Use only in patients who have not responded to or cannot tolerate other recommended therapies.
CNS Toxicity
Seizures and deaths have been reported following repeated or prolonged topical application; however, rare cases reported after a single application. (See CNS Effects under Cautions.)
Increased risk of serious neurotoxicity in infants, children, geriatric patients, patients weighing <50 kg, and patients with certain other skin conditions.
Contraindicated in premature neonates and patients with uncontrollable seizure disorders.
Proper Use
Instruct patients or their caregivers on the proper use of shampoo or lotion, including the amount to apply, how soon to wash the drug off, and the importance of avoiding repeated application.
Inform patients that pruritus may persist after successful treatment and is not an indication for further treatment.
Used as a second-line agent for the topical treatment of pediculosis capitis (head lice infestation) caused by Pediculus humanus var capitis in patients who have not responded to or who cannot tolerate other recommended therapies.
Used as a second-line agent for the topical treatment of pediculosis pubis (pubic lice infestation) caused by Phthirus pubis in patients who have not responded to or cannot tolerate other recommended therapies.
Not recommended as initial therapy for pediculosis capitis or pediculosis pubis because of reports of resistance and neurotoxicity (e.g., seizures). (See CNS Effects under Cautions.)
Scabies
Used as a second-line agent for the topical treatment of scabies in patients who have not responded to or cannot tolerate other recommended therapies.
Not recommended for the treatment of Norwegian scabies because of the risks of neurotoxicity with heavy application and denuded skin. (See CNS Effects under Cautions.)
Not effective in the prophylaxis of scabies; does not prevent infestation or reinfestation.
Used as treatment of individuals (e.g., household, family, and sexual contacts) who have had close personal contact with a patient with scabies within the previous month.
Has been used for treatment of scabies epidemics in institutional settings (e.g., nursing homes, hospitals, residential facilities and communities). However, permethrin is recommended as a scabicide of choice in institutional outbreaks.
Dosage and Administration
General
Measures to Avoid Reinfestation and Transmission
To avoid reinfestation or transmission following treatment, all clothing, bed linens, and towels used within the last 72 hours should be machine-washed in hot water and dried in a hot dryer or dry-cleaned; fumigation of living areas is not necessary.
For lice infestation, it is recommended that items that cannot be laundered or dry-cleaned be removed from contact and sealed in a plastic bag for 10 days.
Combs and brushes used by the infected patient may be disinfected by soaking in hot water (temperature exceeding 53°C) for 5 minutes; alternatively, soaking in a pediculicide for 1 hour may be used. Combs and brushes may be washed with lindane shampoo, but they should be rinsed thoroughly with water to remove the drug.
Pediculosis
Pruritus does not indicate treatment failure and is not an indication for further treatment. Oral antihistamines and/or topical corticosteroids may be used to help relieve pruritus. (See Dermatologic and Sensitivity Reactions under Cautions.)
Scabies
Follow-up examinations of patients recommended 2 and 4 weeks after treatment. If patient is not clear of new lesions at either examination, it should be considered a treatment failure (secondary to failure to treat all exposed individuals or failure to apply the drug properly). If patient is clear of new lesions when examined at 2 weeks but has new lesions at 4 weeks, it should be considered a reinfestation rather than a treatment failure.
Pruritus does not indicate treatment failure and is not an indication for further treatment. Oral antihistamines and/or topical corticosteroids may be used to help relieve pruritus. (See Dermatologic and Sensitivity Reactions under Cautions.)
Scabies rarely affects the head of adults but may affect the head of infants and young children.
Administration
Topical Administration
Lindane shampoo is indicated only for the treatment of lice. Lindane lotion is indicated only for the treatment of scabies.
Apply topically to the skin.
Lindane preparations are for external use only and should not be ingested.
Do not apply to patients with extensive dermatitis or to those with acutely inflamed skin or raw, weeping surfaces. Do not use if open wounds, cuts, or sores are present at the site of application.
Avoid contact with the eyes and mouth. If contact with the eyes occurs, immediately flush the eyes with water.
Not a suitable alternative for infants, young children, pregnant and lactating women, or in those with extensive dermatitis because of the drug’s topical toxicity profile. (See CNS Effects under Cautions.)
Parents or caregivers who apply lindane on an infected individual should wear gloves made of nitrile, latex with neoprene, or sheer vinyl; natural latex gloves should not be used since lindane can diffuse through natural latex gloves. Hands should be thoroughly cleaned after application is completed.
