permethrin
Permethrin is a topical medication that's available in different formulations. Permethrin topical cream (brand name Elimite has been discontinued) is used to get rid of scabies and it's available by prescription only. Permethrin lotion (brand name Nix) is used to treat head lice and it can be found over the counter. Permethrin is typically safe if used as directed by your provider. But it might cause some temporary side effects, such as mild burning or itching.
What is Permethrin?
What is Permethrin used for?
- Scabies (prescription version - 5% cream)
- Head lice (over-the-counter version - 1% shampoo rinse/lotion)
How Permethrin works
Permethrin is a topical antiparasitic known as a pyrethroid. It kills lice and scabies by causing damage to their nerves and muscles. This paralyzes them and causes them to die. Keep in mind that it doesn't kill lice eggs (nits).
Drug facts
Side effects of Permethrin
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Temporary burning and stinging after using (10%)
- Itching (7%)
Please note: Side effects listed were reported by people who used permethrin 5% cream for severe scabies
Less Common Side Effects
- Redness on your skin
- Skin numbness
- Rash
Permethrin serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Allergic reaction: hives, trouble breathing, swelling of your face, hands, skin, or scalp
The following Permethrin side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Less common or rare
Burning, itching, numbness, rash, redness, stinging, swelling, or tingling of the scalp
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Permethrin
Pros
- Usually only need one treatment for scabies
- Available as a lower-cost generic
- Available over-the-counter for treating head lice
- Can be used in children as young as 2 months old
Cons
- Doesn't kill lice eggs (nits)
- You might need to repeat it when treating head lice or scabies.
- Can temporarily make scabies itching worse
- Some head lice cannot be killed with this medication.
Pharmacist tips for Permethrin
General permethrin tips:
- If permethrin gets in your eyes, flush or wash your eyes immediately with water. You can protect your eyes with a washcloth or towel when using this medication.
- Be sure to check other members of your household for lice or scabies and alert people you've been in close contact with recently to check themselves. It's possible they could also have scabies or head lice and will need to use this medication too.
- Topical permethrin is considered safe to use while breastfeeding because very little of the medication gets absorbed by your body. But, it's always a good idea to let your provider know if you are breastfeeding before using any medications.
Tips for using permethrin 1% lotion rinse for lice:
- When treating head lice, it's important to use the fine-toothed comb that comes with permethrin 1% to remove any lice and eggs from your hair. It's best to have someone else to help you with this to make sure all the lice and eggs are removed.
- Before applying permethrin, adults and children over 2 months old should wash their hair with shampoo only (no conditioner). Dry your hair with a towel so that it's damp and no longer wet.
- When you're ready to apply permethrin lotion, shake the bottle well. Cover your hair and scalp with the medication, including behind your ears and on the back of your neck. Leave the medication in your hair for 10 minutes and wash it out. You will then want to remove the lice and eggs from your hair by using the special comb that is included in the box.
Tips for using permethrin 5% cream for scabies:
- Permethrin cream usually treats scabies after a single use. But if you do notice live mites again 2 weeks after you originally used this medication, you should contact your provider. You might need to use permethrin again or try a different medication.
- A common symptom of having scabies is extreme itchiness. When you use permethrin to treat scabies, your itching may be temporarily worse while the medication kills the scabies. The itching will subside once all the scabies have died.
Common questions about Permethrin
If you leave permethrin cream on for longer than the recommended time, you may experience more skin irritation (e.g., itching, burning, redness, and stinging). Follow your providers instructions and wash off the medication as instructed.
Adult and children should spread and massage enough permethrin cream into the skin from the hairline on your head to the bottoms of your feet. You usually don't need to put any into your hair or on your scalp, unless directed by your provider. Infants will need to have permethrin applied to their entire body, including the scalp and temples. Leave the cream on for 8 to 14 hours and then wash off in the shower.
No. It's not recommended to use permethrin everyday. One application can be enough to get rid of the lice or scabies. If you're still itchy shortly after applying permethrin, this doesn't necessarily mean it didn't work for you. Mild itchiness is actually a side effect of the medication. But keep an eye out for lice or scabies in the weeks after your treatment. If you notice lice after a week (or scabies after 2 weeks), your provider might ask you to do another treatment.
People typically only need to use permethrin cream once to treat their scabies. But if you notice live mites after 2 weeks, talk to your provider about possibly doing another treatment. Don't use permethrin more often than prescribed for scabies because doing so can irritate your skin.
Permethrin 5% cream and permethrin 1% lotion rinse are only meant to kill scabies or head lice; they're not approved to kill bed bugs or fleas. There are permethrin-products on the market that can kill bed bugs or fleas, but those products should never be applied directly on humans. If you have a bed bug problem, contact a licensed professional who can talk with you about bedbug-specific chemicals or pesticides. If you or your pet have flea bites, speak with your provider or pet's veterinarian for ways to get rid of fleas.
Talk to your healthcare provider before using permethrin cream or lotion rinse during pregnancy. Permethrin cream and lotion haven't been well-studied in human pregnancies. But animal studies suggest that the permethrin is unlikely to cause harm to unborn babies if used by mothers during pregnancy.
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Risks and warnings for Permethrin
Permethrin can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Allergic reaction
Severe allergic reactions to permethrin are possible, including life-threatening problems like anaphylaxis (closing of the throat). Similar lice medications are known to cross-react and cause an allergic reaction if you are allergic to ragweed. Although permethrin doesn't seem to cross-react, if you do notice hives, a rash, swelling of the lips or tongue, or difficulty breathing after using permethrin, call your healthcare provider right away.
Permethrin dosage
Tube of cream| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 60g of 5% | 1 tube | $23.64 | $23.64 |
Typical dosage for Permethrin
- Scabies (permethrin 5% cream): The typical dose is to massage enough cream into the skin to cover the body from the hairline on your head to the bottoms of your feet (typically about 30 grams for adults). Infants will also need treatment on their scalp and temple. Leave the cream on for 8 to 14 hours and then wash off in the shower.
- Head lice (permethrin 1% lotion rinse): Before applying, make sure to wash your hair with only shampoo, then towel dry your hair. The typical dose is to apply enough lotion to cover your hair and scalp with the medication, including the area behind your ears and on the back of your neck. Leave the medication in your hair for 10 minutes and wash it out.
Interactions between Permethrin and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.
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