Permethrin (Elimite)
Permethrin
Acticin™, Elimite® , Nix® | A-200® Lice Control Spray | Nix® Cream Rinse
Classification:
Antiinfective Agents
Dermatological Agents
Description: Permethrin is a synthetic pyrethroid used primarily as a topical scabicide and pediculicide. Permethrin is a synthetic mixture of cis- and trans- isomers of pyrethrin chemically altered have more light and heat stability versus the natural pyrethrins. Permethrin is a commonly used agricultural pesticide and insect repellent; as a drug it is considered the treatment of choice for pediculosis capitis (head lice infestation). When used to treat head lice, a single application of 1% permethrin lotion is associated with a 97 - 99% cure rate; this cure rate is higher than that following application of 1% lindane. Permethrin is also better tolerated than lindane therapy. However, resistance to permethrin has been documented in several countries, including Argentina, Czech Republic, France, Israel, and the United Kingdom. In 1986, permethrin 1% lotion (Nix® ) was approved by the FDA as a prescription drug for the treatment of head lice; this product was subsequently reclassified to nonprescription (OTC) status. Permethrin 1% lotion is also approved for head lice prophylaxis (see Dosage). Permethrin-based lice control sprays are available, but these are used to spray inanimate objects and are not for topical use on humans. In September 1989, a higher strength permethrin 5% topical cream (Elimite® ) was approved by the FDA as a prescription drug for the treatment of scabies.
Mechanism of Action: Permethrin is active against a broad range of pests, including lice, ticks, fleas, mites, and other arthropods. Permethrin acts on the nerve cell membrane to disrupt the sodium channel current that regulates the polarization of the membrane. This results in delayed repolarization and subsequent paralysis and death of the parasites. Permethrin exhibits residual ovicidal activity after rinsing.
Pharmacokinetics: Permethrin is applied topically. Although the amount of permethrin absorbed after a single application of 5% cream has not been precisely determined, data indicate that 2% or less of the amount of drug applied is absorbed in patients with moderate to severe scabies. The drug is rapidly metabolized by ester hydrolysis to inactive metabolites which are excreted primarily in urine.
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References
. Brandenburg K, Deinard AS, DiNapoli J, et al. 1% permethrin cream rinse vs 1% lindane shampoo in treating pediculosis capitis. Am J Dis Child 1986;140:894 - 6.
. Jones KN, English JC. Review of common therapeutic options in the United States for the treatment of pediculosis capitis. Clin Infect Dis 2003;36:1355 - 61.
[ Revised 6/24/2003 1:15:00 PM ]
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