permethrin
Acticin, Elimite, Nix

Available forms
Available by prescription only
Acticin, Elimite
Cream: 5%
Available without a prescription :
Nix
Cream rinse: 1%

Indications and dosages
 Pediculosis. Adults and children: Apply sufficient volume to saturate the hair and scalp. Leave on hair for 10 minutes before rinsing.
 Scabies. Adults and children: Thoroughly massage into skin from head to soles of feet. Treat infants on hairline, neck, scalp, temple, and forehead. Remove cream by washing after 8 to 14 hours. One application is curative.

Pharmacodynamics
Scabicide action: Acts on the parasites’ nerve cell membranes to disrupt the sodium channel current, thereby paralyzing parasites.

Pharmacokinetics
Absorption: Limited information available; probably less than 2% of amount applied is absorbed.
Distribution: No information available.
Metabolism: Rapidly metabolized by ester hydrolysis to inactive metabolites.
Excretion: Metabolites excreted in urine. Residue on hair detectable for up to 10 days.

Contraindications and precautions
Contraindicated in patients hypersensitive to pyrethrins or chrysanthemums.

Interactions
None reported.

Adverse reactions
Skin: pruritus, burning, stinging, local edema, tingling, numbness or scalp discomfort, mild erythema, scalp rash.

Effects on lab test results
None reported.

Overdose and treatment
For accidental ingestion, perform gastric lavage and use general supportive measures.

Special considerations
• A single treatment is usually effective. Although combing of nits isn’t needed for effectiveness, drug package supplies a fine-tooth comb.
• A second application may be needed if lice are seen 7 days after initial application.
• Permethrin has been shown to be at least as effective as lindane (Kwell) in treating head lice.
Breast-feeding patients
• It isn’t known if drug appears in breast milk. Woman should either discontinue breast-feeding temporarily or stop drug.
Pediatric patients
• Safety and efficacy in children younger than age 2 haven’t been established.

Patient education
• Tell patient or caregiver to wash hair with shampoo, rinse it thoroughly, and then towel dry.
• Tell patient or caregiver to apply sufficient amount to saturate hair and scalp.
• Instruct patient to report itching, redness, or swelling of scalp.
• Advise patient that drug is for external use only and to avoid contact with mucous membranes.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use