Lindane (Topical)

Overview

Originally known as gamma benzene hexachloride, Lindane is an insecticide which is effective in killing scabies and/or lice. When used to treat lice, Lindane is generally prescribed as a shampoo, whilst Lindane cream or lotion is prescribed in the treatment of scabies.

When patients develop a scabies infestation, they can experience extreme itching and may present with a rash on the skin and/or skin irritation. Although a scabies infestation can occur almost anywhere on the body, it does not affect the head and is most common on the wrists, ankles, soles of the feet, fingers and hands. Whilst people of any age can contract scabies, it is particularly common in elderly patients and infants.

Although scabies is highly contagious, the rash caused by the infestation may not appear straight away. As a result, people may not be aware that they have scabies until they have already transmitted to someone else. Usually, everyone in the original patient's household should be treated for scabies, even if they are not displaying symptoms of an infestation.

Similarly, head lice can easily be spread from one person to another. Unlike scabies mites, head lice don't burrow under the skin but survive on the scalp and can cause intense itching. In some cases, patients may also notice red bumps on the affected skin and sores or blisters which develop as a result of the patient scratching the scalp.

As an insecticide, Lindane has operates as a pediculicide and scabicide when applied topically to the human body. This means that Lindane works by killing the scabies mites and/or head lice. Once applied, the medication is absorbed by the parasite and their ova. Lindane blocks the parasite's GABA-gated chloride channel, reducing neuronal inhibition and causing hyperexcitation of the parasite's central nervous system. Ultimately, this processes causes the parasite's death and rids the patient of the infestation.

Whilst Lindane is an effective treatment for scabies and lice, it is no longer considered a first-line form of therapy. As Lindane is a potent insecticide, the potential for toxicity is high. Due to this, Lindane is only used to treat scabies and lice infestations is other treatments have failed to be effective.

Conditions Treated

  • Scabies infestation
  • Lice infestation

Type Of Medicine

  • Insecticide
  • Pediculicide
  • Scabicide

Side Effects

In some cases, Lindane can cause serious side-effects which warrant urgent medical treatment. Patients should obtain medical assistance if they experience any of the following side-effects during or following treatment with Lindane:

  • Convulsions (seizures)
  • Unsteadiness, clumsiness or dizziness
  • Fast heartbeat
  • Hair loss
  • Muscle cramps
  • Tingling or numbness
  • Restlessness, irritability or nervousness
  • Dry skin
  • Vomiting
  • Burning skin
  • Skin irritation not present before use of Lindane
  • Itching
  • Skin rash

Patients may still experience side-effects after discontinuing treatment with Lindane. If so, patients should still obtain medical help, even if they are no longer using the medication.

If patients experience any other side-effects when using Lindane or after using the medication, they should also obtain medical advice.

It is more common for serious side-effects to occur if patients use too much Lindane or use the medication too often. However, serious side-effects could occur when the medication has been used appropriately and may even occur following one application of Lindane.

Due to the risk of severe side-effects occurring, patients should only use Lindane under their doctor's supervision and should discuss the risk of complications before using this medicine.

Dosage

When using Lindane, it is essential that patient's follow their doctor's instructions. Lindane is a poisonous substance which can cause serious complications if it is over-used. Furthermore, Lindane can be fatal is swallowed and must be kept away from the patient's mouth at all times.

Lindane shampoo, lotion and cream must also be kept away from the eyes. If Lindane comes into contact with the patient's eyes, they should rinse them thoroughly with clean water and contact their physician for advice.

Patients should not apply Lindane to broken skin or skin which is irritated or has open wounds. This applies to skin on the body, as well as the scalp. Patients should inform their doctor if they have any cuts, wounds, sores or irritation before Lindane is prescribed.

When applying Lindane, patients may wish to use disposal gloves in order to prevent the medicine from being absorbed into their hands. If so, patients should use gloves made from rubber or latex but should not use gloves made from natural latex as the medication can go through this material. After use, patients should dispose of the gloves carefully.

If patients are using Lindane to treat lice, they should shampoo the affected area with the medicated solution. This should only be done once. Patients should wash their hands thoroughly after applying the shampoo.

Similarly, if patients are using Lindane lotion or cream to treat scabies, they should apply the liquid to the skin once only. After applying the cream or lotion, patients should wash their hands thoroughly.

Patients should not apply more than one dose of Lindane, unless their doctor advises them to use more medication.

When using Lindane lotion or cream, patients should ensure that their skin is clean, dry and free from any other moisturizers, ointments, oils or other skin care products. Patients should apply the lotion or cream from the neck down and should ensure that the cream or lotion comes into contact with every part of the skin's surface, including the soles of the feet. After rubbing it in well, patients are usually advised to leave the Lindane cream or lotion on the skin for eight to twelve hours before washing it off thoroughly. Before washing the lotion or cream off, patients can wear light clothing but should not wear anything tight and should not cover the skin completely.

If patients are using Lindane to treat a scabies infection, they may need to apply the cream or lotion to the skin under their fingernails. After doing so, they should use a clean toothbrush to remove the Lindane from the area. Patients should then throw the toothbrush away immediately.

