PYRETHRINS 0.33% AND PIPERONYL BUTOXIDE 3%
Patient Counselling
Patient Counselling
For non-pharmacological strategies that should be performed in addition to the instructions below, please click on “Non-Pharmacological Treatments and Preventative Strategies” in Lice algorithm.
Goals of treatment <1>:
We want to exterminate lice, relieve itchiness, and prevent spread of the infestation.
General Treatment <1>:
After the first treatment, a second treatment is recommended 7-10 days later to ensure the lice and any hatched eggs are gone.
After the treatment, dead nits must be removed with tweezers or a comb. Clean the comb with soap and hot water after use.
How the medication works <2>:
Pyrethrins are derived from flowers that belong to the chrysanthemum family. Pyrethrins treat lice by disrupting sodium channels, delaying repolarization resulting in paralysis and death of the insect. Piperonyl butoxide is added to to pyrethrin to enhance the product's activity by decreasing the metabolism of pyrethrins in arthropods.
Directions for using the shampoo <2>:
1. Shake well before use.
2. Apply to dry hair that does not have conditioner, gels, creams on it.
3. Soak hair with a minimum of 25 mL.
4. Leave on for 10 min.
5. After 10 minutes, use a small amount of water and lather on hair.
6. Rinse fully.
7. Wash your hands after use
8. Dry with towel
9. Use special nit comb or tweezers to get rid of dead nits from hair
10. Repeat treatment 7-10 days later
11. Do not exceed 2 consecutive applications within 24 hours
Monitoring <1,2>:
After treatment of lice, the dead nits will still be attached to the hair. They can be removed with tweezers or a comb. The patient should observe for any recurrence of lice and nits.
Re-treatment for 7-10 days is necessary to ensure the lice and any hatched eggs are gone.
If treatment fails, or if the patient continues to experience excessive itch, they should see the doctor. It is normal to be itchy for several weeks after the treatment but the patient may require a hydrocortisone cream or antihistamine for relief.
Storage <2>:
The medication should be stored at room temperature (20 to 25 oC). It is important to not puncture the container.
Side effects <1,2>:
This medication is well tolerated. However, the patient may experience mild scalp and skin irritation, burning, stinging, or short term pain. Patient should see physician if they develop shortness of breath, severe rash, wheezing, chest tightness, or swelling of face, lips, tongue.
Precautions <2,3>:
This product is for external use only. It's harmful if swallowed and should not be inhaled. During shampooing, contact should be avoided with eyelashes, eyes, nose, mouth, and other mucous areas. If contact does take place, flush with water.
If accidental ingestion occurs, call a physician immediately. Drink large amounts of water. Do not induce vomiting.
References:
1. Miller, PF. Chapter 71: Parasitic Skin Infections: Lice and Scabies. In: Patient Self Care Helping Your Patients Make Therapeutic Choices 2nd ed. 2010; 679-690.
2. Lexi-Comp. Pyrethrin and Piperonyl butoxide. Available at: http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/home/switch. Accessed March 8, 2013.
3. e-Therapeutics. Pyrethrins. Available at: https://www.e-therapeutics.ca/cps.select.preliminaryFilter.action?simplePreliminaryFilter=pyrethrins&simpleIndex=brand_generic&simpleQuery=pyrethrins#. Accessed March 8, 2013.
For non-pharmacological strategies that should be performed in addition to the instructions below, please click on “Non-Pharmacological Treatments and Preventative Strategies” in Lice algorithm.
Goals of treatment <1>:
We want to exterminate lice, relieve itchiness, and prevent spread of the infestation.
General Treatment <1>:
After the first treatment, a second treatment is recommended 7-10 days later to ensure the lice and any hatched eggs are gone.
After the treatment, dead nits must be removed with tweezers or a comb. Clean the comb with soap and hot water after use.
How the medication works <2>:
Pyrethrins are derived from flowers that belong to the chrysanthemum family. Pyrethrins treat lice by disrupting sodium channels, delaying repolarization resulting in paralysis and death of the insect. Piperonyl butoxide is added to to pyrethrin to enhance the product's activity by decreasing the metabolism of pyrethrins in arthropods.
Directions for using the shampoo <2>:
1. Shake well before use.
2. Apply to dry hair that does not have conditioner, gels, creams on it.
3. Soak hair with a minimum of 25 mL.
4. Leave on for 10 min.
5. After 10 minutes, use a small amount of water and lather on hair.
6. Rinse fully.
7. Wash your hands after use
8. Dry with towel
9. Use special nit comb or tweezers to get rid of dead nits from hair
10. Repeat treatment 7-10 days later
11. Do not exceed 2 consecutive applications within 24 hours
Monitoring <1,2>:
After treatment of lice, the dead nits will still be attached to the hair. They can be removed with tweezers or a comb. The patient should observe for any recurrence of lice and nits.
Re-treatment for 7-10 days is necessary to ensure the lice and any hatched eggs are gone.
If treatment fails, or if the patient continues to experience excessive itch, they should see the doctor. It is normal to be itchy for several weeks after the treatment but the patient may require a hydrocortisone cream or antihistamine for relief.
Storage <2>:
The medication should be stored at room temperature (20 to 25 oC). It is important to not puncture the container.
Side effects <1,2>:
This medication is well tolerated. However, the patient may experience mild scalp and skin irritation, burning, stinging, or short term pain. Patient should see physician if they develop shortness of breath, severe rash, wheezing, chest tightness, or swelling of face, lips, tongue.
Precautions <2,3>:
This product is for external use only. It's harmful if swallowed and should not be inhaled. During shampooing, contact should be avoided with eyelashes, eyes, nose, mouth, and other mucous areas. If contact does take place, flush with water.
If accidental ingestion occurs, call a physician immediately. Drink large amounts of water. Do not induce vomiting.
References:
1. Miller, PF. Chapter 71: Parasitic Skin Infections: Lice and Scabies. In: Patient Self Care Helping Your Patients Make Therapeutic Choices 2nd ed. 2010; 679-690.
2. Lexi-Comp. Pyrethrin and Piperonyl butoxide. Available at: http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/home/switch. Accessed March 8, 2013.
3. e-Therapeutics. Pyrethrins. Available at: https://www.e-therapeutics.ca/cps.select.preliminaryFilter.action?simplePreliminaryFilter=pyrethrins&simpleIndex=brand_generic&simpleQuery=pyrethrins#. Accessed March 8, 2013.