II. Mechanism

  1. Pyrethroid (Synthetic based on Pyrethrins)
  2. Neurotoxin
    1. Acts at the Neuron cell membrane of arthropods (e.g. fleas, lice, mites, ticks)
    2. Binds Sodium channels and prolongs their activation

IV. Advantages

  1. Residual activity for over 2 weeks

V. Precautions

  1. Avoid in under age 2 months old
  2. Safe: Poorly absorbed
  3. Rapidly metabolized to inactive

VI. Pregnancy and Lactation

  1. Pregnancy Category B
  2. Lactation safety is unknown
    1. Consider switching to formula while using Permethrin

VII. Preparations

  1. Permethrin 1% (Nix rinse supplied as 60 ml)
    1. Over the counter
  2. Permethrin 5% (Elimite supplied as 60 g cream)
    1. FDA indication only for Scabies

VIII. Dosing

  1. Scabies treatment (Permethrin 5%)
    1. Apply Permethrin 5% cream from head to soles of feet
      1. Adults and children over age 5 years apply from neck down
      2. Consider forhead application in the elderly
    2. Avoid Mouth, nose and eyes
    3. Wash after 8-14 hours
    4. Repeat application in 1-2 weeks
  2. Lice treatment (Permethrin 1%)
    1. Apply to clean dry hair
    2. Saturate hair and scalp
    3. Wash after 10 minutes
    4. Consider overnight treatment
      1. Leave on overnight for 8-14 hours under shower cap
      2. Rinse hair in morning
    5. Repeat in one week

IX. Supply

  1. Adult: 60 grams per adult per treatment (120 g total)
  2. Child: 30 grams per child per treatment (60 g total)

X. Efficacy

  1. Resistance increasing to 1% Permethrin
  2. Lice Treatment may require 5% Permethrin

XI. Adverse Effects

  1. See Pyrethrin
  2. Mild transient burning, Paresthesias or Pruritus at the application site
  3. Local erythema may occur

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Cost: Medications

permethrin (on 5/17/2017 at Medicaid.Gov Survey of pharmacy drug pricing)
PERMETHRIN 5% CREAM Generic $0.83 per gram

Ontology: Permethrin (C0070455)

Definition (NCI) A synthetic pyrethroid and neurotoxin. Permethrin affects the neuronal membrane by blocking the movement of sodium ions from outside to inside the neuronal cell membrane thereby disrupting the sodium channel current that regulates the polarization of the membrane. This leads to delayed repolarization and subsequent paralysis of the nervous system. Permethrin is used to eradicate parasites such as head lice, ticks and scabies from humans and animals.
Definition (MSH) A pyrethroid insecticide commonly used in the treatment of LICE INFESTATIONS and SCABIES.
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121) , Hazardous or Poisonous Substance (T131)
MSH D026023
SnomedCT 1887004, 410457007
English cyclopropanecarboxylic acid, 3-(2,2-dichloroethenyl)-2,2-dimethyl-, (3-phenoxyphenyl)methyl ester, permethrin (medication), scabicides permethrin, Permethrin [Chemical/Ingredient], PERMETHRIN, (+/-)-3-Phenoxybenzyl 3-(2,2-Dichlorovinyl)-2,2-Dimethylcyclopropanecarboxylate, Cyclopropanecarboxylic Acid, 3-(2,2-Dichloroethenyl)-2,2-Dimethyl-, (3-Phenoxyphenyl)Methyl Ester, M-Phenoxybenzyl (+/-)-3-(2,2-Dichlorovinyl)-2,2-Dimethylcyclopropanecarboxylate, (m-Phenoxybenzyl)-cis,trans-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropanecarboxylate, 3-Phenoxybenzyl-(+-)-cis,trans-2,2-dichlorovinyl-2,2-dimethyl-cyclopropylcarboxylic acid, ester, 3-Phenoxybenzyl-cis,trans-(1RS)-3-(2,2-dichlorovinyl)-2,2-dimethylcyclopropanecarboxylate, permethrin, Permethrin (product), Permethrin, Permethrin (substance)
Swedish Permetrin
Czech permethrin
Finnish Permetriini
Russian PERMETRIN, ПЕРМЕТРИН
Japanese ペルメトリン
Polish Permetryna
Spanish permetrina (producto), permetrina, permetrina (sustancia), Permetrina
French Perméthrine
German Permethrin
Italian Permetrina
Portuguese Permetrina

Ontology: Pyrethroids (C0597329)

Definition (CSP) active insecticidal constituents of pyrethrum (Chrysanthemum cinerariifolum) flowers.
Concepts Hazardous or Poisonous Substance (T131) , Organic Chemical (T109) , Pharmacologic Substance (T121)
MSH D011722
SnomedCT 311846002
English pyrethroid, Pyrethroids, pyrethroids, Pyrethroid insecticide, Pyrethroid insecticide (substance)
French Pyréthrinoïdes, Pyréthroïdes
Spanish piretroide, insecticida (sustancia), piretroide, insecticida

Ontology: Elimite (C0720177)

Concepts Pharmacologic Substance (T121) , Organic Chemical (T109)
MSH D026023
English elimite, Elimite

Ontology: BNIP3L gene (C1332435)

Definition (NCI) This gene is involved in the regulation of apoptosis and induces cell death.
Concepts Gene or Genome (T028)
English BCL2/ADENOVIRUS E1B 19-KD PROTEIN-INTERACTING PROTEIN 3-LIKE, NIX, BNIP3L, BCL2/adenovirus E1B 19kDa interacting protein 3-like, BNIP3a, Nix, BNIP3L gene, BCL2/Adenovirus E1B 19kd Interacting Protein 3-Like Gene, BNIP3L Gene