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Permethrin: Pediatric drug information

Permethrin: Pediatric drug information
(For additional information see "Permethrin: Drug information" and see "Permethrin: Patient drug information")

For abbreviations, symbols, and age group definitions used in Lexicomp (show table)
Brand Names: US
  • Elimite [DSC]
Therapeutic Category
  • Antiparasitic Agent, Topical;
  • Pediculocide;
  • Scabicidal Agent
Dosing: Neonatal
Scabies

Scabies: Very limited data available: Term neonates: Topical: A single application of permethrin 5% cream was shown to be safe and effective in a full-term neonate (PNA: 21 days) when applied from scalp to toes for 6 hours before rinsing with soap and water (Quarterman 1994).

Dosing: Pediatric
Head lice

Head lice: Note: Usual first-line treatment (or pyrethrins) if community resistance is not an issue (AAP [Devore 2015]); Infants ≥2 months, Children, and Adolescents: Topical: Solution/rinse 1%: After hair has been washed with shampoo (nonconditioning), rinsed with water, and towel dried, apply a sufficient volume of permethrin solution/rinse to saturate the hair and scalp; also apply behind the ears and at the base of the neck; leave on hair for 10 minutes before rinsing off with water; remove remaining nits. May repeat in 7 to 10 days if live lice or nits observed; optimal time to repeat is at day 9 based on the life cycle of lice (AAP [Devore 2015]).

Pubic lice

Pubic lice: Limited data available: Adolescents: Topical: Solution/rinse 1%: Apply to affected area, leave on for 10 minutes, then wash off (CDC [Workowski 2015])

Scabies

Scabies: Infants ≥2 months, Children, and Adolescents: Topical: Cream 5%: Apply and massage in cream from head to toe (average adult requires 30 g); leave on for 8 to 14 hours before washing off with water; for infants, also apply on the hairline, neck, scalp, temple, and forehead; may reapply in 14 days if live mites appear.

Dosing: Kidney Impairment: Pediatric

All patients: There are no dosage adjustments provided in the manufacturer's labeling. Since topical permethrin is metabolized in the liver and excreted in the urine as inactive metabolites, there does not appear to be an increased risk of toxic reactions in patients with impaired renal function.

Dosing: Hepatic Impairment: Pediatric

There are no dosage adjustments provided in the manufacturer's labeling.

Dosing: Adult

(For additional information see "Permethrin: Drug information")

Head lice

Head lice: Topical: Cream rinse/lotion 1%: Prior to application, wash hair with conditioner-free shampoo; rinse with water and towel dry. Apply a sufficient amount of lotion or cream rinse to saturate the hair and scalp (especially behind the ears and nape of neck). Leave on hair for 10 minutes (but no longer), then rinse off with warm water; remove remaining nits with nit comb. A single application is generally sufficient; however, may repeat 7 days after first treatment if lice or nits are still present.

Pubic lice

Pubic lice (off-label use): Topical: Cream rinse 1%: Apply to affected areas and wash off after 10 minutes (CDC [Workowski 2021]).

Scabies

Scabies:

Note: For cohabitants or other individuals who have had prolonged skin-to-skin contact within the previous month, simultaneous treatment is recommended (CDC 2018).

Classic scabies, treatment: Topical: Cream 5%: Apply to all areas of the body from the neck to soles of feet (30 g for average adult); leave on for 8 to 14 hours before removing by washing (shower or bath). For older adults, also apply on the hairline, neck, scalp, temple, and forehead. One application is generally curative; may repeat if living mites are observed 14 days after first treatment (CDC [Workowski 2021]; manufacturer’s labeling).

Crusted scabies, treatment: Topical: Cream 5%: Apply to entire body; leave on for 8 to 14 hours before removing by washing (shower or bath). Repeat this regimen daily for 7 days, and then twice weekly until symptoms have resolved. Use in combination with ivermectin on days 1, 2, 8, 9, and 15 (and potentially on days 22 and 29 for severe cases) (CDC [Workowski 2021]).

Dosing: Kidney Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling. Since topical permethrin is metabolized in the liver and excreted in the urine as inactive metabolites, there does not appear to be an increased risk of toxic reactions in patients with impaired renal function.

