lindane

Action and Spectrum

Actions and Spectrum: 

lindane is an organochlorine compound used as a topical treatment for scabies and lice infestations. Its mechanism of action involves disrupting the nervous system of the parasites, leading to their death. Specifically, lindane binds to the gamma-aminobutyric acid (GABA) receptors in the parasites’ nervous system, increasing chloride ion influx into the neurons. This causes hyperpolarization of the neurons, inhibiting their activity and ultimately leading to paralysis and death of the parasites.  

The spectrum of activity of lindane is primarily limited to treating ectoparasitic infestations such as scabies and lice. lindane is effective against both the adult and larval forms of the parasites. However, due to concerns over its safety and potential toxicity, lindane is no longer recommended as a first-line treatment for these conditions in many countries. 

Drug Interaction

Adverse Reaction

Frequency not defined 

Cardiac arrhythmia 

Dizziness 

Pain 

Alopecia 

Hematuria 

Hepatitis 

Paresthesia 

CNS toxicity (seizures) 

Ataxia 

Restlessness 

Seizure 

Urticaria 

Pulmonary edema 

Nausea/vomiting 

Aplastic anemia 

Black Box Warning

Black box warning: 

lindane has a black box warning, the most severe type of warning issued by the US FDA, due to its potential for neurotoxicity and other serious adverse effects. The black box warning highlights the following concerns: 

• Neurotoxicity: lindane can cause seizures and other severe neurological effects, especially in children, elderly patients, and individuals with preexisting neurological conditions. 

• Skin irritation: lindane can cause skin irritation, redness, and itching, especially in individuals with sensitive skin or allergies. 

• Environmental toxicity: lindane is highly toxic to aquatic organisms and can persist in the environment for a long time, leading to potential ecological damage. 

Contraindication / Caution

Contraindications/caution: 

Contraindications: 

• Allergy to lindane: Individuals with a known allergy or hypersensitivity to lindane or its components should not use this medication. 

• Seizure disorders: lindane has been known to cause seizures, especially when misused or in excessive amounts. Therefore, individuals with a history of seizure disorders should avoid using lindane. 

• Pregnancy and breastfeeding: lindane is classified as a pregnancy category C drug, which may harm a developing fetus. It is also not recommended during breastfeeding, as it can be excreted in breast milk and harm a nursing infant. 

• Skin conditions: lindane should not be used on individuals with skin conditions such as dermatitis, psoriasis, or open wounds, as it can cause irritation and potentially worsen these conditions. 

• Age: lindane is not recommended in infants and young children, as they may be more susceptible to adverse effects such as seizures. 

• Impaired liver function: lindane is primarily metabolized in the liver, so individuals with impaired liver function should avoid using this medication. 

Caution: 

• Proper use: lindane should be used according to the directions provided by a healthcare professional, and it should not be used more frequently or for more extended periods than recommended. 

• Application to large areas of skin: lindane should not be applied to large areas of skin, as this can increase the risk of systemic absorption and potential toxicity. 

• Concurrent use of other medications: lindane should not be used concurrently with other medications that may increase the risk of seizures, such as certain antidepressants and antipsychotics. 

• Use in elderly individuals: Elderly individuals may be more susceptible to the adverse effects of lindane, such as seizures and neurotoxicity. 

• Use in individuals with weakened immune systems: Individuals with weakened immune systems, such as those with HIV or undergoing chemotherapy, may be more susceptible to the adverse effects of lindane. 

• Use in individuals with kidney or liver disease: lindane may accumulate in individuals with impaired kidney or liver function, increasing the risk of toxicity. 

• Environmental concerns: lindane is toxic to aquatic organisms and can persist in the environment, so it should be used and disposed of carefully to prevent contamination of water sources. 

Pregnancy / Lactation

Pregnancy consideration: lindane is classified as a category C drug that may harm a developing fetus. 

Lactation: 

• Excretion of the drug in human breast milk is known 
• It is also not recommended during breastfeeding, as it can be excreted in breast milk and harm a nursing infant. 

Pregnancy category: 

Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.   

Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women. 

Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.    

Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.    

Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.    

