Lindane dosing, indications, interactions, adverse effects, and more

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Sections lindane
Dosing & Uses
Adverse Effects
Warnings
Pregnancy
Pharmacology
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Patient Handout
Formulary

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

lotion/shampoo

Scabies

Lotion: Apply thin layer and massage on skin on entire body except face; bathe and remove drug 8-12 hr after application

Head Lice or Crab Lice

Apply 1-2 oz of shampoo (not to exceed 2 oz) on dry hair; leave on 4 min, lather, rinse, remove nits with fine comb

One time application usually sufficient; may use other pediculicide in 1 wk if necessary

Dosage Forms & Strengths

lotion/shampoo

Scabies

Lotion: Apply thin layer and massage on skin on entire body except face; bathe and remove drug 8-12 hr after application

Head Lice or Crab Lice

Apply 1-2 oz of shampoo (not to exceed 2 oz) on dry hair; leave on 4 min, lather, rinse, remove nits with fine comb

One time application usually sufficient; may use other pediculicide in 1 wk if necessary

Frequency Not Defined

Slight local irritation (including eczematous eruptions, rash, conjunctivitis)

Repeated application frequently causes contact dermatitis

CNS toxicity (seizures)

Cardiac arrhythmia

Ataxia

Dizziness

Restlessness

Pain

Seizure

Alopecia

Urticaria

Hematuria

Pulmonary edema

Hepatitis

Nausea/vomiting

Paresthesia

Aplastic anemia

Black Box Warnings

Neurotoxicity, including seizures and death, has been reported with repeat or prolonged application, and rarely with single application.

Use with caution in those at risk for neurotoxicity including infants, children, elderly persons, those who weigh <50 kg, or those with a history of seizures. It is contraindicated in premature infants and in those with uncontrolled seizure disorders. Counseling the patient on proper use is required.

Use only in patients who have failed first line treatments

Provide patient with medication use guide with instructions on how to use

Contraindications

Premature neonates (<28 do) (increased absorption), uncontrolled seizure disorder, hypersensitivity, Norwegian (crusted) scabies, skin conditions that may increase systemic absorption (weeping surface, inflamed skin etc)

Cautions

Not first-line

Risk of serious neurotoxicity in children weighing <50 kg

Use caution in hepatic impairment

HIV infection, history of head trauma or a prior seizure, CNS tumor, severe hepatic cirrhosis, excessive use of alcohol, abrupt withdrawal from alcohol or sedatives, concomitant use of medications known to lower seizure threshold

Pregnancy & Lactation

Pregnancy Category: C

Lactation: distributed in breast milk, do not nurse for 24 hr post-application (express milk & discard)

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Following absorption through the chitinous exoskeleton of arthropods, cyclic chlorinated hydrocarbons like lindane presumably stimulate the nervous system, resulting in seizures & death of parasite

Pharmacokinetics

Absorption: <13% (slowly & incompletely absorbed through intact skin when applied topically)

Metabolism: Liver

Excretion: Urine & feces

Peak serum time: 6 hr

Excretion: Urine; feces

Half-life: 17-22 hr (children)

BRAND	FORM.	UNIT PRICE	PILL IMAGE
lindane topical -	1 % shampoo

Patient Handout

LINDANE SHAMPOO - TOPICAL

(LIN-dane)

COMMON BRAND NAME(S): Kwell

WARNING: This drug should only be used if other, safer medicines (such as permethrin) cannot be used or have not been effective. Do not use lindane to re-treat the same lice infestation after the first lindane treatment does not work.Rarely, lindane has caused seizures (sometimes death) after prolonged or repeated use. Rare (sometimes fatal) nervous system reactions such as seizures may occur, even after correct one-time use of lindane.Lindane should not be used in premature infants or patients with poorly controlled seizures. In addition, lindane should be used with caution in infants, children, older adults, patients with skin conditions (such as skin rash, psoriasis), and patients with low body weight (such as less than 110 pounds or 50 kilograms).Itching may occur after either successful or failed treatments. Avoid re-applying lindane for a few months after use.

USES: This medication is used to treat head and crab (pubic) lice. Lice are tiny insects that lay eggs (nits) on hair shafts. Lice can easily spread to those in close contact with you. Lindane works by killing the lice and nits. An infection with lice is also called an infestation. This drug should not be used to prevent lice infestation or re-infestation.

