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).
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What are the side effects of Permethrin?
Common Side Effects
- Temporary burning and stinging after using (10%)
- Itching (7%)
Other Side Effects
- Redness on your skin
- Skin numbness
- Rash
Serious Side Effects
- Allergic reaction: hives, trouble breathing, swelling of your face, hands, skin, or scalp
Source: DailyMed
The following 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.
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.
Frequently asked questions about Permethrin
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What are the 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 forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 60g of 5% | 1 tube | $27.83 | $27.83 |
Typical dosing 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.
How much does Permethrin cost?
What are alternatives to Permethrin?
Scabies (prescription version - 5% cream)
Head lice (over-the-counter version - 1% shampoo rinse/lotion)
What is the latest news about Permethrin?
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References
Best studies we foundCenters for Disease Control and Prevention. (2019). Treatment.
Centers for Disease Control and Prevention. (2020). Getting rid of fleas.
Drugs and Lactation Database (LactMed). (2023). Permethrin. National Institute of Child Health and Human Development.
Encube Ethicals Private Limited. (2023). Permethrin- permethrin cream 5% w/w cream [package insert]. DailyMed.
Insight Pharmaceuticals LLC. (2021). Nix - permethrin rinse [package insert]. DailyMed.
L. Perrigo Company. (2022). Good Sense Lice Killing Creme Rinse- permethrin lotion [package insert]. DailyMed.
Orkin LLC. (n.d.). How to identify and treat flea bites on human.
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