Category N: There is no data available for the drug under this category 

Pharmacology

Pharmacology: 

lindane is a medication that belongs to the class of drugs known as pediculicides and scabicides. It is used to treat infestations of lice and scabies. The mechanism of action of lindane is not entirely understood, but it is thought to work by disrupting the nervous system of the parasites. It acts as a neurotoxin by binding to gamma-aminobutyric acid (GABA) receptors, which are present in the central nervous system of parasites. This binding results in the inhibition of nerve impulses, leading to paralysis and the death of the parasites. 

Pharmacodynamics: 

lindane is a medication that is used to treat lice and scabies infestations. Its pharmacodynamics involves the interaction with the nervous system of the parasites, leading to their death. 

lindane binds to the GABA receptors in the parasites’ central nervous system. GABA is a neurotransmitter that plays a role in regulating nerve impulses. By binding to GABA receptors, lindane inhibits the transmission of nerve impulses, leading to paralysis and death of the parasites. 

lindane is effective against several parasites, including head lice, pubic lice, and scabies mites. It is usually applied topically to the affected areas of the skin, where it is absorbed and distributed throughout the body. 

Pharmacokinetics: 

Absorption 

lindane is absorbed through the skin when applied topically as a lotion or shampoo. It can also be absorbed through ingestion, inhalation, or contact with mucous membranes. However, absorption is generally limited when used as directed and not applied to large areas of the skin. 

Distribution 

lindane is distributed throughout the body after absorption. It has a high affinity for fatty tissues and can accumulate in adipose tissue, leading to a long half-life. However, lindane does not appear to cross the blood-brain barrier to a significant extent.

Metabolism 

lindane is primarily metabolized in the liver, where it undergoes biotransformation to form metabolites excreted in urine and feces. The metabolism of lindane can be impaired in individuals with liver disease, leading to a potential for toxicity. 

Elimination and Excretion 

lindane and its metabolites are excreted primarily in urine and feces. The elimination half-life of lindane ranges from 18 to 54 hours, depending on the dose and duration of exposure. 

Adminstartion

Administration: 

lindane is a medication that is used to treat lice and scabies infestations. It is available as a lotion or shampoo and is usually applied topically to the affected areas of the skin. Here are some general guidelines for the administration of lindane: 

Before using lindane, it is essential to read and understand the instructions provided by the manufacturer or your healthcare provider. Follow the recommended dosage and duration of treatment, as well as any safety precautions. 

• Apply to dry skin: lindane should be applied to dry skin and hair, avoiding contact with the eyes, mouth, and other mucous membranes. The lotion or shampoo should be applied thoroughly to cover all affected areas, including the scalp, neck, and behind the ears. 

• Leave on for recommended time: The time for leaving lindane on the skin or hair varies depending on the product and the severity of the infestation. Follow the instructions carefully, and do not leave lindane on longer than recommended. 

• Rinse thoroughly: After the recommended time has elapsed, rinse the skin or hair thoroughly with warm water. Avoid using hot water, as this can increase absorption and potential toxicity. 

• Repeat if necessary: In some cases, a second application of lindane may be necessary to ensure the complete eradication of lice or scabies. Follow the instructions for repeat applications carefully. 

• Dispose of unused products safely: lindane should be stored and disposed of according to local regulations. Do not reuse or share lindane products, as this can increase the risk of toxicity and resistance. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: lindane 

Why do we use lindane? 

lindane is a medication that is used to treat lice and scabies infestations. It is effective against several parasites, including head lice, pubic lice, and scabies mites. Lindane works by binding to the GABA receptors in the parasites’ central nervous system, leading to paralysis and death of the parasites. 

lindane is usually applied topically to the affected areas of the skin, where it is absorbed and distributed throughout the body. It is available as a lotion or shampoo and is used when other treatments have failed or are inappropriate due to resistance or adverse effects. 

In addition to its use in treating lice and scabies, lindane has been used for other indications in the past, such as the treatment of agricultural pests and the control of mosquitoes and other insect vectors. However, due to its potential for toxicity and the availability of safer alternatives, the use of lindane for these purposes has been discontinued in many countries.