Head lice and scabies infections are treated topically with the neurotoxic pesticide lindane (as a second-line agent).

Lindane Uses:

• Lotion:

  • Used to treat Sarcoptes scabiei (scabies)

• Shampoo:

  • Used to cure Phthirus pubis and Pediculus capitis (head lice) (crab lice)

Note: The use of this medication should only be reserved for individuals who are intolerant to or have failed to respond to first-line treatments.

Lindane Dose in Adults:

Note: The United States hasn't sold Lindane lotion for more than a year.

Lindane Dose in the treatment of Scabies:

• Topical:Should be applied as a thin layer of lotion and massaged into the skin from the neck to the toes; after 8–12 hours, take a bath and wash the medication off; the majority of people would need 30mL; larger individuals might need 60mL. Retreatment is not advised. not be left unattended for longer than 12 hours. It should be used for 8 hours, per CDC STD guidelines.

Lindane dose in the treatment of head lice/ crab lice:

• Topical:Dry hair should first be treated with shampoo, which should then be massaged into the hair for 4 minutes. After adding tiny amounts of water to the hair to create a lather, the hair should be completely rinsed and combed with a fine-tooth comb to remove any nits. The amount of shampoo needed depends on the length and density of the patient's hair; while most only need 30 mL, others may need 60 mL. Retreatment is not advised.

Lindane Dose in Childrens:

Note: Despite being FDA-approved, it is not advised as a treatment for head lice or scabies in paediatric patients under 50 kg due to safety concerns; avoid use if at all feasible and look into other medicines. The United States hasn't sold Lindane lotion for more than a year.

Lindane dose in the treatment of head lice as a second-line agent:

• Infants, Children, and Adolescents:

  • Shampoo:

    • Topical: Dry hair should first be treated with shampoo, which should then be massaged into the hair for 4 minutes. After adding tiny amounts of water to the hair to create a lather, the hair should be completely rinsed and combed with a fine-tooth comb to remove any nits. The amount of shampoo needed depends on the length and density of the patient's hair; while most only need 30 mL, others may need 60 mL. Retreatment is not advised.

Lindane dose in the treatment of Scabies as a second-line drug:

• Infants, Children, and Adolescents:

  • Lotion:

    • Topical:30mL would be needed for the majority of patients, but 60mL may be needed for larger people. It should be applied as a thin layer of lotion and massaged into the skin from the neck to the toes. After 8–12 hours, take a bath and remove the medication. Retreatment is not advised.

• Infants and Children:

  • Wash after 6 hours of application

Pregnancy Risk Factor C

• Studies on animal reproduction have shown that there are adverse events.
• Studies on animals point to neurologic problems that could be brought on by the fetus's undeveloped central nervous system and greater vulnerability to medicines.
• Lindane can build up in the placenta as a result of its lipophilic properties.
• If used during pregnancy, may cause mental retardation and neural tube defects.

Use during breastfeeding:

• Breast milk contains Lindane.
• Do not interrupt breastfeeding mothers who are nursing. After use, milk should be expressed and thrown away for no less than one day.
• Avoid skin-to-skin contact with the infant and affected area.

Dose in Kidney Disease:

No dosage adjustments provided in the manufacturer's labeling.

Dose in Liver disease:

No dosage adjustments provided in the manufacturer's labeling.

Side effects of Lindane:

• Central nervous system:

  • Ataxia
  • Dizziness
  • Localized burning
  • Neurotoxicity (risk greater in patients <110 lbs [50 kg])
  • Restlessness
  • Seizure
  • Stinging sensation

• Dermatologic:

  • Contact dermatitis
  • Eczematous rash

• Hematologic & oncologic:

  • Aplastic anemia (CDC 2010)

Contraindications to Lindane:

• Hypersensitivity to lindane and any other component of the formulation
• Premature infants
• Uncontrolled seizure disorders
• Crusted (Norwegian), scabies, or other skin conditions (eg atopic dermatitis (atopic dermatitis), that can cause increased systemic absorption

Warnings and precautions

• Neurotoxicity: [US Boxed Warn]

  • Use of the drug can cause severe neurologic toxicities, including seizures or death. This may happen with repeated, prolonged, or single-use.
  • Premature infants and uncontrolled seizures are contraindications to use.
  • Use caution when administering this medication to patients under the age of 50 kg, newborns, small children, patients with skin disorders, and patients.
  • Patients with a history or epilepsy, including those who have suffered from seizures, head trauma or HIV infection, and patients in other conditions that could increase the chance of seizures or medication which lowers seizure threshold.

• Hepatic impairment

  • Be careful.

Monitoring Parameters:

None mentioned.

How to administer Lindane?

Use only topically, never give orally. Shake well before use. Caregivers should use gloves while applying (natural latex should be avoided, may be permeable to lindane). Use warm (not hot) water to rinse off.

Lotion:

• Avoid applying it to the face or eyes and instead use it on dry, cold skin. 60 minutes should pass after taking a shower or a bath (absorption is increased from warm and wet skin). The skin should be clean and free of any other creams, lotions, or oils before using lindane. not be applied to sores or open wounds. Steer clear of occlusive dressings.

Shampoo:

• It needs to be used on dry, clean hair. Before using lindane shampoo, one should give their hair at least 60 minutes to dry. Hair should be washed with a shampoo without a conditioner before being treated with lindane.

Mechanism of action of Lindane:

The exoskeleton is absorbed by parasites and ova, causing stimulation to the nervous system and leading to seizures and death for these arthropods.

Absorption:

• 10% systemically, more readily absorbed when given to skin that is weeping or excoriated

Metabolism:

• Liver disease

Half-life elimination:

• Infants >=5 Months and Children =8 Years: Healthy skin takes 21.4 hours Infected skin: 17.9 Hours

Time to reach peak, serum:

• Infants >=5 Months and Children: 6 Hours

Excretion

• Via urine and stool

International Brand Names of Lindane:

• Agalin
• Aphtiria
• Aprurol
• Ascabiol
• Benhex Cream
• Bexarid
• Davesol
• Delice
• Delitex
• Demar
• Desintan
• Elentol
• Esoderm
• GAB
• Gama Acaderm
• Gambex
• Gamma-Scab
• Gatox
• GBHC
• Herklin
• Hexa-Defital
• Hexin
• Jacutin
• Kwell
• Kwellada
• Lencid
• Lendianon
• Lindan
• Lindano
• Lindano-GBHG
• Linden Lotion
• Milinor
• Nedax
• Paracid
• Parakil
• Plomurol
• Pruritrat
• Quellada
• Quellada Cream
• Quellada Creme Rinse
• Quellada Head Lice Treatment
• Quellada Lotion
• Sarcoderma
• Scabcur
• Scabecid
• Scabene
• Scabi
• Scabix
• Scaboma
• Skabicid
• Somergan
• Texa

Lindane Brand Names in Pakistan: