. Avoid sun exposure and tanning beds during treatment, and wear a hat and sunscreen when outdoors.

Carac is not for use in children or anyone under 18 years old. No notable differences in safety or effectiveness were seen in patients 65 and older compared with younger adults.

If you miss an application, apply it when you remember, but skip it if it is almost time for your next dose — do not apply two doses at once.

Available forms and strengths

• Cream

Side effects of Carac Cream

Common

• Skin redness, irritation, and dryness
• Scaling or peeling of skin
• Burning or stinging sensation
• Pain, tenderness, or soreness at the application site
• Swelling of treated skin
• Skin erosion (loss of the top layer of skin)
• Eye irritation (burning, watering, sensitivity, stinging, itching)
• Skin darkening or scarring
• Small blood vessels visible under the skin
• Headache, common cold, or sinus infection (less common)

Serious

• Severe pain or swelling of treated skin
• Severe itching, burning, or irritation
• New or worsening skin sores
• Fever or chills
• Severe stomach pain, bloody diarrhea, or vomiting (possible sign of DPD enzyme deficiency reaction)
• Signs of an allergic reaction: hives, difficulty breathing, swelling of the face, lips, tongue, or throat

Warnings and precautions

• People may have a delayed allergic reaction to fluorouracil, and skin testing may not reliably confirm it.
• Stop using Carac if you develop symptoms of DPD enzyme deficiency, a rare condition that can cause serious, even life-threatening reactions with fluorouracil-containing products.
• Do not apply Carac to the mucous membranes (such as inside the mouth, nose, or eyes), since this can cause inflammation and sores.
• Carac should not be used by anyone with a known DPD enzyme deficiency, since the drug may build up and cause serious toxic effects.
• Carac can be fatal to pets if they lick or swallow it, so keep it and any treated skin, clothing, or surfaces away from animals.
• Carac must not be used during pregnancy or if you may become pregnant, since it can cause serious harm to an unborn baby, including birth defects and miscarriage. Tell your doctor right away if you become pregnant while using it.
• It isn't known whether fluorouracil passes into breast milk. Because of the potential for serious side effects in a nursing baby, you and your doctor should decide whether to stop breastfeeding or stop using Carac.
• No routine renal dose adjustment is established for topical use. No routine hepatic dose adjustment is established. No major direct topical interaction with alcohol is established. Carac is not generally expected to impair driving.

Storage

• Store at room temperature, 68° to 77°F (20° to 25°C)
• Keep away from moisture and heat; do not freeze
• Keep the container tightly closed when not in use
• Keep out of reach of children and pets
• Throw away unused medicine
• Fluorouracil can be fatal to pets if licked or ingested — keep pets away from the tube and from treated skin, and safely discard or clean any cloth or applicator that touched the cream

When to see a doctor

• Get emergency help right away if you have signs of a serious allergic reaction, such as trouble breathing, throat tightness, or swelling of the lips, face, or tongue, or hives.
• Stop using Carac and contact your doctor right away if you develop stomach pain, bloody diarrhea, vomiting, fever, or chills, since these could be signs of a rare but serious reaction linked to a DPD enzyme deficiency.
• Call your doctor if you have severe pain or swelling of treated skin, severe itching, burning, or irritation, or new or worsening skin sores.
• If Carac is accidentally swallowed, seek emergency medical help or contact a poison control service right away.

Alternatives

• Efudex
• Fluorouracil 5% cream
• Imiquimod
• Diclofenac topical gel