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INTRODUCTION

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permethrin (per-meth-rin)

Acticin, Elimite, Nix

Classification

Therapeutic: pediculicides

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Indications
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1% lotion: Eradication of Pediculus humanus capitis (head lice and their eggs): Prevention of infestation of head lice during epidemics. 5% cream: Eradication of Sarcoptes scabiei (scabies).

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Action
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Causes repolarization and paralysis in lice by disrupting sodium transport in normal nerve cells. Therapeutic Effects: Death of parasites.

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Adverse Reactions/Side Effects
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Derm: burning, itching, rash, redness, stinging, swelling. Neuro: numbness, tingling.

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PHYSICAL THERAPY IMPLICATIONS

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Examination and Evaluation
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  • Monitor symptoms such as itching scalp to help document drug effectiveness.

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Interventions
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  • Avoid contact with infected areas or wear protective gloves when treating patient.

  • Always wash hands thoroughly and disinfect bedding and equipment (whirlpools, electrotherapeutic devices, treatment tables, and so forth) to help prevent the spread of infection.

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Patient/Client-Related Instruction
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  • Advise patient to report any increased local sensitivity to this drug (pain, burning, itching, stinging, swelling, numbness, tingling).

  • Instruct patient about proper hygiene; e.g., clean or discard infected clothing, not share combs and hats with others, thoroughly wash and dry the scalp, and so forth.

  • Advise patient to apply the drug as directed; that is, apply the drug topically for the recommended period of time before washing off.

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Pharmacokinetics
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Absorption: Small amounts (<2%) systemically absorbed. Remains on hair for 10 days.

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Distribution: Unknown.

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Metabolism and Excretion: Rapidly inactivated by enzymes.

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Half-life: Unknown.

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TIME/ACTION PROFILE (pediculicidal action)

ROUTE ONSET PEAK DURATION
topical 10 min unknown 14 days

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Contraindications/Precautions
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Contraindicated in: Hypersensitivity to permethrin, pyrethrins (insecticides or veterinary pesticides), chrysanthemums, or isopropyl alcohol.

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Use Cautiously in: Pregnancy or lactation; Children <2 yr (1% lotion); Children <2 mo (5% cream).

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Interactions
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Drug-Drug: No significant interactions.

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Route/Dosage
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Head Lice (Treatment and Prevention)
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Topical (Adults and Children >2 yr): 1% lotion applied to the hair, left on for 10 min, then rinsed, for 1 application.

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Scabies
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Topical (Adults and Children): Massage 5% cream into all skin surfaces. Leave on for 8–14 hr, then wash off.

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Topical (Infants >2 mo): Massage 5% cream into hairline, scalp, neck, temple, and forehead. Leave on for 8–14 hr, then wash off.

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Availability (generic available)
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Liquid cream rinse (lotion): 1% in 60-mL containers OTC. Cream: 5% in 60-g tube.

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