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Lindane
Pronouncation: (LIN-dane)
Class: Scabicide, Pediculicide
Trade Names:
Lindane
- Lotion 1%
- Shampoo 1%
Hexit (Canada)
PMS-Lindane (Canada)
Mechanism of Action
Pharmacology
Exerts its action by being directly absorbed into the parasite
and ova.
Indications and Usage
Lotion
Treatment of Sarcoptes scabiei (scabies) in patients who have
failed to respond to adequate doses or are intolerant of other
approved therapies.
Shampoo
Treatment of Pediculus capitis (head lice) and Pediculus pubis
(crab lice) and their ova in patients who have failed to respond to
adequate doses or are intolerant of other approved therapies.
Contraindications
Premature neonates because their skin may be more permeable than
full-term infants, and neonates" liver enzymes may not be
sufficiently developed; patients with known seizure disorders;
hypersensitivity to any component of the product.
Dosage and Administration
Provide a patient medication guide each time lindane is
dispensed.
Lotion
Apply a thin layer over all skin from neck down. Wash hands
immediately after applying or use gloves. One ounce is sufficient
for an average adult. Do not prescribe more than 2 oz for larger
adults. Apply only once. Wash off in 8 to 12 hr (max, 12
hr). Do not retreat. Do not cover areas where medication is
applied.
Shampoo
Apply shampoo directly to dry hair without adding water. Work
thoroughly into hair and allow to remain in place for 4 min only.
Special attention should be given to the fine hairs along the neck.
After 4 min, add small quantities of water to hair until a good
lather forms. Immediately rinse all lather away. Avoid unnecessary
contact of lather with other body surfaces. Most patients will
require only 1 oz; do not prescribe more than 2 oz for larger
adults. Do not retreat.
General Advice
- For topical use only. Not for
ophthalmic, oral, or intravaginal use.
- Do not apply to skin that has open
wounds, cuts, or sores unless specifically directed by health care
provider.
- Avoid contact with eyes. If eye
contact occurs, flush immediately and thoroughly with water.
Lotion
- Shake well; use gloves if applying to
patient; apply prescribed amount to dry, affected skin in a thin
layer and rub in thoroughly; trim nails and apply under nails with
toothbrush (throw away toothbrush after use); leave lotion on for 8
to 12 hr (eg, overnight) then wash off with shower or bath.
Shampoo
- Wash hair with regular shampoo
(without conditioners), rinse, and dry thoroughly; use gloves if
applying lindane shampoo to patient; shake well and apply
prescribed amount of shampoo directly to dry hair without adding
water; work thoroughly into hair and allow to remain in place for 4
min only; add small quantities of water to hair until a good lather
forms then immediately rinse all lather away, avoiding unnecessary
contact of lather with other body surfaces; towel dry hair briskly
and remove nits with nit comb or tweezers.
Storage/Stability
Shampoo
Store at controlled room temperature (59° to 86°F). Keep
bottle tightly capped.
Drug Interactions
Drugs that may lower seizure threshold (eg, antipsychotics,
antidepressants, centrally acting anticholinesterases)
Because seizure threshold may be lowered, use with caution.
Oils
Oils may enhance absorption; therefore, avoid oil treatments and
oil-based hair dressings or conditioners immediately before or
after application of lindane shampoo.
Laboratory Test Interactions
None well documented.
Adverse Reactions
CNS
Stimulation, dizziness, seizures/convulsions; headache
(postmarketing).
Dermatologic
Irritant dermatitis; alopecia, dermatitis, paresthesia,
pruritus, urticaria (postmarketing).
Miscellaneous
Death; pain (postmarketing).
Precautions
Warnings
Reserved for patients who are intolerant or failed first-line
therapy. Contraindicated in premature infants and those with
uncontrolled seizure disorders. Patient counseling in proper use is
required.
Neurotoxicity
Seizures and death have been reported with repeat or prolonged
application and rarely with single application. Use with caution
because of increased risk in infants, children, elderly, in those
with other skin conditions, and in those who weigh less than 50
kg.
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Pregnancy
Category C .
Lactation
Excreted in breast milk in low concentrations.
Children
Pediatric patients have a higher surface to volume ratio and may
be at risk of greater systemic exposure when lindane is applied.
Infants and children may be at even higher risk because of
immaturity of organ systems such as skin and liver. Use with
caution in patients weighing less than 50 kg and especially in
infants.
Absorption
Lindane penetrates human skin and has the potential for CNS
toxicity (eg, seizures). Toxic effects of topically applied lindane
may be greater in the young.
External use
Avoid contact with eyes.
Reinfestation
Lindane does not prevent infestation or reinfestation and should
not be used to ward off a possible infestation.
Overdosage
Symptoms
CNS excitation, seizures, convulsions.
Patient Information
- Explain name, dose, action, and
potential side effects of drug.
- Advise patient or caregiver to review
Patient Directions for Use before applying medication.
- Caution patient or caregiver that
medication has potential for causing serious harm and not to exceed
prescribed dose or apply more frequently than prescribed by health
care provider. Advise patient or caregiver not to reapply unless
specifically advised by health care provider.
- Caution patient or caregiver to avoid
contact with eyes, and if accidental eye contact occurs,
immediately flush the eyes with water to remove medication. Advise
patient or caregiver to notify health care provider if eye
irritation or sensitivity follows exposure to the eyes.
- Teach patient or caregiver proper
technique for applying lotion: shake well; wash hands; use gloves
if applying to another person; apply prescribed amount to dry,
affected skin in a thin layer and rub in thoroughly; trim nails and
apply under nails with toothbrush (throw away toothbrush after
use); wash hands after applying lotion; leave lotion on for 8 to 12
hr (eg, overnight) then wash off with shower or bath. Advise
patient or caregiver that itching will continue for several weeks
but that this is normal and does not require a second
application.
- Advise patient or caregiver to avoid
concurrent use of creams, ointments, or oils while using lindane
lotion because of increased risk of absorption and toxicity.
- Teach patient or caregiver proper
technique for applying shampoo: wash hair with regular shampoo
(without conditioners), rinse, and dry thoroughly; use gloves if
applying to another person; shake well and apply prescribed amount
of shampoo directly to dry hair without adding water; work
thoroughly into hair and allow to remain in place for 4 min only;
add small quantities of water to hair until a good lather forms
then immediately rinse all lather away, avoiding unnecessary
contact of lather with other body surfaces; towel dry hair briskly
and remove nits with nit comb or tweezers.
- Advise patient or caregiver to avoid
concurrent use of oil treatments or oil-based hair dressings or
conditioners immediately before or after applying lindane shampoo
because of increased risk of absorption and toxicity.
- Advise patient not to use any covering
over the applied lotion that does not breathe, such as diapers with
plastic lining, or plastic or tight clothes.
- Advise patient or caregiver that all
recently used clothing, underwear, pajamas, bedclothes, pillows,
and towels should be washed in hot water or dry cleaned to prevent
reexposure.
- Advise nursing mother who is being
treated that medication is probably safe but if there is any
concern, use an alternate method of feeding for 4 days following
application.
- Advise patient or caregiver that
follow-up visits may be necessary and to keep appointments.
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