II. Indications

III. Contraindications

  1. Ragweed allergy (relative; may cross-react to Pyrethrins)

IV. Mechanism

  1. Pyrethrins are Insecticides extracted from chrysanthemums
    1. Pyrethroids are longer acting derivatives (Permethrin)
  2. RID is a combination of Pyrethrin and Piperonyl Butoxide
    1. Piperonyl Butoxide is a synthetic derivative of benzodioxole
    2. Piperonyl Butoxide is an Insecticide synergist that inhibits Insect microsomal enzyme detoxification activity
    3. Piperonyl Butoxide is toxic if ingested (Seizures, hepatotoxicity, nephrotoxicity, carcinogenic)
  3. Pesticide Agents related to Pyrethrins
    1. Allethrin
    2. Cyfluthrin
    3. Cypermethrin
    4. Deltamethrin
    5. Dimethrin
    6. Fenothrin
    7. Fenvalerate
    8. Permethrin
    9. Remethrin

V. Background

  1. Advantages
    1. Available without a prescription
    2. Convenient (only 10 minute application)
  2. Disadvantages
    1. Does not kill all unhatched eggs
    2. Requires repeat application in 5-7 days
    3. Treatment failures are common

VI. Medications

  1. Pyrethrin with Piperonyl Butoxide (RID)
    1. Shampoo: 60, 120, 240 ml

VII. Dosing: Lice Treatment

  1. Apply Shampoo to involved area and avoiding mucous membranes
  2. Wash after 10 minutes
  3. Reapply Shampoo in 5-7 days

VIII. Adverse Effects

  1. See Pyrethroid Toxicity
  2. Mechanism
    1. Nerve toxicity is rare in humans
    2. Minimal absorption and rapid hepatic metabolism
  3. Effects
    1. Allergic Reaction in 1-3%
      1. Nasal congestion
      2. Asthma exascerbation
    2. Topical effects
      1. Paresthesias (hands and face)
    3. Rare neurologic effects
      1. Seizures
      2. Tremor
      3. Incoordination

IX. Safety

  1. Pregnancy Category C
  2. Unknown safety in Lactation

X. Resources

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Related Studies

Ontology: Piperonyl Butoxide (C0031962)

Definition (NCI) A synthetic derivative of benzodioxole and used as an insecticide synergist, Piperonyl Butoxide enhances the active properties of pyrethrin, pyrethroid, rotenone, and carbamate pesticide ingredients by inhibiting insect microsomal enzyme detoxification activity. It is toxic and suspected of causing anorexia, carcinogenesis, convulsions, and dermal irritation, as well as hepatic and renal damage. (NCI04)
Definition (MSH) An insecticide synergist, especially for pyrethroids and ROTENONE.
Concepts Pharmacologic Substance (T121) , Hazardous or Poisonous Substance (T131) , Organic Chemical (T109)
MSH D010882
SnomedCT 32340007, 412273005
English Butoxide, Piperonyl, Piperonyl Butoxide, 1,3-Benzodioxole, 5-((2-(2-butoxyethoxy)ethoxy)methyl)-6-propyl-, PBO, 5-[[2-(2-Butoxyethoxy)ethoxy]methyl]-6-propyl-1,3-benzodioxole, NCI CO28l3, piperonyl butoxide, Piperonyl Butoxide [Chemical/Ingredient], PIPERONYL BUTOXIDE, Alpha-[2-(2-butoxyethoxy)ethoxy]-4,5-Methylenedioxy-2-Propyltoluene, Piperonyl butoxide, Piperonyl butoxide (substance), Piperonyl butoxide (product), PIPERONYL BUTOXIDE TECHNICAL
Swedish Piperonylbutoxid
Czech piperonylbutoxid
Finnish Piperonyylibutoksidi
Russian BUTATSID, PIPERONILBUTOKSID, БУТАЦИД, ПИПЕРОНИЛБУТОКСИД
Polish Butotlenek piperonylu
Spanish butóxido de piperonilo (sustancia), butóxido de piperonilo, butóxido de piperonilo (producto), Butóxido de Piperonilo
French Pipéronyl butoxyde
German Piperonylbutoxid
Italian Piperonilbutossido
Portuguese Butóxido de Piperonila

Ontology: Pyrethrins (C0034245)

Definition (MSH) The active insecticidal constituent of CHRYSANTHEMUM CINERARIIFOLIUM flowers. Pyrethrin I is the pyretholone ester of chrysanthemummonocarboxylic acid and pyrethrin II is the pyretholone ester of chrysanthemumdicarboxylic acid monomethyl ester.
Concepts Hazardous or Poisonous Substance (T131) , Organic Chemical (T109)
MSH D011722
SnomedCT 23178000, 400602009, 45620004
English Pyrethrins, pediculicides pyrethrins, pyrethrins (medication), pyrethrins, Pyrethrins [Chemical/Ingredient], pyrethrin, Pyrethrins (substance), Pyrethrin, Pyrethrin (product), Pyrethrin (substance), Pyrethrins, NOS, PYRETHRINS
Swedish Pyretriner
Czech pyrethriny
Finnish Pyretriinit
Russian PIRETRINY, ПИРЕТРИНЫ
Polish Pyretryny
Japanese ピレスリン, ピレトリン
French Pyréthrines
Spanish piretrinas (sustancia), piretrinas, piretrina (producto), piretrina (sustancia), piretrina, Piretrinas
German Pyrethrine
Italian Piretrine
Portuguese Piretrinas

Ontology: RID (C0073361)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH C027982
English RID, Rid Pediculicide, rid pediculicide product, rid

Ontology: Pyrethrum extract (C0347993)

Concepts Pharmacologic Substance (T121)
SnomedCT 256038001, 411383009
English Pyrethrum extract, pyrethrum extract, PYRETHRUM EXTRACT, Pyrethrum Extract, pyrethrum, Pyrethrum, Pyrethrum (substance), Pyrethrum (product)
Spanish piretro (sustancia), piretro, piretro (producto)