Lindane is a neurotoxic insecticide that is used topically in the treatment of head lice and scabies infection (as a second-line agent).

Lindane Uses:

• Lotion:

  • Used to treat Sarcoptes scabiei (scabies)

• Shampoo:

  • Used to treat Pediculus capitis (head lice) and Phthirus pubis (crab lice)

Note: Not recommended for first line-treatment; use should be reserved for patients who are intolerant to or have failed first-line agents.

Lindane Dose in Adults:

Note: It's been more than a year that Lindane lotion has been discontinued in the US.

Lindane Dose in the treatment of Scabies:

• Topical: Should be applied as a thin layer of lotion and do a massage on the skin from the neck to the toes; after 8-12 hours, take a bath and remove the drug; 30mL would be required for most of the patients; 60mL may be required for larger adults. Re-treatment should not be done. Should not be left for more than 12 hours. According to CDC STD guidelines, it should be applied for 8 hours.

Lindane dose in the treatment of head lice/ crab lice:

• Topical: Shampoo should be applied to dry hair; do a massage for 4 minutes into the; small quantities of water should be added to hair until lather forms, then the hair should be rinsed thoroughly and combed with a fine-tooth comb for removal of nits. Length and the density of hair determine the amount of shampoo; 30 mL is enough for most patients, some may require 60mL. Re-treatment should not be done.

Lindane Dose in Childrens:

Note: Although approved by the FDA, keeping in view the safety concerns it is not a recommended treatment option for head lice or scabies in pediatric patients <50 kg; avoid use if possible and consider alternative agents. It's been more than a year that Lindane lotion has been discontinued in the US.

Lindane dose in the treatment of head lice as a second-line agent:

• Infants, Children, and Adolescents:

  • Shampoo:

    • Topical: Shampoo should be applied to dry hair; do a massage for 4 minutes into the; small quantities of water should be added to hair until lather forms, then the hair should be rinsed thoroughly and combed with a fine-tooth comb for removal of nits. Length and the density of hair determine the amount of shampoo; 30 mL is enough for most patients, some may require 60mL. Re-treatment should not be done.

Lindane dose in the treatment of Scabies as a second-line drug:

• Infants, Children, and Adolescents:

  • Lotion:

    • Topical: It should be applied as a thin layer of lotion and do a massage on the skin from the neck to the toes; after 8-12 hours, take a bath and remove the drug; 30mL would be required for most of the patients; 60mL may be required for larger adults. Re-treatment should not be done.

• Infants and Children:

  • Wash after 6 hours of application

Pregnancy Risk Factor C

• Studies on animal reproduction have shown that there are adverse events.
• Animal studies suggest neurologic abnormalities that may be caused by the increased susceptibility to drugs and the immature central nerve system of the fetus.
• Due to its lipophilic nature, Lindane can accumulate in the placenta.
• If used during pregnancy, may cause mental retardation and neural tube defects.

Use during breastfeeding:

• Breast milk contains Lindane.
• Do not interrupt breastfeeding mothers who are nursing. After use, milk should be expressed and thrown away for no less than one day.
• Avoid skin-to-skin contact with the infant and affected area.

Dose in Kidney Disease:

No dosage adjustments provided in the manufacturer's labeling.

Dose in Liver disease:

No dosage adjustments provided in the manufacturer's labeling.

Side effects of Lindane:

• Central nervous system:

  • Ataxia
  • Dizziness
  • Localized burning
  • Neurotoxicity (risk greater in patients <110 lbs [50 kg])
  • Restlessness
  • Seizure
  • Stinging sensation

• Dermatologic:

  • Contact dermatitis
  • Eczematous rash

• Hematologic & oncologic:

  • Aplastic anemia (CDC 2010)

Contraindications to Lindane:

• Hypersensitivity to lindane and any other component of the formulation
• Premature infants
• Uncontrolled seizure disorders
• Crusted (Norwegian), scabies, or other skin conditions (eg atopic dermatitis (atopic dermatitis), that can cause increased systemic absorption

Warnings and precautions

• Neurotoxicity: [US Boxed Warn]

  • Use of the drug can cause severe neurologic toxicities, including seizures or death. This may happen with repeated, prolonged, or single-use.
  • Premature infants and uncontrolled seizures are contraindications to use.
  • Use caution when using this product on infants, small children and patients with skin conditions or patients weighing less than 50 kg.
  • Patients with a history or epilepsy, including those who have suffered from seizures, head trauma or HIV infection, and patients in other conditions that could increase the chance of seizures or medication which lowers seizure threshold.

• Hepatic impairment

  • Be careful.

Monitoring Parameters:

None mentioned.

How to administer Lindane?

Use only topically, never give orally. Shake well before use. Caregivers should use gloves while applying (natural latex should be avoided, may be permeable to lindane). Use warm (not hot) water to rinse off.

Lotion:

• It Should be applied to dry, cool skin avoiding contact with the face or eyes. One should wait at least 60mins after bathing or showering (absorption is increased from warm and wet skin). Before the application of lindane, the skin should be clean and free of any other lotions, creams, or oil. Should not be used on open wounds or sores. Avoid occlusive dressings.

Shampoo:

• It should be applied to clean, dry hair. One should wait for at least 60mins after washing their hair before applying lindane shampoo. Wash hair with a shampoo not containing a conditioner; Before application of lindane, the hair and skin of the head and neck should be free of any lotions, oils, or creams. A shower cap or towel should not be used for covering the head.

Mechanism of action of Lindane:

The exoskeleton is absorbed by parasites and ova, causing stimulation to the nervous system and leading to seizures and death for these arthropods.

Absorption:

• 10% systemically, better absorbed when applied on weeping skin or excoriated skin

Metabolism:

• Liver disease

Half-life elimination:

• Infants >=5 Months and Children =8 Years: Healthy skin takes 21.4 hours Infected skin: 17.9 Hours

Time to reach peak, serum:

• Infants >=5 Months and Children: 6 Hours

Excretion

• Via urine and stool

International Brand Names of Lindane:

• Agalin
• Aphtiria
• Aprurol
• Ascabiol
• Benhex Cream
• Bexarid
• Davesol
• Delice
• Delitex
• Demar
• Desintan
• Elentol
• Esoderm
• GAB
• Gama Acaderm
• Gambex
• Gamma-Scab
• Gatox
• GBHC
• Herklin
• Hexa-Defital
• Hexin
• Jacutin
• Kwell
• Kwellada
• Lencid
• Lendianon
• Lindan
• Lindano
• Lindano-GBHG
• Linden Lotion
• Milinor
• Nedax
• Paracid
• Parakil
• Plomurol
• Pruritrat
• Quellada
• Quellada Cream
• Quellada Creme Rinse
• Quellada Head Lice Treatment
• Quellada Lotion
• Sarcoderma
• Scabcur
• Scabecid
• Scabene
• Scabi
• Scabix
• Scaboma
• Skabicid
• Somergan
• Texa

Lindane Brand Names in Pakistan: