LINDANE 1%
Place in Therapy
Place In Therapy
Lindane therapy is not recommended as a first line option for lice treatment.1 Although it is effective at treating lice infestations there are many safety risks involved with its use and lindane should be considered as second line or even "last-line" treatment. Lindane products should only be used if patients cannot tolerate other lice treatment products or if there has been an inadequate response with use other lice treatment products.1 Some studies have shown an increased resistance to lindane in the United States and other countries, probably due to its historical use as a first-line agent before safety concerns were evident.2,3,4,5 Other lice-treatment options such as permethrin or pyrethrin have shown lower incidence of resistance and greater ovicidal activity and therefore should be considered first before the use of lindane.2,4
Lindane's use as a lice treatment was very popular since the 1950's, however, several case reports have since been released regarding the safety of lindane for the treatment of lice.5 Serious side effects of lindane use include neurotoxicity including seizures, ataxia, and tremors, aplastic anemia, shortness of breath, rash and even death. Due to occurrence of these side effects the use of lindane is contraindicated in patients with a history of seizures, children under the age of 10, elderly patients, patients with psoriasis, atopic dermatitis or any rash that may increase absorption through the skin, patients weighing less than 110 lbs and patients with a hypersensitivity to any lindane products.1 Lindane is metabolized by the liver and precautions should be taken when used in patients with hepatic impairment.1 Although there are no listed drug interactions, it has been noted to avoid concomitant use of lindane and any drugs that can reduce the seizure threshold in patients.6
The FDA classifies lindane as a risk category of C for pregnancy, meaning animal studies have shown no adverse effect on the fetus and there are no adequate and well-controlled studies in humans.1,6 The potential risks associated with lindane due to its potential to cause neurotoxicity should be taken into consideration when recommending treatment to pregnant patients. Lindane crosses into breastmilk and should be avoided in breastfeeding.1,6
Cost and application of lindane is very similar to other ovicidal agents. The shampoo for head lice and pubic lice is applied to dry hair and washed off in four minutes which is a much shorter period of time than the other agents.1 A safe interval for reapplication in unknown and it is not recommended to repeat treatment to ensure complete eradication of the infestation.1 The cost of lindane for one treatment is approximately $9.7
REFERENCES:
1. Lindane. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically. Retrieved on March 3rd, 2013 from: http://www.micromedexsolutions.com/micromedex2/librarian/ND_T/evidencexpert/ND_PR/evidencexpert/CS/10610E/ND_AppProduct/evidencexpert/DUPLICATIONSHIELDSYNC/389A70/ND_PG/evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/PFActionId/evidencexpert.DisplayDrugdexDocument?docId=340920&contentSetId=100&title=Lindane&servicesTitle=Lindane
2. Jones KN and English JC. Review of Common Therapeutic Options in the United States for the Treatment of Pediculosis Capitis. Clin Infect Dis 2003; 36: 1355-1361.
3. Finlay J and MacDonald NE. Head lice infestations: A clinical update. Paediatr Child Health 2008; 13(8): 692-8.
4. Lebwohl M, Clark L, and Levitt J. Therapy for head lice based on lice cycle, resistance, and safety considerations. Pediatrics 2007; 119(5): 956-974.
5. Nolan K, Kamrath J, and Levitt J. Lindane toxicity: a comprehensive review of the medical literature. Pediatr Dermatol. 2012; 29(2): 141-146.
6. Lindane. Lexi-Comp, Inc. (Lexi-DrugsTM ). Lexi-Comp, Inc.; January 29, 2011
7. RxFiles. Over the Counter Products - Head Lice. 2010. 97.
Lindane therapy is not recommended as a first line option for lice treatment.1 Although it is effective at treating lice infestations there are many safety risks involved with its use and lindane should be considered as second line or even "last-line" treatment. Lindane products should only be used if patients cannot tolerate other lice treatment products or if there has been an inadequate response with use other lice treatment products.1 Some studies have shown an increased resistance to lindane in the United States and other countries, probably due to its historical use as a first-line agent before safety concerns were evident.2,3,4,5 Other lice-treatment options such as permethrin or pyrethrin have shown lower incidence of resistance and greater ovicidal activity and therefore should be considered first before the use of lindane.2,4
Lindane's use as a lice treatment was very popular since the 1950's, however, several case reports have since been released regarding the safety of lindane for the treatment of lice.5 Serious side effects of lindane use include neurotoxicity including seizures, ataxia, and tremors, aplastic anemia, shortness of breath, rash and even death. Due to occurrence of these side effects the use of lindane is contraindicated in patients with a history of seizures, children under the age of 10, elderly patients, patients with psoriasis, atopic dermatitis or any rash that may increase absorption through the skin, patients weighing less than 110 lbs and patients with a hypersensitivity to any lindane products.1 Lindane is metabolized by the liver and precautions should be taken when used in patients with hepatic impairment.1 Although there are no listed drug interactions, it has been noted to avoid concomitant use of lindane and any drugs that can reduce the seizure threshold in patients.6
The FDA classifies lindane as a risk category of C for pregnancy, meaning animal studies have shown no adverse effect on the fetus and there are no adequate and well-controlled studies in humans.1,6 The potential risks associated with lindane due to its potential to cause neurotoxicity should be taken into consideration when recommending treatment to pregnant patients. Lindane crosses into breastmilk and should be avoided in breastfeeding.1,6
Cost and application of lindane is very similar to other ovicidal agents. The shampoo for head lice and pubic lice is applied to dry hair and washed off in four minutes which is a much shorter period of time than the other agents.1 A safe interval for reapplication in unknown and it is not recommended to repeat treatment to ensure complete eradication of the infestation.1 The cost of lindane for one treatment is approximately $9.7
REFERENCES:
1. Lindane. In: DRUGDEX® System [Internet database]. Greenwood Village, Colo: Thomson Reuters (Healthcare) Inc. Updated periodically. Retrieved on March 3rd, 2013 from: http://www.micromedexsolutions.com/micromedex2/librarian/ND_T/evidencexpert/ND_PR/evidencexpert/CS/10610E/ND_AppProduct/evidencexpert/DUPLICATIONSHIELDSYNC/389A70/ND_PG/evidencexpert/ND_B/evidencexpert/ND_P/evidencexpert/PFActionId/evidencexpert.DisplayDrugdexDocument?docId=340920&contentSetId=100&title=Lindane&servicesTitle=Lindane
2. Jones KN and English JC. Review of Common Therapeutic Options in the United States for the Treatment of Pediculosis Capitis. Clin Infect Dis 2003; 36: 1355-1361.
3. Finlay J and MacDonald NE. Head lice infestations: A clinical update. Paediatr Child Health 2008; 13(8): 692-8.
4. Lebwohl M, Clark L, and Levitt J. Therapy for head lice based on lice cycle, resistance, and safety considerations. Pediatrics 2007; 119(5): 956-974.
5. Nolan K, Kamrath J, and Levitt J. Lindane toxicity: a comprehensive review of the medical literature. Pediatr Dermatol. 2012; 29(2): 141-146.
6. Lindane. Lexi-Comp, Inc. (Lexi-DrugsTM ). Lexi-Comp, Inc.; January 29, 2011
7. RxFiles. Over the Counter Products - Head Lice. 2010. 97.