Dosing & Uses
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
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
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)
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.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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Formulary
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