Lindane

LINDANE- lindane lotion
Olta Pharmaceuticals Corporation

Rx only

WARNINGS

Lindane Lotion should only be used in patients who cannot tolerate or have failed first-line treatment with safer medications for the treatment of scabies. (See INDICATIONS AND USAGE.)

Neurologic Toxicity

Seizures and deaths have been reported following Lindane Lotion use with repeat or prolonged application, but also in rare cases following a single application used according to directions. Lindane Lotion should be used with caution for infants, children, the elderly, and individuals with other skin conditions (e.g., atopic dermatitis, psoriasis) and in those who weigh < 110 lbs (50 kg) as they may be at risk of serious neurotoxicity.

Contraindications

Lindane Lotion is contraindicated in premature infants and individuals with known uncontrolled seizure disorders.

Proper Use

Instruct patients on the proper use of Lindane Lotion, the amount to apply, how long to leave it on, and avoiding retreatment. Inform patients that itching occurs after the successful killing of scabies and is not necessarily an indication for retreatment with Lindane Lotion. (See DOSAGE AND ADMINISTRATION.)

DESCRIPTION

Lindane Lotion USP, 1%, is an ectoparasiticide and ovicide. In addition to the active ingredient, lindane, it contains 2-amino-2-methyl-1-propanol, butylparaben, carrageenan, cetyl alcohol, glyceryl monostearate, methylparaben, perfume compound, purified water, stearic acid and triethanolamine to form a lotion. The pH range is between 6.5 and 8.5. Lindane is the gamma isomer of 1,2,3,4,5,6-hexachlorocyclohexane having the following structural formula:

Chemical Structure

C6 H6 Cl6 M.W. 290.83

CLINICAL PHARMACOLOGY

Lindane Lotion USP, 1%, is an ectoparasiticide and ovicide effective against Sarcoptes scabiei (scabies). Lindane exerts its parasiticidal action by being directly absorbed into the parasites and their ova. Feldmann and Maibach1 reported approximately 10% systemic absorption of a lindane acetone solution when applied to the forearm of human subjects and left in place for 24 hours. This vehicle was different from the approved product and the percutaneous penetration of lindane is dependent on the vehicle. Therefore, the clinical significance of these observations is unknown. Dale, et al2 reported a blood level of 290 ng/mL associated with convulsions following the accidental ingestion of a lindane-containing product. Ginsburg 3 found the greatest peak blood level of 64 ng/mL, 6 hours after total body application of Lindane Lotion in 1 of 8 non-scabietic pediatric patients. The half-life in blood was determined to be approximately 18 hours.

Data available in the literature suggest that lindane has a rapid distribution phase followed by a longer β-elimination phase.1, 2, 3

INDICATIONS AND USAGE

Lindane Lotion is indicated for the treatment of scabies (infestations of Sarcoptes scabei) only in patients who:

  1. cannot tolerate other approved therapies, or
  2. have failed treatment with other approved therapies.

Lindane Lotion should be used in the context of an overall scabies management program that includes:

  • Microscopic evaluation of skin scrapings to confirm the diagnosis.
  • Evaluation and treatment of sexual contacts simultaneously. Sexual contacts should be prescribed Lindane Lotion only if they either have failed to respond to adequate doses of other approved therapies or are intolerant of other approved therapies.
  • Washing of all recently worn clothing, underwear, pajamas, used sheets, pillowcases, and towels in very hot water or dry-cleaned.

Caregivers applying this product to patients should wear gloves less permeable to Lindane, such as nitrile, latex with neoprene, or sheer vinyl, and thoroughly clean hands after application. Natural latex gloves should be avoided because they are more permeable to Lindane.

Lindane Lotion does not prevent infestation or reinfestation and should not be used to ward off a possible infestation.

CONTRAINDICATIONS

Lindane Lotion is contraindicated for premature infants because their skin may be more permeable than that of full term infants and their liver enzymes may not be sufficiently developed to metabolize Lindane.

Lindane Lotion is also contraindicated for patients with crusted (Norwegian) scabies and other skin conditions (e.g., atopic dermatitis, psoriasis) that may increase systemic absorption of the drug.

Lindane Lotion is contraindicated for patients with known uncontrolled seizure disorders and for individuals with a known sensitivity to the product or any of its components.

WARNINGS

(See boxed WARNINGS.)

Seizures and deaths have been reported following Lindane Lotion’s use with repeat or prolonged application, but also in rare cases following a single application reportedly used according to directions. It is not known how soon after application of a single dose of Lindane Lotion that a second dose of Lindane Lotion can be safely applied.

