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Ectoparasiticides, Including ScabicidesInsecticides and RepellentsTopical Scabicides
Synthetic pyrethroid used primarily as topical scabicide and pediculicide; residual activity after rinsing; ovicidal; 97-99% cure rate for head lice; better tolerated than lindane; available OTC.
Acticin, Elimite, Nix Lice Killing Creme Rinse
Acticin/Elimite/Permethrin Topical Cream: 5%Nix Lice Killing Creme Rinse Topical Lotion: 1%
Shampoo hair with regular shampoo, rinse and towel dry. Then, apply permethrin 1% lotion sufficient to saturate the hair and scalp (usually 25 to 30 mL), especially behind the ears and on the nape of the neck. Leave on hair for 10 minutes but no longer. Then, rinse thoroughly with water. Retreatment is required in less than 1% to 2% of patients. If live lice are seen 7 days or more after the first application, a second treatment should be given.
Apply 1% cream topically to affected areas and washed off after 10 minutes. Patients should be evaluated 1 week after therapy and retreatment may be necessary.
Shampoo hair with regular shampoo, rinse and towel dry. Then, apply topical permethrin 1% lotion sufficient to saturate the hair and scalp (usually 25 to 30 mL), especially behind the ears and on the nape of the neck. Leave on hair for 10 minutes but no longer. Then, rinse thoroughly with water. One application has been shown to protect more than 95% of patients against reinfestation for at least 2 weeks. In epidemic settings, a second prophylactic application is recommended 2 weeks after the first since the life cycle of a head louse is approximately 4 weeks.
Apply a full body application (all body parts from neck down) of permethrin 5% cream topically daily for 7 days and then 2 times weekly until cure in combination with oral ivermectin. Retreatment 2 weeks after the initial treatment regimen can be considered for those persons who are still symptomatic or when live mites are observed. Use of an alternative regimen is recommended for those persons who do not respond initially to the recommended treatment.
Massage 5% topical cream into the skin from the head to the soles of the feet. Scabies rarely infests the scalp of adults, although the hairline, neck, temple, and forehead may be infested in geriatric patients. Usually 30 grams is sufficient for the average adult. Wash cream off after 8 to 14 hours. One application is generally curative. Although pruritus may persist after treatment, this is rarely a sign of treatment failure and is not an indication for retreatment. Retreatment is indicated if living mites persist after 7 to 14 days of initial treatment.
Massage 5% topical cream into the skin from the head to the soles of the feet. Wash cream off after 8 to 14 hours. One application is generally curative. Although pruritus may persist after treatment, this is rarely a sign of treatment failure and is not an indication for retreatment. Retreatment is indicated if living mites persist after 7 to 14 days of initial treatment.
†Indicates off-label use
One application to affected area; do not repeat for >= 7 days.
Specific guidelines for dosage adjustments in hepatic impairment are not available; it appears that no dosage adjustments are needed.
Specific guidelines for dosage adjustments in renal impairment are not available; it appears that no dosage adjustments are needed.
Permethrin is administered topically. Avoid getting into the eyes. Do not ingest.
Elimite topical cream: For the treatment of scabies, thoroughly massage cream into the skin from the head to the soles of the feet. Remove by washing after 8—14 hours.
Nix Creme Rinse: Shake well before using. For the treatment of head lice, apply a sufficient amount to saturate the hair and scalp, especially behind the ears and on the nape of the neck. Leave on hair for 10 minutes. Then, rinse thoroughly with water.
Generic:- Avoid extreme temperatures- Protect from freezing- Store at room temperature (between 59 to 86 degrees F)- Store uprightActicin:- Store at controlled room temperature (between 68 and 77 degrees F)Elimite:- Store at controlled room temperature (between 68 and 77 degrees F)Nix Lice Killing Creme Rinse:- Store between 68 to 77 degrees F
Use permethrin with caution in patients with hypersensitivity to other synthetic pyrethroids or pyrethrins, or to chrysanthemums. Many veterinary or household insecticides contain permethrin or other synthetic pyrethroids. Thus, permethrin should be used with caution in patients sensitive to these insecticides. In cases of pediculosis capitis, self-medication of permethrin is not recommended if infestation of the eyebrows or eyelashes occurs. A physician should be consulted in these situations. Permethrin was not mutagenic when evaluated in several in vitro and in vivo genetic toxicity studies.
Permethrin-containing products are for external use only. In the event of ocular exposure, immediately flush eye with water.
Safe and effective use of permethrin has not been established in neonates or infants less than 2 months of age.
Permethrin is classified as pregnancy category B. Reproductive studies in animals revealed no evidence of impaired fertility or harm to the fetus. However, there are no adequate and well-controlled studies in pregnant women. Thus, permethrin should be used during pregnancy only if clearly needed.
It is not known if permethrin is excreted in human milk. However, absorption of permethrin from the skin is minimal, and it is rapidly metabolized to inactive metabolites. Guidelines recommend permethrin for use in breast-feeding patients with lice and scabies. Consider the benefits of breast-feeding, the risk of potential infant drug exposure, and the risk of an untreated or inadequately treated condition. If a breast-feeding infant experiences an adverse effect related to a maternally administered drug, healthcare providers are encouraged to report the adverse effect to the FDA.
erythema / Early / 1.0-2.0edema / Delayed / Incidence not known
skin irritation / Early / 10.0-10.0pruritus / Rapid / 7.0-7.0rash / Early / 1.0-2.0hypoesthesia / Delayed / 1.0-2.0
There are no drug interactions associated with Permethrin products.
Mechanism of Action: Permethrin is active against a broad range of pests, including lice, ticks, fleas, mites, and other arthropods. Permethrin acts on the nerve cell membrane to disrupt the sodium channel current that regulates the polarization of the membrane. This results in delayed repolarization and subsequent paralysis and death of the parasites. Permethrin exhibits residual ovicidal activity after rinsing.
Permethrin is applied topically. The drug is rapidly metabolized by ester hydrolysis to inactive metabolites which are excreted primarily in urine.
Although the amount of permethrin absorbed after a single application of 5% cream has not been precisely determined, data indicate that 2% or less of the amount of drug applied is absorbed in patients with moderate to severe scabies.