Permethrin (Nix) is available as a cream, lotion, soap, spray, and capsule formulations for the treatment of scabies and as a mosquito repellent.

Permethrin Uses:

• Head lice (lotion/ cream rinse):

  • Treatment of head lice (Pediculus humanus capitis) and its nits (eggs).

• Scabies (cream):

  • Treatment of scabies (Sarcoptes scabiei) infestation.

• Use: Off-Label: Adult

  • Pubic lice (Pediculosis pubis)
  • Crusted Scabies (Norwegian scabies)

Permethrin Dose in Adults

Permethrin Dose in the treatment of Head lice:

• Topical: Cream rinse/lotion 1%:

  • wash hair with conditioner-free shampoo Prior to application;
  • rinse with water and towel dry.
  • A sufficient amount of lotion or cream rinse is Applied to saturate the hair and scalp (especially behind the ears and nape of the neck).
  • Leave on hair for 10 minutes (but no longer), then wash with warm water; remove remaining nits with a nit comb.
  • A single application is generally enough; however, may be repeated 7 days after the first treatment if lice or nits are still there.

Permethrin Dose in the treatment of Pubic lice (off-label):

• Topical: Cream rinse 1%: Apply to affected areas and rinse off after 10 minutes.

Permethrin Dose in the treatment of Scabies:

• Topical: Cream 5%:

  • Thoroughly massage cream (30 g for the average adult) from head to soles of feet; leave on there 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 present there 14 days after the first treatment;
  • one application is generally curative.

Permethrin Dose in the treatment of Scabies, crusted (Norwegian scabies) (off-label):

• Topical: Cream 5%:
  • Apply to the entire body; leave on for 8 to 14 hours before rinsing off with water.
  • Repeat this regimen every day for 7 days, and then twice a week until symptoms have resolved. Ivermectin should be given.

Permethrin Dose in Childrens

Permethrin Dose in the treatment of Head lice:

• Note Usual first-line treatment (or pyrethrins) if community resistance is not a problem.

• Infants ≥2 months, Children, and Adolescents:

  • Topical: Solution/rinse 1%:
    • After the hair has been washed with shampoo (non-conditioning), rinsed with water, and is towel dried.
    • application of  a sufficient volume of permethrin solution/rinse to saturate the hair and scalp; also apply behind the ears and at the base of the neck;
    • leave on hair for 10 minutes prior to rinsing off with water; remove remaining nits.
    • May repeat in 7 to 10 days if live lice or nits are still there.
    • The best time to repeat is at day 9 based on the life cycle of lice.

Permethrin Dose in the treatment of Pubic lice: Limited data available:

• Adolescents:

  • Topical: Solution/rinse 1%:

    • Apply to affected area, leave on for 10 minutes, then rinse off .

Permethrin Dose in the treatment of Scabies:

• Infants ≥2 months, Children, and Adolescents:

  • Topical: Cream 5%:

    • Apply and massage in cream from head to toe all over the body (average adult requires 30 g);
    • leave on for 8 to 14 hours before rinsing off with water;
    • for infants, also apply on the hairline, neck, scalp, temple, and forehead;
    • may reapply in 14 days if live mites appear.

Pregnancy Risk Factor B

• Studies on oral animal reproduction have not examined adverse events.
• Permethrin is available systemically in a maximum of 2% after topical application.
• Permethrin and pyrethrins with Piperonyl Butoxide are the preferred drugs for treating pubic lice in pregnant women, according to the CDC.
• Permethrin is the best treatment for scabies in pregnancy.

Permethrin use during breastfeeding:

• Breastmilk contains permethrin after environmental exposure, such as exposure to pyrethroids for agriculture or malaria control.
• Permethrin's presence in breast milk after topical application for the treatment or scabies of lice is unknown.
• Permethrin has a low systemic absorption after topical administration (=2%). Any drug absorbed is quickly metabolized to inactive compounds.
• Breastfeeding is unlikely to cause significant exposure for a breastfed baby.
• Permethrin is recommended against breastfeeding during therapy. However, it is widely used to treat pubic lice and crusted skin in breastfeeding mothers.

Permethrin Dose in Kidney Disease:

• There are no dosage adjustments provided in the drug manufacturer’s labeling.
• Since topical permethrin is metabolized primarily in the liver and excreted in the urine in the form of inactive metabolites, there does not appear to be an increased risk of toxic reactions in patients with impaired renal function.

Permethrin Dose in Liver Disease:

• There are no dosage adjustments provided in the drug manufacturer’s labeling.

Side Effects of Permethrin:

• 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

Contraindications to Permethrin:

• Hypersensitivity/allergy to any pyrethroid or pyrethrin, or to any component of the formulation.

OTC labeling (cream rinse/lotion).

• Do not use self-medication while using this product.
• Infants under 2 months old
• Near the eyes
• Inside the nose, ear and mouth.
• For eyebrows and eyelashes, consult your doctor.

Warnings and precautions

• Skin irritation:

  • The symptoms of redness, itching, swelling, and redness may be temporarily worsened by treatment.
  • If hypersensitivity develops, discontinue use.

Monitoring parameters:

None mentioned. Monitor response to the treatment

How to administer Permethrin?

• 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 the manufacturer’s labeling for additional information.

Cream 5%:

• Apply to the 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 the nape of the 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.

Mechanism of action of Permethrin:

• Parasites are able to inhibit sodium ion influx via nerve cell membrane channels, resulting in delayed depolarization and paralysis.

Absorption:

• ≤2%

Metabolism:

• Hepatic via ester hydrolysis to inactive metabolites

Excretion:

• Urine

International Brand Names of Permethrin:

• Elimite
• A Scabs
• A-Lices
• A-Scab
• A-Scabs
• Arotrix
• Assy
• Cabis
• Davesol-P
• Delice
• Destolit
• Dronol
• Ectomethrin
• Gamabenceno Plus
• Glenper
• Infectopedicul
• Infectoscab
• Klinits
• Lice-omite
• Lindell
• Loxazol
• Lyclear
• Lyclear Creme Rinse
• Lyclear Dermal Cream
• Lyderm
• Nastizol EX
• Nedax Plus
• Nittyfor
• Nix
• Nix Cream
• Nix Creme Rinse
• Nix Dermal Cream
• Nolice
• Novo-Herklin
• Novo-Herklin 2000
• Omeclean
• Parapoux
• Pedeks
• Perlice
• Perme-Cure
• Permicren
• Permin
• Permite
• Piokil Plus
• Pyrifoam
• Quellada Head Lice Treatment
• Sarcop
• Scabicare
• Scabimite
• Scabisan
• Skab
• Zalvor

Permethrin Brand Names in Pakistan: