lindane (Rx)

Brand and Other Names:

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

lotion/shampoo

  • 1%

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

  • 1%

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

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Adverse Effects

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

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Warnings

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

Instruct patients or their caregivers on proper use of shampoo or lotion, including the amount to apply, how soon to wash the drug off, and the importance of avoiding repeated application

Inform patients that pruritus may persist after successful treatment and is not an indication for further treatment

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

Use caution in hepatic impairment

Dermatologic and Sensitivity Reactions

  • If primary irritation or hypersensitivity occurs, discontinue treatment and remove drug with soap and water
  • Alopecia, dermatitis, pruritus, and urticaria reported
  • Pruritus (caused by an acquired sensitivity to the ectoparasites and their products) frequently persists for one to several weeks following treatment, does not indicate treatment failure, and is not an indication for further treatment; oral antihistamines and/or topical corticosteroids may be used to help relieve pruritus

CNS Effects

  • Neurotoxicity, including seizures and deaths, occurred following repeated or prolonged topical application; however, rare cases reported after single application; serious CNS effects have occurred more frequently with lindane lotion than with lindane shampoo
  • Infants, children, geriatric patients, patients weighing <50 kg, and patients with certain other skin conditions may be at greater risk of serious neurotoxicity than other individuals
  • Dizziness, headache, pain, and paresthesia reported
  • Use with caution in patients at increased risk of seizure (eg, patients with HIV infection, a history of head trauma, seizure history, CNS tumor, severe hepatic cirrhosis, excessive alcohol consumption, or concomitant use of agents that lower the seizure threshold, or who are undergoing abrupt discontinuance of alcohol or sedatives)
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Pregnancy & Lactation

Pregnancy

Use in pregnant women associated with neural tube defects and mental challenges; not recommended for treatment of pediculosis during pregnancy; pregnant patients should avoid contact with lindane as much as possible if applying to others

Animal data

  • Animal studies suggest possible neurologic abnormalities due to increased susceptibility of drug and immature central nervous system of the fetus; this drug is lipophilic and may accumulate in the placenta

Lactation

Distributed into milk; risk of toxicity if lindane were absorbed through the skin in the course of breast-feeding if the mother has applied lindane to the chest area; discontinue nursing for at least 24 hours following application of lindane and avoid large areas of skin-to-skin contact with infant while lindane applied

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.

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Pharmacology

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)

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Images

No images available for this drug.
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Patient Handout

A Patient Handout is not currently available for this monograph.
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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.

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.
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Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
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Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
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Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.