There have been cases of adverse events reported for Lindane Lotion and Lindane Shampoo in which a serious outcome (hospitalization, disability or death) has occurred.4 In approximately 20% of the total reported cases, Lindane Lotion and Shampoo were reported to have been used according to the labeled directions. Of these cases, thirteen deaths were reported, many cases which were remote from the time of actual Lindane use. Lindane toxicity, verified by autopsy was the cause of one infant’s death, was the cause of death reported for an adult who ingested it orally in a successful suicide. The direct causes of death for the other cases were attributed to reasons other than Lindane. Most of these adverse events occurred with Lindane Lotion.

Infants, children, the elderly, and individuals with other skin conditions and those who weigh < 110 lbs (50 kg) may be at greater risk of serious neurotoxicity. (See Pediatric Use and Geriatric Use.) Animal studies have shown increased susceptibility to neurologic adverse events in younger animals. Children have a larger body surface area to volume ratio that may result in a proportionately larger systemic exposure.

Careful consideration should be given before prescribing Lindane Lotion to patients with conditions that may increase the risk of seizure, such as HIV infection, history of head trauma or a prior seizure, CNS tumor, the presence of severe hepatic cirrhosis, excessive use of alcohol, abrupt withdrawal from alcohol or sedatives, as well as concomitant use of medications known to lower seizure threshold. (See PRECAUTIONS: Drug Interactions.)

Patients should be instructed on proper use of Lindane Lotion, especially the amount to apply, how long to leave the lotion on, and the need to avoid retreatment. Patients should be informed that itching may occur, and even worsen, after the successful killing of scabies. Repeat treatment is usually not necessary.

A Lindane Lotion Medication Guide must be given to the patient each time Lindane Lotion is dispensed, as required by law.

PRECAUTIONS

General

Care should be taken to avoid contact with the eyes. If such contact occurs, eyes should be immediately flushed with water. If irritation or sensitization occurs, the patient should be advised to consult a physician.

Information for Patients (and Caregivers)

  • This product can be poisonous if misused.
  • Other important information is found in the Medication Guide, which by law, must be dispensed with Lindane Lotion.
  • If someone other than the patient will be applying Lindane Lotion to the patient, they should wear less permeable gloves such as nitrile, latex with neoprene, or sheer vinyl, and thoroughly clean their hands after application. Natural latex gloves should be avoided because they are more permeable to lindane.
  • If the person applying Lindane Lotion could be pregnant, contact with Lindane Lotion should be avoided as much as possible.
  • If the patient could be pregnant, other treatments may be preferable.
  • Lindane Lotion should be used for scabies only.
  • The skin should be clean and without any other lotion, cream, or oil on it. Oils can make the Lindane Lotion go through the skin faster and possibly increase the risk of neurotoxicity (e.g., seizures).
  • Wait at least 1 hour after bathing or showering before putting Lindane Lotion on the skin. Wet or warm skin can make the Lindane Lotion go through skin faster.
  • Information for Use:
    • Shake Lindane Lotion well.
    • Put Lindane Lotion under fingernails after trimming the fingernails short, because scabies are very likely to remain there. A toothbrush can be used to apply the Lindane Lotion under the fingernails. Immediately after use, the toothbrush should be wrapped in paper and thrown away. Use of the same brush in the mouth could lead to poisoning.
    • Use only a single application, applied as a very thin layer over all skin from the neck down.
    • Close the bottle with the leftover Lindane Lotion and immediately throw it away in a trash can out of the reach of children.
    • Do not use any covering over the applied Lindane Lotion that does not breathe, like diapers with plastic lining, plastic clothes, tight clothes, or blankets.
    • Wash the Lindane Lotion completely off after 8 to 12 hours. Never leave Lindane Lotion on the skin for more than 12 hours. Warm, but not hot water can be used. Lindane Lotion will not kill any more scabies after 8 to 12 hours, but may cause serious health problems.
    • Keep Lindane Lotion away from mouth and eyes. If contact with eyes occurs, immediately flush eyes with water. Do not use if you have open wounds, cuts or sores that are present, unless specifically directed by the prescribing physician.
    • All recently worn clothing, underwear, pajamas, used sheets, pillowcases, and towels should be washed in very hot water or dry-cleaned.
    • The patient may still itch after using Lindane Lotion. This does not mean the medicine did not work. Even after all the scabies (bugs) are dead, they can still make the skin itch for a few weeks. Lindane Lotion sometimes makes this itch even worse. Other treatments can be used to soothe the itch. Do not use more Lindane Lotion.
    • The patient should contact the physician with any questions or concerns about his or her condition or use of the Lindane Lotion.
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