Dosing: Hepatic Impairment: Adult

There are no dosage adjustments provided in the manufacturer’s labeling.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Cream, External:

Elimite: 5% (60 g [DSC]) [contains formaldehyde solution]

Generic: 5% (60 g)

Generic Equivalent Available: US

Yes

Administration: Pediatric

For external topical use only. Avoid contact with eyes and mucous membranes during application. Because scabies and lice are highly contagious, use caution to avoid spreading or infecting the caregiver/parent; wear gloves when applying. For the treatment of head lice, use as a component of a whole lice removal program, which includes washing or dry cleaning all clothing, hats, bedding, and towels recently worn or used by the patient and washing combs, brushes, and hair accessories in hot water; items that cannot be washed should be sealed in a plastic bag for ≥4 weeks. Refer to manufacturer's labeling for additional information.

Cream 5%: Apply to skin from head to soles of feet. Remove cream after 8 to 14 hours (shower or bath).

Solution/rinse 1%: Shake well before using. Apply immediately after hair is shampooed (without conditioner), rinsed, and towel-dried. Apply enough product to saturate hair and scalp (especially behind ears and on nape of neck). Leave on hair for 10 minutes before rinsing with warm water. Remove nits with fine-tooth comb. Protect eyes with a washcloth or towel.

Administration: Adult

Avoid contact with eyes and mucous membranes during application. Because scabies and lice are so contagious, use caution to avoid spreading or infecting oneself; wear gloves when applying. For the treatment of head lice, use as a portion of a whole lice removal program, which includes washing or dry cleaning all clothing, hats, bedding, and towels recently worn or used by the patient and washing combs, brushes, and hair accessories in hot water; items that cannot be washed should be sealed in a plastic bag for ≥4 weeks. Refer to manufacturer’s labeling for additional information.

Cream 5%: Apply to all areas of the body from the neck to soles of feet. For older adults, also apply on the hairline, neck, scalp, temple, and forehead. Remove cream after 8 to 14 hours (shower or bath) (CDC [Workowski 2021]; manufacturer’s labeling).

Cream rinse/lotion 1%: Shake well before using. Apply immediately after hair is shampooed (without conditioner), rinsed, and towel-dried. Apply enough product to saturate hair and scalp (especially behind ears and on nape of neck). Leave on hair for 10 minutes (but no longer) before rinsing with warm water. Remove nits with fine-tooth comb. Protect eyes with a washcloth or towel.

Storage/Stability

Store at 20°C to 25°C (68°F to 77°F).

Use

Solution/rinse 1%: Treatment of infestation with Pediculus humanus capitis (head lice) and nits (FDA approved in ages ≥2 months and adults); has also been used for treatment of pubic lice

Cream 5%: Treatment of Sarcoptes scabiei (scabies) (FDA approved in ages ≥2 months and adults)

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Dermatologic: Burning sensation of skin (≤10%), erythema of skin (≤2%), pruritus (7%), skin rash (≤2%), stinging of the skin (≤10%)

Nervous system: Numbness (≤2%), tingling of skin (≤2%)

Postmarketing:

Gastrointestinal: Abdominal pain, diarrhea, nausea, vomiting

Nervous system: Dizziness, headache

Miscellaneous: Fever

Contraindications

Hypersensitivity to permethrin, pyrethroid, pyrethrin, or any component of the formulation.

OTC labeling (cream rinse/lotion): When used for self-medication, do not use on infants <2 months of age; near the eyes; inside the nose, ear, mouth, or vagina. Consult health care provider for use on eyebrows or eyelashes.

Warnings/Precautions

Concerns related to adverse effects:

• Skin irritation: Treatment may temporarily exacerbate the symptoms of itching, redness, and swelling. Discontinue use if hypersensitivity occurs.

Other warnings/precautions:

• Appropriate use: For external use only. Avoid contact with eyes.

• Ragweed allergy (cream rinse/lotion): May cause difficulty in breathing or an asthmatic attack.

Metabolism/Transport Effects

None known.

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program

There are no known significant interactions.

Pregnancy Considerations

The amount of permethrin available systemically following topical application is ≤2%.

The CDC considers permethrin as one of the drugs of choice for the treatment of pubic lice during pregnancy; permethrin is the preferred treatment of scabies during pregnancy (CDC [Workowski 2021]).

Monitoring Parameters

Eye irritation; skin or scalp irritation/itching; breathing difficulty; live lice and/or eggs (to determine if retreatment is needed).