If patients are using Lindane shampoo to treat head lice, they should use normal shampoo to remove any existing products from the scalp or hair and rinse and dry the hair before using Lindane. When applying Lindane shampoo, patients should ensure that the product does not run down their body on to other areas of the skin. Patients should not sit in the bath to apply Lindane shampoo, as Lindane is likely to contaminate the bath water and could be absorbed through their skin. When washing Lindane shampoo off their scalp, the patient should also rinse their body well to ensure that the shampoo does not remain on the skin.

Patients should apply Lindane shampoo to dry hair and should only use the appropriate amount of medication. Usually, 1 ounce or less can be used for short hair, 1.5 ounces for medium length hair and 2 ounces or less can be used for long hair. The Lindane shampoo should thoroughly wet the hair and scalp.

Patients should rub the shampoo into the hair and scalp and allow it to remain in place for approximately four minutes. Following this, patients should use water to create a lather in their hair. When adding water to Lindane shampoo on the scalp, patients should use just enough to create a lather, rather than using an excessive amount.

Patients can then rinse their hair with water but must ensure that the Lindane shampoo is completely removed from the scalp or hair. After drying their hair with a clean towel, patients should use a nit comb or a fine tooth comb to remove any lice or eggs which may remain in the hair.

As lice and scabies are contagious, other members of the patient's household should be treated, even if symptoms of an infestation are not present. However, medical advice should be sought before Lindane is used on other individuals.

Lindane comes with a medication guide and instructions for use. Patients should read these carefully before applying the shampoo, cream or lotion and should ensure they understand how to use the medication. If patients are unsure how to apply the medication, how long to leave the lotion, cream or shampoo on for or how to wash it off appropriately, they should seek advice from their physician or pharmacist.

Potential Drug Interactions:

Due to the possibility of a drug interaction occurring, Lindane is not normally prescribed if patients are taking either of the following medicines:

  • Donepezil
  • Bupropion

Before using Lindane, patients should tell their physician if they are taking any other prescription medicines, over-the-counter medicines, supplements or vitamins. Once Lindane has been applied, patients should obtain medical advice before using any new medicines, vitamins or supplements.

Warnings

If patients have any other health conditions, they should notify their doctor before they use Lindane. In addition to this, patients should discuss their medical history with their physician before Lindane is prescribed. There are some conditions which can affect the use of this medication and these may include:

  • Skin conditions
  • Seizures disorders
  • Excessive alcohol use
  • Hypersensitivity to Lindane
  • HIV infection
  • Brain tumor
  • Head injuries
  • Liver disease
  • Suddenly stopping the regular use of sedatives or alcohol

Generally, Lindane is not recommended for use on pediatric patients due to the problems with toxicity and should never be used to treat premature infants. However, if Lindane is prescribed to pediatric patients, parents, guardians and caregivers should be aware that people who weigh less than 110 pounds (50kg) are likely to be more sensitive to the effects of this medication. Parents, guardians or caregivers should discuss the risks associated with Lindane with the patient's physician before using it on a child or infant.

Although Lindane can be prescribed to elderly patients, any patients weighing less than 110 pounds (50kg) may be particularly sensitive to the effects of this medication.

To prevent recurrent infestations of scabies, patients should wash all worn underwear, clothing, pajamas, bed linen and towels in very hot water or have them dry-cleaned. Similarly, patients should wash all worn clothing, bed linen and towels in very hot water or have them dry-cleaned in order to prevent a reinfestation of lice.

Lindane should not be used during pregnancy unless the benefits significantly outweigh the risks posed to the patient and the unborn fetus. If no other alternative is available and Lindane is prescribed to a patient who is pregnant, extreme caution must be used.

As Lindane can be excreted in breast milk and may cause to the infant, patients should not breastfeed after applying this medication. Although patients should not breastfeed for at least twenty four hours after using Lindane, they should consult their physician to determine when they can resume breastfeeding. Nursing mothers may want to express milk before using Lindane and resume nursing once the medication is out of their system and no longer poses a risk to the infant.

If Lindane causes the patient to exhibit an allergic reaction, they will require emergency medical treatment. An allergic reaction may include the following symptoms:

  • Hives
  • Difficulty breathing
  • Itching
  • Hoarseness
  • Rash on the skin
  • Difficulty swallowing
  • Shortness of breath
  • Wheezing
  • Tightness in the chest
  • Swelling of the face, lips, tongue, throat, mouth or hands

Storage

When storing Lindane at home, patients should ensure that the medication is kept in a safe location. Patients may be advised to use a locked medicine cabinet or lockable medicine box if they need to keep Lindane at home. However, Lindane should not be kept in the home for any longer than is necessary. Once patients have been prescribed the medication, they should use it as soon as possible so that their condition can be resolved and the medication can be disposed of carefully.

It is vital that children and/or pets cannot gain access to Lindane.

In order to store Lindane properly, patients should follow the manufacturer's instructions. Generally, Lindane can be kept at room temperature but should always be kept in a closed container. Lindane will also need to be protected from heat, light and moisture.

When disposing of Lindane, patients should not discard the medication or used containers with normal household waste as they could pose a risk to other people. Instead, patients should contact their physician's office or pharmacist and use a specialist medicine disposal service.

Summary

Although Lindane is effective in treating scabies and lice infestations, it is an extremely potent insecticide and can cause serious harm, and even death. Due to this, Lindane is not a first-line treatment for either lice or scabies and should only be used if other treatments have failed.

If patients are prescribed Lindane, they will need to understand the risks associated with the medicine and use extreme caution when applying it, storing it in the home and disposing of it.