PERMETHRIN 1%
Place in Therapy
Place in Therapy
For the treatment of pediculus, permethrin 1% lice treatment is a first line option that can be purchased as an over the counter product. According to the Centers for disease control and prevention, permethrin is both effective and safe when applied properly.1 Patient Self-care 2010, states that permethrin is considered first line treatment for pediculosis due to demonstrated efficacy and lack of toxicity.2 Permethrin has a 96-100% efficacy rate with good ovicidal activity (70-80%).2 There are multiple studies, some of which discussed above that substantiate the efficacy of permethrin. In a study by Bainbridge et al, permethrin 1% rinse demonstrated 100% efficacy on day 7 of treatment and only one patient had a re-infestation on day 15.3 In another study by Clineschmidt et al, permethrin use resulted in a lice-free rate of 83.1% on day 2, 77.6% on day 9 and 78.3% on day 14.4 Unfortunately as permethrin 1% rinse has been used for multiple years, lice are starting to develop resistance to the treatment. It is therefore now recommended that an additional treatment be used 7-10 days post the first treatment.2 This resistance may be responsible for the decreased efficacy of NIX (only 55% eradication) in the trial performed by Meinking et al.5 Resistance does not appear to be as significant an issue in Canada as it is in other countries, however it is starting to increase and warrants a second treatment.6
Permethrin 1% lice treatment has an excellent safety profile. It has a lack of toxicity, unlike some other lice treatments and has minimal adverse effects associated with its use.2 After using the product there may be mild, transient itching, redness or swelling. In uncommon circumstances there is burning, stinging, rash, tingling and numbness.1 This product should not be used in children under the age of 2 months of age. Permethrin is contraindicated in patients who have allergies to ragweed and chrysanthemum due to cross reactivity. There are no known drug interactions with permethrin.2 Permethrin is an acceptable option in pregnancy (pregnancy risk B) as well as lactation, although excretion in breast milk is unknown. There is very minimal systemic absorption (< 2%), which is why this treatment is a safe option.2 Finally permethrin ranges from $11-14 per treatment and two treatments are recommended.7/8 It may be recommended to use two bottles if an individual has very long or thick hair. Directions for application of the product are on the product and are easy to follow.
REFERENCES
1. Centers for Disease Control and Prevention. Parasites: Lice – Head Lice. 2010. Accessed February 24, 2013 from http://www.cdc.gov/parasites/lice/head/treatment.html
2. Miller, P. 2010. Patient Self-Care; Second Edition. Parasitic Skin Infections: Lice and Scabies. 679-688.
3. Bainbridge C, Klein G, Neibart S, Hassman H, Ellis K, Manrin D et al. 1998. Comparative Study of the Clinical Effectiveness of a Pyrethrin-Based pediculicide with combing versus a Permethrin-based pediculicide with combing. Clin Pediatr. 37:17-22.
4. Meiking T, Clineschmidt C, Chen C, Kolber M, Tipping R, Furtek C, Villar M et al. 2002. An observer blinded study of 1% permethrin crème rinse with and without adjunctive combing in patients with head lice. Journal of Pediatrics. 141(5); 665-670.
5. Meinking T, Vicaria M, Eyerdam D, Villar M, Reyna S, Suarez G. 2004. Efficacy of a Reduced Application Time of Ovide Lotion (0.5% Malathion) Compared to Nix Creme Rinse (1% Permethrin) for the Treatment of Head Lice. Clinical Practice Guidelines – Canadian Pediatric Society 2004 – Head lice infestations: A Clinical update. 647-651.Pediatric Derm; 6(21); 670-674.