Shampoo
Apply to hair that is clean and completely dry.
Hair may be washed at least 1 hour before applying lindane shampoo with regular shampoo (without conditioner) and dried completely.
Avoid use of oil treatments or oil-based hair preparations immediately before or after applying lindane shampoo. (See Oils and Oil-based Preparations under Interactions.)
Apply 30–60 mL of shampoo to hair; use just enough to lightly coat hair and scalp. Work shampoo thoroughly into hair and allow to stay in place for 4 minutes. Special attention should be given to the fine hairs along the neck and behind the ears. After 4 minutes, add small quantities of water to the hair to form a good lather and then immediately and thoroughly rinse hair until all the lather is gone. Avoid unnecessary contact of lather with other body parts.
One treatment usually is effective in eradicating pediculosis capitis and pediculosis pubis.
If symptoms persist, do not retreat with lindane because of concerns about neurotoxicity. (See CNS Effects under Cautions.) Retreatment with an alternative pediculicide may be appropriate at the advice of the clinician if live lice or nits are detected after 1 week.
For further information on application of lindane shampoo, consult manufacturer’s patient information.
Lotion
Apply a thin layer of lotion to skin that is clean and free of any creams, ointments, or oil. Do not apply to the skin immediately after a bath or shower; patients should wait at least 1 hour after bathing or showering and the skin should be completely dry before applying lotion. (See Oils and Oil-based Preparations under Interactions.)
Apply uniformly and gently massage into all skin surfaces (entire trunk and extremities) from the neck to the toes (including the soles of the feet). Do not apply to the face, eyes, mucous membranes, or urethral meatus. After 8–12 hours, completely wash lotion off the body using warm (not hot) water. Do not leave lotion on the skin for >12 hours.
One treatment usually is successful. If symptoms persist, do not retreat with lindane because of concerns about neurotoxicity. Additional treatment with an alternative scabicide generally is warranted only if live mites can be demonstrated.
For further information on application of lindane lotion, consult manufacturer’s patient information.
Dosage
Pediatric Patients
Use with caution in children weighing <50 kg, especially infants. (See Pediatric Use under Cautions.)
Pediculosis
Topical
Children ≥2 years of age: Apply about 30–60 mL of shampoo once to hair; amount of shampoo needed depends on the length of the hair (most patients require only 30 mL). After 4 minutes, add small quantities of water to the hair to form a good lather and then immediately and thoroughly rinse hair until all the lather is gone.
Because of concerns about neurotoxicity, retreatment with lindane is not recommended. (See CNS Effects under Cautions.)
Scabies
Topical
Children ≥2 years of age: Apply lotion once into all skin surfaces (entire trunk and extremities) from the neck to the toes (including the soles of the feet).
After 8–12 hours, lotion must be completely washed off the body using warm (not hot) water. Do not leave on the skin for >12 hours.
Because of concerns about neurotoxicity, retreatment with lindane is not recommended. (See CNS Effects under Cautions.)
Adults
Pediculosis
Topical
Apply about 30–60 mL of shampoo once to hair; amount of shampoo needed depends on the length of the hair (most patients require only 30 mL). After 4 minutes, add small quantities of water to the hair to form a good lather and then immediately and thoroughly rinse hair until all the lather is gone.
Because of concerns about neurotoxicity, retreatment with lindane is not recommended. (See CNS Effects under Cautions.)
Scabies
Topical
Apply lotion once into all skin surfaces (entire trunk and extremities) from the neck to the toes (including the soles of the feet).
Approximately 30 mL of the lotion is recommended for an average adult.
After 8–12 hours, lotion must be completely washed off the body using warm (not hot) water. Do not leave on the skin for >12 hours.
Because of concerns about neurotoxicity, retreatment with lindane is not recommended. (See CNS Effects under Cautions.)
Prescribing Limits
Pediatric Patients
Pediculosis
Topical
Children ≥2 years of age: Do not leave shampoo in the hair for >4 minutes and do not retreat.
Scabies
Topical
Children ≥2 years of age: Do not leave lotion on the skin for >12 hours and do not retreat.
Adults
Pediculosis
Topical
Do not leave shampoo in the hair for >4 minutes and do not retreat.
Scabies
Topical
Do not leave lotion on the skin for >12 hours and do not retreat.
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