lindane (Rx)

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

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)

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.

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)