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Lindane

Pronunciation: LIN-dane
Class: Scabicide, Pediculicide

Trade Names

Lindane
- Lotion 1%
- Shampoo 1%

Hexit (Canada)
PMS-Lindane (Canada)

Pharmacology

Exerts its action by being directly absorbed into the parasite and ova.

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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 h (max, 12 h). 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 h (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.


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

  • 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 h (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 breast-feeding 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.

Copyright © 2009 Wolters Kluwer Health.

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