Medically reviewed on September 10, 2018
(per METH rin)
- Nix Crème Rinse
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Elimite: 5% (60 g) [contains formaldehyde solution]
Generic: 5% (60 g)
Generic: 1% (59 mL [DSC])
Brand Names: U.S.
- Antiparasitic Agent, Topical
- Scabicidal Agent
Inhibits sodium ion influx through nerve cell membrane channels in parasites resulting in delayed repolarization and thus paralysis and death of the pest
Hepatic via ester hydrolysis to inactive metabolites
Use: Labeled Indications
Head lice (lotion/cream rinse): Treatment of head lice (Pediculus humanus capitis) and its nits (eggs).
Scabies (cream): Treatment of scabies (Sarcoptes scabiei) infestation.
Off Label Uses
Pubic lice (Pediculosis pubis)
Based on the Centers for Disease Control and Prevention (CDC) sexually transmitted diseases treatment guidelines, permethrin is an effective and recommended alternative treatment for P. pubis (ie, pubic lice).
Scabies, crusted (Norwegian scabies)
Based on the CDC sexually transmitted diseases treatment guidelines, permethrin 5% cream, in combination with ivermectin, is an effective and recommended treatment regimen for crusted scabies (ie, Norwegian scabies).
Hypersensitivity to any pyrethroid or pyrethrin, or to 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.
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 (off-label use): Topical: Cream rinse 1%: Apply to affected areas and wash off after 10 minutes (CDC [Workowski 2015]).
Scabies: Topical: Cream 5%: Thoroughly massage cream (30 g for average adult) from head to soles of feet; leave on for 8 to 14 hours before removing (shower or bath); for infants and the elderly, also apply on the hairline, neck, scalp, temple, and forehead; may repeat if living mites are observed 14 days after first treatment; one application is generally curative.
Scabies, crusted (Norwegian scabies) (off-label use): Topical: Cream 5%: Apply to entire body; leave on for 8 to 14 hours before washing off with water. Repeat this regimen daily for 7 days, and then twice weekly until symptoms have resolved. Ivermectin should be given concomitantly on days 1, 2, 8, 9, and 15 (and potentially on days 22 and 29 for severe cases) (CDC [Workowski 2015]).
When treating scabies in elderly patients, also apply on the hairline, neck, scalp, temple, and forehead. Refer to adult dosing.
Head lice: Topical: Cream rinse/lotion 1%: Infants ≥2 months, Children, and Adolescents: Refer to adult dosing.
Scabies: Topical: Cream 5%: Infants ≥2 month, Children, and Adolescents: Refer to adult dosing.
Dosing: Renal Impairment
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
There are no dosage adjustments provided in the manufacturer’s labeling.
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 skin from head to soles of feet. Remove cream after 8 to 14 hours (shower or bath).
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.
Store at 20°C to 25°C (68°F to 77°F).
There are no known significant interactions.
1% to 10%:
Central nervous system: Local discomfort (scalp), localized burning, localized numbness, tingling of skin
Dermatologic: Pruritus, erythema, skin rash (scalp), stinging of the skin
Local: Localized edema
Concerns related to adverse effects:
• Skin irritation: Treatment may temporarily exacerbate the symptoms of itching, redness, and swelling. Discontinue use if hypersensitivity occurs.
• Appropriate use: For external use only. Avoid contact with eyes.
• Ragweed allergy (cream rinse/lotion): May cause difficulty in breathing or an asthmatic attack.
Pregnancy Risk Factor
Adverse events have not been observed in oral animal reproduction studies. The amount of permethrin available systemically following topical application is ≤2%. The CDC considers the use of permethrin or pyrethrins with piperonyl butoxide the drugs of choice for the treatment of pubic lice during pregnancy; permethrin is the preferred treatment of scabies during pregnancy (CDC [Workowski 2015]).
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience itching. Have patient report immediately to prescriber difficulty breathing, burning or numbness feeling, eye irritation, or severe application site irritation (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
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- Drug class: topical anti-infectives