Permethrin

Aka: Permethrin, Elimite, Nix

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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

III. Indications

  1. Pediculosis (Lice)
  2. Scabies
  3. Prevention of Vector-borne Infection

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. See Pyrethroid Toxicity
  3. Mild transient burning, Paresthesias or Pruritus at the application site
  4. Local erythema may occur

XII. References

  1. Marco (2013) Crit Dec in Emerg Med 27(1): 2-7
  2. Mumcuoglo (1995) Med Vet Entomol, 9:427 [PubMed]
  3. Rupes (1995) Cent Eur J Public Health, 3:30 [PubMed]

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Cost: Medications

permethrin (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
PERMETHRIN 5% CREAM Generic $0.30 per gram
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information. GoodRx is another tool for finding lower drug prices.

Related Topics in Pharmacology

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