Permethrin (Nix) is available as a cream, lotion, soap, spray, and capsule formulations for the treatment of scabies and as a mosquito repellent.

Permethrin Uses:

• Head lice (lotion/ cream rinse):

  • Treatment of Pediculus humanus capitis head lice and their nits (eggs).

• Scabies (cream):

  • Treatment of scabies (Sarcoptes scabiei) infestation.

• Use: Off-Label: Adult

  • Pubic lice (Pediculosis pubis)
  • Crusted Scabies (Norwegian scabies)

Permethrin Dose in Adults

Permethrin Dose in the treatment of Head lice:

• Topical: Cream rinse/lotion 1%:

  • Use shampoo devoid of conditioner to wash your hair. Before applying, rinse with water and pat dry with a towel.
  • Applying enough lotion or cream rinse to completely cover the hair and head (especially behind the ears and nape of the neck).
  • Leave on hair for 10 minutes (or less), wash with warm water, and then use a nit comb to remove any leftover nits.
  • Generally, one application is sufficient; however, if lice or nits are still present seven days following the initial treatment, the procedure may need to be repeated.

Permethrin Dose in the treatment of Pubic lice (off-label):

• Topical: Apply 1% cream rinse to the affected areas, then rinse it off after 10 minutes.

Permethrin Dose in the treatment of Scabies:

• Topical: Cream 5%:

  • Apply cream (30 g for the average adult) all over, massaging it in well from top to bottom. Leave it on for 8 to 14 hours before washing it off (in the shower or bath). For infants and the elderly, apply cream as well to the hairline, neck, scalp, temples, and forehead. Repeat the treatment if living mites are still present 14 days after the initial application. One application is typically curative.

Permethrin Dose in the treatment of Scabies, crusted (Norwegian scabies) (off-label):

• Topical: Cream 5%:
  • Apply all over the body and let it sit for 8 to 14 hours before washing it off with water.
  • Follow this routine daily for seven days, then twice weekly until symptoms go away. Giving ivermectin is necessary.

Permethrin Dose in Childrens

Permethrin Dose in the treatment of Head lice:

• Note Usual first-line treatment (or pyrethrins) if community resistance is not a problem.

• Infants ≥2 months, Children, and Adolescents:

  • Topical: Solution/rinse 1%:
    • After shampoo (without conditioning) has been used to wash, rinse, and towel-dry the hair.
    • Applying enough permethrin solution or rinse to completely cover the hair and scalp, as well as behind the ears and at the nape of the neck, and letting it sit for 10 minutes before rinsing it off with water to get rid of any leftover nits.
    • If live lice or nits are still present, the procedure may be repeated in 7 to 10 days.
    • According to the lice life cycle, day 9 is the optimal time to repeat.

Permethrin Dose in the treatment of Pubic lice: Limited data available:

• Adolescents:

  • Topical: Solution/rinse 1%:

    • Apply to the affected area, wait 10 minutes, and then rinse.

Permethrin Dose in the treatment of Scabies:

• Infants ≥2 months, Children, and Adolescents:

  • Topical: Cream 5%:

    • Apply and massage in the cream from head to toe (the typical adult needs 30 g); leave on for 8 to 14 hours before rinsing off with water. For newborns, also apply to the hairline, neck, scalp, temples, and forehead. Reapply in 14 days if live mites are discovered.

Pregnancy Risk Factor B

• Studies on oral animal reproduction have not examined adverse events.
• Permethrin is available systemically in a maximum of 2% after topical application.
• Permethrin and pyrethrins with Piperonyl Butoxide are the preferred drugs for treating pubic lice in pregnant women, according to the CDC.
• Permethrin is the best treatment for scabies in pregnancy.

Permethrin use during breastfeeding:

• Breastmilk contains permethrin after environmental exposure, such as exposure to pyrethroids for agriculture or malaria control.
• Permethrin's presence in breast milk after topical application for the treatment or scabies of lice is unknown.
• Permethrin has a low systemic absorption after topical administration (=2%). Any drug absorbed is quickly metabolized to inactive compounds.
• Breastfeeding is unlikely to cause significant exposure for a breastfed baby.
• Permethrin is recommended against breastfeeding during therapy. However, it is widely used to treat pubic lice and crusted skin in breastfeeding mothers.

