Spinosad topical Disease Interactions

The use of spinosad is not recommended in infants and neonates under six months of age. Spinosad topical preparations contain benzyl alcohol, which may be systemically absorbed to a significant extent in this population due to a high ratio of skin surface area to body mass and a potentially immature skin barrier. Benzyl alcohol has been associated with serious adverse reactions and death in neonates and low birthweight infants. The "gasping syndrome," characterized by central nervous system depression, metabolic acidosis, gasping respirations, and high levels of benzyl alcohol and its metabolites found in the blood and urine, has been associated with benzyl alcohol dosages exceeding 99 mg/kg/day in neonates and low ­birthweight infants. Additional symptoms may include gradual neurological deterioration, seizures, intracranial hemorrhage, hematologic abnormalities, skin breakdown, hepatic and renal failure, hypotension, bradycardia, and cardiovascular collapse. The minimum amount of benzyl alcohol at which toxicity may occur is not known. Premature and low-birthweight infants, as well as patients receiving high dosages, may be more likely to develop toxicity.