Nix, Elimite (permethrin) dosing, indications, interactions, adverse effects, and more

Sections

Sections permethrin
Dosing & Uses
Adverse Effects
Warnings
Pregnancy
Pharmacology
Images
Patient Handout
Formulary

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

cream

liquid

lotion

Scabies

Cream: Apply from head to toe, leave on for 8-14 hr, rinse; may reapply in 7 days if live mites reappear

Single application usually curative

Head Lice & Nits (Eggs)

Lotion/cream rinse/liquid: apply to washed hair, leave on 10 min, rinse and comb out nits and eggs; may repeat in 7 days if lice or nits still present

Single application usually curative.

Dosage Forms & Strengths

cream

liquid

lotion

Scabies & Head Lice

<2 months

Safety & efficacy not established

>2 months

Scabies: Apply cream from head to toe; leave on for 8-14 hr, rinse; may reapply in 7 days if live mites reappear; single application usually curative
Head Lice & Nits (Eggs): Apply lotion/cream/liquid to washed hair, leave on 10 min, rinse and comb out nits and eggs; may repeat in 7 days if lice or nits still present; single application usually curative

1-10%

Mild and transient burning and stinging (10%)

Pruritus (7%)

Contraindications

Hypersensitivity

< 2 months of age (OTC)

Cautions

May exacerbates itching, swelling, and redness temporarily

For external use only

Avoid contact with eyes

May cause difficulty breathing or asthmatic attack in patients with ragweed allergies

Pregnancy & Lactation

Pregnancy Category: B

Lactation: Not known if distributed in breast milk; may temporarily withhold the drug while the mother is nursing

Pregnancy Categories

A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

NA: Information not available.

Mechanism of Action

Like natural pyrethrins, permethrin acts as a neurotoxin by depolarizing nerve cell membranes of parasites

The drug disrupts sodium ion influx through cell membrane channels by which membrane repolarization is regulated

Delayed repolarization results in paralysis of nerves in the exoskeletal respiratory muscles of parasite leading to death

Pharmacokinetics

Absorbed: Small amounts (< 2%)

Metabolism: Rapidly metabolized by ester hydrolysis to inactive metabolites

Excretion: Urine

BRAND	FORM.	UNIT PRICE	PILL IMAGE
RID Complete Lice Elimination Kit -	0.5 % aerosol
permethrin topical -	5 % cream
permethrin topical -	5 % cream
permethrin topical -	5 % cream
Lice Treatment (permethrin) topical -	1 % liquid
Lice Bedding Spray -	0.5 % aerosol
Nix Creme Rinse topical -	1 % liquid
Nix Creme Rinse topical -	1 % liquid

Patient Handout

Select a drug:

PERMETHRIN CREAM RINSE - TOPICAL

(purr-METH-rin)

COMMON BRAND NAME(S): NIX

USES: This medication is used to treat head lice, tiny insects that infest and irritate your scalp. It belongs to a class of drugs known as pyrethrins. Permethrin works by paralyzing and killing lice and their eggs (nits).

HOW TO USE: Apply this medication as soon as possible after it is prescribed. When treating head lice, apply this medication to the hair and scalp only. First wash hair with your regular shampoo, but do not use conditioner. Thoroughly rinse the shampoo out with water, and towel-dry hair. Shake this medication well before using. Cover your eyes with a towel while applying this medication. Completely cover the hair and scalp with the medicine (especially behind the ears and on the hairline at the neck). Avoid getting permethrin in your nose, ears, mouth, vagina, or eyes. If the medicine gets in any of these areas, flush with plenty of water. Do not use more medication than prescribed. Leave the medication on your hair for 10 minutes or as directed by your doctor, then rinse with warm water. Towel-dry your hair and comb out any tangles. A single permethrin treatment can help prevent lice from coming back for 14 days. If eyebrows or eyelashes are infested, do not apply this medication to those areas without first consulting your doctor.Head lice lay small white eggs (nits) at the base of hair close to the scalp, especially on the hairline at the back of the neck and behind the ears. After treatment with this medication, the infected person should be checked by another person for lice and nits using a magnifying glass and bright light. To remove nits, use the special comb provided, and follow the instructions on the package. After combing, re-check the entire head every day for nits you might have missed. Remove any nits by combing, by hand using a disposable glove, or by cutting them out. If live lice are seen 7 days or more after treatment, a second treatment with permethrin or another drug may be needed.Tell your doctor if your condition lasts or gets worse.

SIDE EFFECTS: Scalp irritation, including itching, swelling, or redness may occur with head lice and temporarily worsen after treatment with permethrin. Mild burning, stinging, tingling, or numbness may also occur. If any of these effects last or get worse, tell your doctor or pharmacist promptly.Remember that this medication has been prescribed because your doctor has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.A very serious allergic reaction to this drug is rare. However, get medical help right away if you notice any symptoms of a serious allergic reaction, including: rash, itching/swelling (especially of the face/tongue/throat), severe dizziness, trouble breathing.This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.In the US -Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.In Canada - Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

PRECAUTIONS: Before using permethrin, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.Before using this medication, tell your doctor or pharmacist your medical history, especially of: skin infections, asthma.Constant or forceful scratching of the skin/scalp may lead to a bacterial skin infection. Tell your doctor right away if you develop worsening redness or pus.Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).Tell your doctor if you are pregnant before using this medication.It is unknown if this drug passes into breast milk but is unlikely to harm a nursing infant. Consult your doctor before breast-feeding.

DRUG INTERACTIONS: Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor's approval.

OVERDOSE: This medicine may be harmful if swallowed. If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center.

NOTES: Do not share this medication with other person unless directed to do so by your doctor.One application is usually all that is needed. To avoid giving lice to another person or getting them again, all head wear, scarves, coats, and bed linens should be machine-washed with hot water and dried in a dryer (at high setting) for at least 20 minutes, dry cleaned, sealed in a plastic bag for 2 weeks, or sprayed with a disinfectant that kills lice. Brushes or combs should be soaked in hot water (hotter than 130 degrees F/54 degrees C) for 10 minutes, soaked in alcohol for 1 hour, or thrown away. Furniture and floors should be thoroughly vacuumed.People who are in close contact with the infected person, such as members of the same household, should also be checked for lice and nits.

MISSED DOSE: Not applicable.

STORAGE: Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

Formulary

FormularyPatient Discounts

Adding plans allows you to compare formulary status to other drugs in the same class.

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Create Your List of Plans

Adding plans allows you to:

View the formulary and any restrictions for each plan.
Manage and view all your plans together – even plans in different states.
Compare formulary status to other drugs in the same class.
Access your plan list on any device – mobile or desktop.

The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

View explanations for tiers and restrictions

Tier	Description
1	This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
2	This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
3	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
4	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
5	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
6	This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
NC	NOT COVERED – Drugs that are not covered by the plan.

Code	Definition
PA	Prior Authorization Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
QL	Quantity Limits Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
ST	Step Therapy Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
OR	Other Restrictions Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.

Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.

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