SCABICIDES & PEDICULICIDES

Scabicides aka antiscabious agents; used to treat mites, Sarcoptes scabiei, an organism that thrives under poor personal hygiene
Pediculicides aka antipedicular agents; used to eliminate head, body, & crab lice Ideal agents must kill the adult parasites & destroy their eggs.

BENZYL BENZOATE
(Scabicide)
Naturally occurring ester obtained from

Peru balsam and other resins Prepared synthetically from Benzyl alcohol & Benzyl chloride Insoluble in water; soluble in organic solvents Applied topically as a lotion over the entire dampened body (except face) Effective when applied topically:
Immediate relief from itching results from local

anaesthetic effect; Complete cure with single application of 25% emulsion in OLEIC ACID, stabilized with TRIETHANOLAMINE
This prep is odorless, nonstaining, nonirritating to the skin

BENZYL BENZOATE
(Scabicide)
NONPRESCIPTION DRUG REFERENCE:
Irritating topically, stinging & contact dermatitis

when applied to excoriated skin Has strong odor

***New formulation: emulsion in OLEIC ACID, stabilized with TRIETHANOLAMINE causes odorless, nonstaining, nonirritating version.***

INGESTION = CONVULSION!!!
Not considered as effective as other agents.

BENZYL BENZOATE
(Scabicide)
NONPRESCIPTION DRUG REFERENCE:
Most common regimen: 25%: a single application for a period of 24hrs is possibly effective Other recommendations: 2-3 applications either on successive days, separated by a week or within a 24hr period. Bath should follow 24 hrs after last treatment Children: half-strength to lessen irritation Infant: 1/3-strength to lessen irritation

CROTAMITON
(Scabicide)
Colorless, odorless, oily liquid Insoluble in water, soluble in most organic solvents Available in 10% lotion & cream for topical scabies Antipruritic effect from local anesthetic effect

NONPRESCIPTION DRUG REFERENCE: Sometimes used as Lindane alternative <50% effectiveness in children Not for use in pregnant & lactating women: (lack of
evidence in toxicity)

LINDANE
Benzene hexachloride (Scabicide & Pediculide)
Halogenated HC prepared by chlorination of benzene Insoluble in water, soluble in most organic solvents LIPID SOLUBILITY = ACCUMMULATION IN BODY when ingested

Used as an insecticide: action is 3-fold: (like DDT) 1. Direct contact poison 2. Fumigant 3. Stomach poison Used locally as cream, lotion, shampoo for scabies &

pediculosis ADR: NEUROTOXICITY!!!

LINDANE
Gamma-benzene hexachloride (Scabicide & Pediculide)
NONPRESCIPTION DRUG REFERENCE:
ADR: NEUROTOXICITY: Seizures & death in infants; APLASTIC ANEMIA

Risks: 1. long application times 2. Frequent administration 3. Use on infants with skin disease 4. Ingestion *Risks are greater in younger children due to high surface area to body mass ratio *About 10% of topical dose may be absorbed, especially in scrotal area *Wet, warm skin has higher risk of absorption

LINDANE
Gamma-benzene hexachloride (Scabicide & Pediculide)
NONPRESCIPTION DRUG REFERENCE:
Ways to decrease risks of absorption: 1. Apply to cool, dry skin 2. Avoid hot soapy bath prior to application 3. Apply to affected areas only, shortest contact time 4. Wash drug off well, specially in scrotal area 5. Wear long-sleeves, pants, mittens to eliminate skin contact 6. Repeat only if reinfestation occurs:
Not sooner than 7-8 days between tx; not > 2x a month

Recommend alternate therapy for infants, kids, pregnant & nursing women, pts with neurologic disorders

LINDANE
Gamma-benzene hexachloride (Scabicide & Pediculide)
NONPRESCIPTION DRUG REFERENCE: Side effects: Irritant contact dermatitis: Burning, stinging, pruritus, erythema, thingling, rash Resistance has been reported but low in N. America Toxicity usually occurred when used as pesticide for agricultural purposes: chronic exposure

SYNTHETIC PYRETHRINS
(Scabicide & Pediculide)
PYRETHRINS: insecticidal chemicals found in Pyrethrum, which is the dried flower from Chrysanthemum (caution in patient with allergy to Chrysanthemum, ragweeds)
Synthetics: Increased effectiveness Lowered toxicity More photostable Biodegradable Permethrin 2. Piperonyl butoxide
1.

PERMETHRIN
(Scabicide & Pediculide: synthetic Pyrethrin)
Synthetic pyrethrinoid compound, more stable than most natural Pyrethrins & at least as active as an insecticide

Racemic commercial products

Lethal action agaisnt lice, ticks, mites, & fleas Acts on nerve CM to disrupt Na channel conductance

Pediculicide for head lice

Most frequent SE: PRURITUS!

PERMETHRIN
(Scabicide & Pediculide: synthetic Pyrethrin)
NONPRESCIPTION DRUG REFERENCE: MoA: delays repolarization on the neural CM, resulting in paralysis of the insect For treating LINDANE-RESISTANT cases of scabies Photostable & thermostable Has residual activity: effect persists as long as 10 days nymphs that hatch will be killed More effective than lindane, crotamiton, and other pyrethrins in a single dose

PYRETHRIN + PIPERONYL BUTOXIDE

(Scabicide & Pediculide: synthetic Pyrethrin)
NONPRESCIPTION DRUG REFERENCE:
PIPERONYL BUTOXIDE: synergist in inhibiting enzymes in louse that metabolize pyrethrins

Absorption is not extensive & is excreted rapidly

Uncommon SE: contact dermatitis & allergic rxn; corneal damage Ingestion with PETROLEUM DISTILLATE IS FATAL!