6. Clinical Practice Guidelines – Canadian Pediatric Society 2004 – Head lice infestations: A Clinical update. 647-651.
7. RxFiles. Over the Counter Products – Head Lice. 2010. 97.a
8. Lexi – Comp 2012. Permethrin. Accessed February 24, 2013 from http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/7471
For the treatment of pediculus, permethrin 1% lice treatment is a first line option that can be purchased as an over the counter product. According to the Centers for disease control and prevention, permethrin is both effective and safe when applied properly.1 Patient Self-care 2010, states that permethrin is considered first line treatment for pediculosis due to demonstrated efficacy and lack of toxicity.2 Permethrin has a 96-100% efficacy rate with good ovicidal activity (70-80%).2 There are multiple studies, some of which discussed above that substantiate the efficacy of permethrin. In a study by Bainbridge et al, permethrin 1% rinse demonstrated 100% efficacy on day 7 of treatment and only one patient had a re-infestation on day 15.3 In another study by Clineschmidt et al, permethrin use resulted in a lice-free rate of 83.1% on day 2, 77.6% on day 9 and 78.3% on day 14.4 Unfortunately as permethrin 1% rinse has been used for multiple years, lice are starting to develop resistance to the treatment. It is therefore now recommended that an additional treatment be used 7-10 days post the first treatment.2 This resistance may be responsible for the decreased efficacy of NIX (only 55% eradication) in the trial performed by Meinking et al.5 Resistance does not appear to be as significant an issue in Canada as it is in other countries, however it is starting to increase and warrants a second treatment.6
Permethrin 1% lice treatment has an excellent safety profile. It has a lack of toxicity, unlike some other lice treatments and has minimal adverse effects associated with its use.2 After using the product there may be mild, transient itching, redness or swelling. In uncommon circumstances there is burning, stinging, rash, tingling and numbness.1 This product should not be used in children under the age of 2 months of age. Permethrin is contraindicated in patients who have allergies to ragweed and chrysanthemum due to cross reactivity. There are no known drug interactions with permethrin.2 Permethrin is an acceptable option in pregnancy (pregnancy risk B) as well as lactation, although excretion in breast milk is unknown. There is very minimal systemic absorption (< 2%), which is why this treatment is a safe option.2 Finally permethrin ranges from $11-14 per treatment and two treatments are recommended.7/8 It may be recommended to use two bottles if an individual has very long or thick hair. Directions for application of the product are on the product and are easy to follow.
REFERENCES
1. Centers for Disease Control and Prevention. Parasites: Lice – Head Lice. 2010. Accessed February 24, 2013 from http://www.cdc.gov/parasites/lice/head/treatment.html
2. Miller, P. 2010. Patient Self-Care; Second Edition. Parasitic Skin Infections: Lice and Scabies. 679-688.
3. Bainbridge C, Klein G, Neibart S, Hassman H, Ellis K, Manrin D et al. 1998. Comparative Study of the Clinical Effectiveness of a Pyrethrin-Based pediculicide with combing versus a Permethrin-based pediculicide with combing. Clin Pediatr. 37:17-22.
4. Meiking T, Clineschmidt C, Chen C, Kolber M, Tipping R, Furtek C, Villar M et al. 2002. An observer blinded study of 1% permethrin crème rinse with and without adjunctive combing in patients with head lice. Journal of Pediatrics. 141(5); 665-670.
5. Meinking T, Vicaria M, Eyerdam D, Villar M, Reyna S, Suarez G. 2004. Efficacy of a Reduced Application Time of Ovide Lotion (0.5% Malathion) Compared to Nix Creme Rinse (1% Permethrin) for the Treatment of Head Lice. Clinical Practice Guidelines – Canadian Pediatric Society 2004 – Head lice infestations: A Clinical update. 647-651.Pediatric Derm; 6(21); 670-674.
6. Clinical Practice Guidelines – Canadian Pediatric Society 2004 – Head lice infestations: A Clinical update. 647-651.
7. RxFiles. Over the Counter Products – Head Lice. 2010. 97.a
8. Lexi – Comp 2012. Permethrin. Accessed February 24, 2013 from http://online.lexi.com.proxy.lib.uwaterloo.ca/lco/action/doc/retrieve/docid/patch_f/7471