LINDANE

(lin'dane)

Gamma Benzene, Kwell, Scabene
Classifications: scabicide; pediculicide;
Therapeutic:antiparasitic; pediculicide
Pregnancy Category: C

Availability

1% lotion, shampoo

Action

Related to its direct absorption by parasites and ova (nits). Drug absorption through the parasite exoskeleton results in death of parasites and their ova.

Therapeutic Effect

Has ectoparasitic and ovicidal activity against the two variants of Pediculus humanus, Pediculus capitis (head louse) and Pediculus pubis (crab louse), and the arthropod Sarcoptes scabiei (scabies).

Uses

To treat head and crab lice and scabies infestations and to eradicate their ova.

Contraindications

Premature neonates, patient with known seizure disorders; application to eyes, face, mucous membranes, urethral meatus, open cuts or raw, weeping surfaces; prolonged or excessive applications or simultaneous application of creams, ointments, oils; extensive dermatitis; uncontrolled seizures; pregnancy (category C), lactation, infants, neonates, children <10 y, individuals <110 lb.

Cautious Use

History of seizures; HIV infection; alcoholism.

Route & Dosage

Lice and Scabies Infestation
Adult/Child: Topical Apply to all body areas except the face, leave lotion on 8–12 h, then rinse off; leave shampoo on 5 min, then rinse thoroughly; do NOT repeat in <1 wk

Administration

Note: Caregiver needs to wear plastic disposable or rubber gloves when applying lindane, especially if pregnant or applying medication to more than one patient, to avoid prolonged skin contact.

Topical

Remove all skin lotions, creams, and oil-based hair dressings completely and allow skin to dry and cool before applying lindane; this will reduce percutaneous absorption.
Shake cream or lotion container well. Scabies: Apply thin film from neck down over entire body surface including soles of feet. Avoid face and urethral meatus. Pay particular attention to intertriginous areas (finger webs and other body creases and folds), wrists, elbows, and belt line. Rub drug in; allow skin to dry and cool after application. After 8–12 h, remove medication by bath or shower. Crab lice: Apply thin film of drug to hair and skin of pubic area and, if infected, to thighs, trunk, axillary areas. Leave in place 8–12 h and follow with bath or shower. Observation of living lice after 7 d indicates the need for reapplication.
Shampoo (head lice): Apply sufficient quantity to wet hair and skin. Work drug thoroughly onto hair shafts and scalp and allow to remain in place 4 min. Add small amounts of water sufficient to make a thick lather; then rinse well with water. Pay particular attention to areas above and behind ears and occipital region. Use fine-tooth comb or tweezers to remove remaining nit shells. If necessary, treatment may be repeated after 7 d but not more than twice in 1 wk. Crab lice: See above. Repeat treatment after 7 d only if live lice can be demonstrated.
Store in tight container away from direct light and heat. Protect from freezing.

Adverse Effects (≥1%)

CNS: CNS stimulation (usually after accidental ingestion or misuse of product): restlessness, dizziness, tremors, convulsions; seizures; death. Body as a Whole: Inhalation (headache, nausea, vomiting, irritation of ENT). Skin: Eczematous eruptions.

Interactions

Drug: No clinically significant interactions established.

Pharmacokinetics

Absorption: Slowly and incompletely absorbed through intact skin; maximum absorption from face, scalp, axillae. Distribution: Stored in body fat. Metabolism: In liver. Elimination: In urine and feces.

Nursing Implications

Assessment & Drug Effects

Monitor for seizure activity in individuals with a history of seizures. Withhold drug and report to physician immediately.
Suspect scabies if a person complains of nocturnal itching (classic symptom). Infestation sources: sex partner, other family members, people and animals in close contact.
Identify and treat the sex partner simultaneously because both scabies and P. pubis infestation are sexually transmitted diseases.
Burrows made by scabies mites (may or may not be visible) appear as grayish black straight or S-shaped lines with a papule containing the mite at one end and surrounded by a mild erythematous area.

Patient & Family Education

Lindane is highly toxic drug if topical applications are excessive or if swallowed or inhaled. Keep out of reach of children.
Note: Lindane shampoo is an effective disinfectant for personal items such as combs, brushes.
Skin penetration with scabies mites causes an intolerable itching that may persist 2–3 wk after they have been killed.
Discontinue medication and notify physician if skin eruptions appear.
Do not apply medication to face, mouth, open skin lesions, or to eyelashes; avoid contact with eyes. If accidental eye contact occurs, flush with water.
Recurring limited infestations of scabies may indicate a domestic animal source (e.g., cat, dog, cattle, poultry).

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

(64)