HOW TO USE: Read the Medication Guide provided by your pharmacist before you start using lindane. If you have any questions, consult your doctor or pharmacist.This drug can be poisonous if used incorrectly. Do not take this drug by mouth, and avoid contact with your eyes, nose, or mouth. If lindane gets in these areas, rinse with water immediately and get medical help right away if a burning feeling remains. Do not use if there is skin irritation (such as open wounds, rash, cuts, or sores) on the area to be treated unless directed to do so by your doctor. Do not apply any oil-based hair products (such as oil treatments or oil-based hair dressings/conditioners) immediately before or after using lindane. If you are currently using any of these products, they must be washed off before you apply lindane. Oil-based products may increase the absorption of lindane, increasing the risk of side effects.Wash your hair with your regular shampoo (without conditioner) and dry it well. Wait at least 1 hour after drying your hair before using lindane shampoo.Most adults require only 1 ounce (30 milliliters), but those with longer and thicker hair should use no more than 2 ounces (60 milliliters).Shake the bottle well before use. For application, use gloves made of nitrile, latex with neoprene, or sheer vinyl to avoid unnecessary contact with your skin. Do not use natural latex gloves because more lindane can penetrate that type of glove. Apply a small amount of lindane to lightly coat your hair and scalp as directed by your doctor. Work thoroughly (do not lather) through dry hair. Do not add water. Make sure to include the fine hairs along your neck and behind your ears. Leave lindane in your hair for exactly 4 minutes (use a timer or clock). Do not cover your hair with anything (such as a shower cap or towel). After 4 minutes, add a small amount of warm (not hot) water, rub until a lather forms, then immediately rinse away all lather. Try to keep lindane from touching other parts of your body. Do not re-apply. Dry your hair with a towel, then use the special nit comb or tweezers to remove the nits. It is best to have someone else do this for you to make sure all the nits are removed. They should wear gloves while removing the nits.Close the bottle with any remaining lindane and throw it away out of reach from children and pets. Wash your hands well after treatment.If an infant or young child is prescribed lindane, watch the child carefully while the lindane shampoo is in the hair to make sure the child does not touch the hair then put the hands in the mouth.If you are putting lindane shampoo on someone else, use gloves as directed above. Wash your hands well afterwards.The easiest way to tell if you have lice is to look for small gray-white nits fixed to the hair shafts. Symptoms of lice include an intense itching, mostly on the scalp, but also possibly on the eyebrows, eyelashes, beard, or groin. Itching may continue even after treatment with lindane shampoo. Even if the lindane kills all the lice, the dead lice can still make you itch for a long time after treatment. Ask your doctor about other medications that may be used to soothe the itching.Tell your doctor if your condition lasts or gets worse 1-2 weeks after treatment.

SIDE EFFECTS: See also Warning section.Stinging, burning, or redness of the skin may occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.Tell your doctor right away if you have any serious side effects, including: vomiting, dizziness, drowsiness, seizures.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: See also Warning section.Before using lindane shampoo, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: other skin conditions (such as psoriasis, dermatitis), HIV infection, history of serious head injury, seizures, brain tumors, liver disease, alcohol abuse, sudden stopping of regular alcohol or sedative use.This drug may make you dizzy or drowsy. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).Before having an imaging test (such as X-rays, CT scan) requiring the use of dye, tell your doctor that you have used this medication.This medication is not recommended for use during pregnancy. Consult your doctor for more details. If you are pregnant, do not apply lindane shampoo to others unless it is absolutely necessary and you have discussed it with your doctor. Use gloves as directed. (See How to Use section.)Lindane passes into breast milk and could have undesirable effects on a nursing infant. Your baby should not come into direct contact with your skin while it has lindane on it. In addition, to lessen the chance of exposing your baby to the medication and possible side effects, pump your breast milk and discard it for 24 hours after using lindane. During this time, feed your baby formula or breast milk you stored from before you used lindane shampoo.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include nausea, vomiting, restlessness, unsteadiness, seizures, irregular heartbeat.

NOTES: Do not share this medication with others.Lice are easily passed from one person to another. All family members and people you have close contact with (especially if you have crab/pubic hair lice) should be examined.After treatment, soak all possibly infested combs, brushes, and other hair care items in water that has been heated to 130 degrees F (54 degrees C) for 5 to 10 minutes. Also, any recently worn clothing, hats, sheets/blankets, plush/fabric toys, and towels should be washed in very hot water or dry-cleaned.

MISSED DOSE: Not applicable.

STORAGE: Store at room temperature. Do not freeze. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

Formulary

FormularyPatient Discounts

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The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

View explanations for tiers and restrictions

Tier	Description
1	This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2	This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC	NOT COVERED – Drugs that are not covered by the plan.

Code	Definition
PA	Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL	Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST	Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR	Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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