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

Pharmacokinetics (Adult data unless noted)

Absorption: ≤2%

Metabolism: Hepatic via ester hydrolysis to inactive metabolites

Excretion: Urine

Pricing: US

Cream (Permethrin External)

5% (per gram): $1.97 - $2.06

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Brand Names: International
  • A Scabs (ID);
  • A-Scab (SG);
  • A-Scabs (HK, LK, MY, VN);
  • Arotrix (BD);
  • Assy (AR);
  • Cabis (BD);
  • Davesol-P (EC);
  • Delice (BD);
  • Destolit (PE);
  • Dronol (PY);
  • Ectomethrin (EG);
  • Gamabenceno Plus (CO, CR, DO, GT, HN, NI, PA, SV);
  • Glenper (LK);
  • Infectopedicul (DE);
  • Infectoscab (CZ);
  • Klinits (CL);
  • Kwell (PH);
  • Lice Clear (NZ);
  • Lice-omite (PK);
  • Lindell (PH);
  • Loxazol (CH, NL);
  • Lyclear (AU, GB, IE, MT);
  • Lyclear Creme Rinse (AE, CY, IQ, IR, JO, KW, LB, LY, OM, SA, SY, YE);
  • Lyclear Dermal Cream (IL);
  • Lyderm (NZ);
  • Nedax Plus (BR);
  • Nittyfor (HU);
  • Nix (BG, DK, EE, FI, IT, NO, PT, SI);
  • Nix Cream (BB, BM, BS, BZ, GY, JM, PR, SR, TT);
  • Nix Creme Rinse (LU);
  • Nix Dermal Cream (BB, BM, BS, BZ, GY, JM, PR, SR, TT);
  • Nolice (BD);
  • Novo-Herklin (CR, DO, NI, PA, SV);
  • Omeclean (KR);
  • Parapoux (FR);
  • Pedeks (LV);
  • Perlice (LK);
  • Perme-Cure (ES);
  • Permicren (UY);
  • Permin (BD);
  • Permite (IN);
  • Piokil Plus (VE);
  • Pyrifoam (AU);
  • Quellada Head Lice Treatment (NZ);
  • Sarcop (ES);
  • Scabimite (ID);
  • Scabisan (CR, DO, GT, HN, MX, NI, PA, SV);
  • Skab (LK);
  • Skabi-Rid (ZA);
  • Zalvor (BE, LU, TR)


For country code abbreviations (show table)
  1. Bouwman H, Kylin H. Malaria control insecticide residues in breast milk: the need to consider infant health risks. Environ Health Perspect. 2009;117(10):1477-1480. [PubMed 20019894]
  2. Centers for Disease Control and Prevention (CDC). Parasites - Scabies: Treatment. https://www.cdc.gov/parasites/scabies/treatment.html. Updated October 31, 2018. Accessed November 1, 2022.
  3. Corcellas C, Feo ML, Torres JP, et al. Pyrethroids in human breast milk: occurrence and nursing daily intake estimation. Environ Int. 2012;47:17-22. [PubMed 22717642]
  4. Devore CD, Schutze GE, Council on School Health and Committee on Infectious Diseases, American Academy of Pediatrics. Head lice. Pediatrics. 2015;135(5):e1355-1365. [PubMed 25917986]
  5. Elimite (permethrin) [prescribing information]. Newton, PA: Prestium PHarma; August 2015.
  6. Feo ML, Eljarrat E, Manaca MN, et al. Pyrethroid use-malaria control and individual applications by households for other pests and home garden use. Environ Int. 2012;38(1):67-72. [PubMed 21982035]
  7. Nix Creme Rinse [prescribing information]. Tarrytown, NY: Insight Pharmaceuticals LLC; received June 2019.
  8. Permethrin cream 5% [prescribing information]. Parsippany, NJ: Actavis; December 2019.
  9. Permethrin lotion [prescribing information]. Lincolnton, NC: Actavis; August 2008.
  10. Quarterman MJ and Lesher JL. Neonatal Scabies Treated With Permethrin 5% Cream. Pediatr Dermatol. 1994; 11(3):264-266. [PubMed 7971563]
  11. Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1 [PubMed 34292926]
  12. Workowski KA, Bolan GA; Centers for Disease Control and Prevention (CDC). Sexually transmitted diseases treatment guidelines, 2015 [published correction appears in MMWR Recomm Rep. 2015;64(33):924]. MMWR Recomm Rep. 2015;64(RR-03):1-137. [PubMed 26042815]
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