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Permethrin
Pronunciation
U.S. Brand Names
Generic Available
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Drug Interactions
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(per METH rin)

U.S. Brand Names
Acticin® Cream; Elimite™ Cream; Nix™ Creme Rinse

Generic Available

No


Pharmacological Index

Antiparasitic Agent, Topical; Scabicidal Agent


Use

Single application treatment of infestation with Pediculus humanus capitis (head louse) and its nits or Sarcoptes scabiei (scabies); indicated for prophylactic use during epidemics of lice


Pregnancy Risk Factor

B


Contraindications

Known hypersensitivity to pyrethyroid, pyrethrin, or chrysanthemums


Warnings/Precautions

Treatment may temporarily exacerbate the symptoms of itching, redness, swelling; for external use only; use during pregnancy only if clearly needed


Adverse Reactions

1% to 10%:

Local: Burning, stinging, tingling, numbness or scalp discomfort, edema


Drug Interactions

No data reported


Mechanism of Action

Inhibits sodium ion influx through nerve cell membrane channels in parasites resulting in delayed repolarization and thus paralysis and death of the pest


Pharmacodynamics/Kinetics

Absorption: Topical: Minimal (<2%)

Metabolism: In the liver by ester hydrolysis to inactive metabolites

Elimination: In urine


Usual Dosage

Topical: Children >2 months and Adults:

Scabies: Apply cream from head to toe; leave on for 8-14 hours before washing off with water; for infants, also apply on the hairline, neck, scalp, temple, and forehead; may reapply in 1 week if live mites appear

Permethrin 5% cream was shown to be safe and effective when applied to an infant <1 month of age with neonatal scabies; time of application was limited to 6 hours before rinsing with soap and water


Mental Health: Effects on Mental Status

None reported


Mental Health: Effects on Psychiatric Treatment

None reported


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

For external use only. Do not apply to face and avoid contact with eyes or mucous membrane. Clothing and bedding must be washed in hot water or dry cleaned to kill nits. May need to treat all members of household and all sexual contacts concurrently. Wash all combs and brushes with permethrin and thoroughly rinse. Breast-feeding precautions: Consult prescriber if breast-feeding.

Cream: Apply from neck to toes. Bathe to remove drug after 8-14 hours before washing off. Repeat in 7 days if lice or nits are still present. Report if condition persists or infection occurs.


Nursing Implications

Because scabies and lice are so contagious, use caution to avoid spreading or infecting oneself; wear gloves when applying


Dosage Forms

Cream: 5% (60 g)

Liquid, topical: 1% (60 mL)


References

Dorman DC and Beasley VR, "Neurotoxicology of Pyrethrin and the Pyrethroid Insecticides," Vet Hum Toxicol, 1991, 33(3):238-43.

"Drugs for Head Lice," Med Lett Drugs Ther, 1997, 39(992):6-7.

"Drugs for Parasitic Infections," Med Lett Drugs Ther, 1998, 40(1017):1-12.

He F, Wang S, Liu L, et al, "Clinical Manifestations and Diagnosis of Acute Pyrethroid Poisoning," Arch Toxicol, 1989, 63(1):54-8.

Hogan DJ, Schachner L, Tanglertsampan C, "Diagnosis and Treatment of Childhood Scabies and Pediculosis," Pediatr Clin North Am, 1991, 38(4):941-57.

Krowchuk DP, Tunnessen WW Jr, and Hurwitz S, "Pediatric Dermatology Update," Pediatrics, 1992, 90(2 Pt 1):259-64.

Liu LX and Weller PF, "Antiparasitic Drugs," N Engl J Med, 1996, 334(18):1178-84.

Quarterman MJ and Lesher JL, "Neonatal Scabies Treated With Permethrin 5% Cream," Pediatr Dermatol, 1994, 11(3):264-6.


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