Lindane

Aka: Lindane, Kwell, Organochlorine, Gamma Benzene Hexachloride

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II. Indications

  1. Third-line topical Antiparasitic Agent (other agents are preferred)
    1. Scabies
    2. Lice

III. Contraindications

  1. Infants
  2. Caution in young children and elderly
  3. Caution in weight <50 kg
  4. Seizure Disorder

IV. Precautions

  1. Carcinogenic
  2. Much greater risk of toxicity (esp. neurotoxicity) than with other agents
  3. CNS toxicity 2-4 fold over Permethrin
    1. Seizure risk in epileptics and children

V. Mechanism

  1. Organochlorine similar to DDT
    1. Used as an Insecticide for hardwood logs and on crops
    2. Lindanes use as a topical pediculicide and scabicide is related to its neurotoxic effects in these Parasites
  2. Organochlorine Agents
    1. Chlorobenzilate
    2. Dicofol
    3. Dienochlor
    4. Endosulfan
    5. Lindane

VI. Medications

  1. Lindane 1% Shampoo (60 ml)
  2. Lindane 1% Lotion (60 ml)

VII. Dosing

  1. Quantity
    1. Adult (and child age >6 years): 30 to 60 ml
    2. Child age <6 years: 30 ml
  2. Scabies
    1. Apply lotion to skin from neck to toes
    2. Wash off in 8 to 12 hours
    3. May repeat application in 1 week
    4. Treat all family members
  3. Lice
    1. Apply Shampoo to dry hair
    2. Massage into hair for 4 minutes before rinsing
    3. Rinse thoroughly
    4. Comb with fine tooth comb to remove nits
    5. Repeat treatment in one week

VIII. Adverse Effects

  1. Neurotoxicity
    1. Mechanism
      1. Disrupts axonal Sodium and Potassium flow
      2. Affects both central and Peripheral Nerves
      3. Higher toxicity in broken skin and young children
    2. Findings
      1. Seizure
      2. Headache
      3. Paresthesias
      4. Incoordination
      5. Tremor
      6. Deaths have occurred
  2. Other adverse effects (large exposures, ingestions)
    1. Nose and throat irritation (inhalational exposure)
    2. Anemia
    3. Hepatotoxicity
    4. Arrhythmia
    5. Skin Irritation (topical)
    6. Carcinogenic
  3. Management of toxicitiy
    1. Skin Decontamination
    2. ABC Management
    3. Seizure control with Diazepam
    4. Intravenous Fluids (D5W) with Thiamine

IX. Pharmacokinetics

  1. Percutaneous absorption 10-20 fold over Permethrin
  2. Serum levels are 40 fold higher than Permethrin

X. Safety

  1. Pregnancy Category B (but not recommended)
  2. Unknown safety in Lactation

XI. Resources

  1. Lindane Lotion (DailyMed)
    1. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=54b9526e-29ab-46b0-ab82-d765fbee5c6f
  2. Lindane (EPA)
    1. https://www.epa.gov/sites/default/files/2016-09/documents/lindane.pdf
  3. Lindane (Wikipedia)
    1. https://en.wikipedia.org/wiki/Lindane

XII. References

  1. Meinking (1996) Arch Dermatol 132:959-62 [PubMed]

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