Permethrin

About Permethrin

For scabies, the cream is massaged into the skin from the head to the soles of the feet, about 30 g for an average adult, and washed off in a bath or shower after 8 to 14 hours. Adults rarely have mites on the scalp, but infants are treated on the scalp, temples and forehead as well, and MedlinePlus adds adults over 65. One application is generally curative, and it is repeated only if living mites are found 14 days later. For head lice, the 1 percent lotion goes on hair that has been shampooed without conditioner and towel dried, saturating the hair and scalp; it stays on for 10 minutes, no longer, and is rinsed out with warm water, and MedlinePlus says to repeat the treatment if live lice are seen seven or more days later.

Anyone allergic to permethrin, to any other synthetic pyrethroid or to pyrethrins must not use the cream, and the Nix label says to ask a doctor first if you are allergic to ragweed. Burning, stinging and itching are the most common effects of the cream, and redness, numbness, tingling and rash can occur. Scabies itself causes itching, swelling and redness, which may get worse for a while after treatment, so persistent itching alone is not a reason to treat again. Both products are kept out of the eyes; the lice product is not used inside the nose, ears, mouth or vagina or on eyebrows or eyelashes, and it is stopped if breathing trouble, eye irritation or continuing skin irritation develops.

In pregnancy, the cream label advises use only if clearly needed, and because it is not known whether permethrin passes into breast milk, it suggests a nursing mother may pause breastfeeding or not use the cream. MedlinePlus also lists household steps: recently used clothing, towels and bedding are washed in very hot water or dry cleaned, combs and brushes are washed in hot water, family members are checked for lice, and sexual partners are treated for scabies. Elimite (Aurobindo) remains listed in the Orange Book with generic 5 percent creams rated equivalent to it, and one older generic is listed as discontinued. Nix Lice Killing Creme Rinse is sold over the counter under its own FDA approval and comes with a nit comb.

Taking Permethrin

How to take it

Scabies: massage the cream thoroughly into the skin from head to soles, keeping it out of the eyes, and wash it off after 8 to 14 hours. Head lice: shampoo without conditioner, towel dry, shake the lotion, protect the eyes with a washcloth or towel, saturate the hair and scalp, leave it 10 minutes, rinse with warm water in a sink rather than a shower or tub, then comb out lice and nits.

If you miss a dose

It is a one-time treatment, repeated only when the label or prescriber says: for scabies if living mites are seen 14 days later, and for lice if live lice are seen seven or more days later.

Storage

At room temperature in the closed original container, away from heat and moisture, out of reach of children. Use a take-back program rather than flushing.

Interactions to know about

Tell the prescriber about allergies to permethrin, pyrethrins or ragweed, other medicines and skin products you use, and pregnancy or breastfeeding. Stop the lice product and see a doctor for trouble breathing, eye irritation, or skin or scalp irritation that continues or becomes infected.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Permethrin differs from pharmacy to pharmacy

Generic 5 percent cream rated equivalent to Elimite comes from a few makers, so a prescription that allows substitution can be filled with whichever one the pharmacy stocks, while one that names Elimite and blocks substitution is priced as a brand.

The cream comes in a 60 g tube, and about 30 g treats an average adult, so the number of tubes written for a household or a repeat application drives the total. The lice creme rinse is sold over the counter.

Ways to pay less for Permethrin without insurance

• Ask for the generic 5 percent cream, and check that the prescription allows substitution rather than naming Elimite only.
• Ask the prescriber to write the number of tubes the whole treatment needs, since one 60 g tube may cover two average adults or a repeat application.
• For head lice in anyone 2 months or older, ask the pharmacist about permethrin 1 percent lotion (creme rinse) sold over the counter, and check that permethrin is the active ingredient, since other lice products contain different ones.
• Compare more than one pharmacy for the cream.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Permethrin

1. 1.How much cream do I need, and should everyone in my household be treated at the same time?
2. 2.How long do I leave it on, and when do I wash it off?
3. 3.Is my child old enough for this product?
4. 4.What should I do if my itching continues after treatment?

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