II. Indications
- Pediculosis (Lice)
- Scabies
- Prevention of Vector-borne Infection (applied to clothes)
III. Contraindications
- Age <2 months
IV. Mechanism
- Pyrethroid (Synthetic based on Pyrethrins)
- Neurotoxin
V. Precautions
- Avoid in under age 2 months old
- Safe: Poorly absorbed
- Rapidly metabolized to inactive
VI. Medications
- Permethrin 1% (Nix rinse supplied as 60 ml)
- Over the counter
- Permethrin 5% (Elimite supplied as 60 g cream)
- FDA indication only for Scabies
- Adult: 60 grams per adult per treatment (120 g total)
- Child: 30 grams per child per treatment (60 g total)
VII. Dosing
-
Scabies Treatment (Permethrin 5%, FDA approved for age >2 months)
- Apply Permethrin 5% cream from head to soles of feet, massaging onto surface
- Adults and children over age 5 years apply from neck down
- Consider forhead application in the elderly
- Include nail beds in application
- Avoid mouth, nose and eyes
- Wash off after 8-14 hours
- Repeat application in 1-2 weeks
- Apply Permethrin 5% cream from head to soles of feet, massaging onto surface
-
Lice Treatment (Permethrin 1%, FDA approved for age >2 years)
- Apply to clean dry hair
- Saturate hair and scalp
- Wash off after 10 minutes
- Consider overnight treatment
- Leave on overnight for 8-14 hours under shower cap
- Rinse hair in morning
- Repeat in one week
VIII. Pharmacokinetics
- Residual activity for over 2 weeks after application
IX. Adverse Effects
- See Pyrethrin
- See Pyrethroid Toxicity
- Mild transient burning, Paresthesias or Pruritus at the application site
- Local erythema may occur
X. Safety
- Pregnancy Category B
-
Lactation safety is unknown
- Consider switching to formula while using Permethrin
XI. Efficacy
- Resistance increasing to 1% Permethrin
- Lice Treatment may require 5% Permethrin
XII. Resources
- Permethrin Cream (DailyMed)
XIII. References
- Marco (2013) Crit Dec in Emerg Med 27(1): 2-7
- Mumcuoglo (1995) Med Vet Entomol, 9:427 [PubMed]
- Rupes (1995) Cent Eur J Public Health, 3:30 [PubMed]
Images: Related links to external sites (from Bing)
Related Studies
| permethrin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing) | ||
| PERMETHRIN 5% CREAM | Generic | $0.30 per gram |