Permethrin Dose in Kidney Disease:

• The labelling on the medication from the manufacturer does not mention dosage adjustments.
• There does not seem to be an increased risk of adverse responses in patients with compromised renal function because topical permethrin is metabolised largely in the liver and eliminated in the urine as inactive metabolites.

Permethrin Dose in Liver Disease:

• There are no dosage adjustments provided in the drug manufacturer’s labeling.

Side Effects of Permethrin:

• Central Nervous System:

  • Local Discomfort (Scalp)
  • Localized Burning
  • Localized Numbness
  • Tingling Of Skin

• Dermatologic:

  • Pruritus
  • Erythema
  • Skin Rash (Scalp)
  • Stinging Of The Skin

• Local:

  • Localized Edema

Contraindications to Permethrin:

• Hypersensitivity/allergy to any pyrethroid or pyrethrin, or to any component of the formulation.

OTC labeling (cream rinse/lotion).

• Do not use self-medication while using this product.
• Infants under 2 months old
• Near the eyes
• Inside the nose, ear and mouth.
• For eyebrows and eyelashes, consult your doctor.

Warnings and precautions

• Skin irritation:

  • The symptoms of redness, itching, swelling, and redness may be temporarily worsened by treatment.
  • If hypersensitivity develops, discontinue use.

Monitoring parameters:

None mentioned. Monitor response to the treatment

How to administer Permethrin?

• When applying, stay away from the eyes and mucous membranes.
• Because scabies and lice are extremely dangerous, use caution to prevent spreading or catching them from oneself; apply with gloves on.
• Use as part of a comprehensive lice removal programme for the treatment of head lice, which includes washing or dry cleaning all clothing, hats, bedding, and towels that the patient has recently worn or used, as well as washing combs, brushes, and hair accessories in hot water; items that cannot be washed should be sealed in a plastic bag for about four weeks.
• For more details, consult the labelling provided by the manufacturer.

Cream 5%:

• Apply to skin from the tops of the feet to the head. After 8 to 14 hours, remove the cream (shower or bath).

Cream rinse/lotion 1%:

• Shake vigorously before use.
• Apply right away after shampooing (without conditioner), rinsing, and towel-drying your hair.
• Apply enough product to completely cover your hair and scalp (especially behind ears and on the nape of the neck).
• Before rinsing with warm water, let the product sit on the hair for no more than 10 minutes.
• Utilize a fine-tooth comb to remove nits.
• Use a towel or washcloth to cover your eyes.

Mechanism of action of Permethrin:

• By blocking sodium ion inflow through membrane channels in nerve cells, parasites can cause delayed depolarization and paralysis.

Absorption:

• ≤2%

Metabolism:

• Hepatic via ester hydrolysis to inactive metabolites

Excretion:

• Urine

International Brand Names of Permethrin:

• Elimite
• A Scabs
• A-Lices
• A-Scab
• A-Scabs
• Arotrix
• Assy
• Cabis
• Davesol-P
• Delice
• Destolit
• Dronol
• Ectomethrin
• Gamabenceno Plus
• Glenper
• Infectopedicul
• Infectoscab
• Klinits
• Lice-omite
• Lindell
• Loxazol
• Lyclear
• Lyclear Creme Rinse
• Lyclear Dermal Cream
• Lyderm
• Nastizol EX
• Nedax Plus
• Nittyfor
• Nix
• Nix Cream
• Nix Creme Rinse
• Nix Dermal Cream
• Nolice
• Novo-Herklin
• Novo-Herklin 2000
• Omeclean
• Parapoux
• Pedeks
• Perlice
• Perme-Cure
• Permicren
• Permin
• Permite
• Piokil Plus
• Pyrifoam
• Quellada Head Lice Treatment
• Sarcop
• Scabicare
• Scabimite
• Scabisan
• Skab
• Zalvor

Permethrin Brand Names in Pakistan: