Elimite 5% Cream 60gm
It is used to treat scabies.
Drug Class
Scabicides and Pediculicides
Pharmacologic Class
Pyrethroid
Pregnancy Category
Category B
FDA Approved
Dec 1989
DEA Schedule
Not Controlled
Overview
What is this medicine?
Permethrin cream is a medicine used to treat scabies, which is caused by tiny mites that burrow into the skin. It works by killing these mites. You apply it to your skin, leave it on for several hours, and then wash it off.
How to Use This Medicine
Proper Use of This Medication
To use this medication correctly, follow your doctor's instructions and read all the information provided. It is essential to use this medication as directed.
Application Instructions
Apply this medication only to your skin. Do not take it by mouth.
Avoid getting the medication in your mouth, nose, or eyes, as it may cause burning. If accidental contact occurs, rinse the affected area thoroughly with water.
Wash your hands before and after applying the medication.
Apply a thin layer of the medication to your skin, covering the area from the neck to the toes. Be sure to include the skin folds, creases, spaces between the fingers and toes, and the soles of the feet.
Trim your fingernails short before application.
Use a toothbrush to apply the medication under your nails. Dispose of the toothbrush after use to prevent reuse.
Precautions and Safety Measures
Wear lightweight clothing while the medication is on your skin.
Avoid direct skin-to-skin contact with others while wearing the medication.
Removing the Medication
After 8 to 14 hours, wash the medication off your skin using warm, soapy water.
Wash all bedding, towels, and recently worn clothing in hot water or have them dry cleaned.
Storage and Disposal
Store the medication at room temperature.
Discard any unused portion of the medication after use.
Missed Dose
* If you miss a dose, apply it as soon as you remember.
To use this medication correctly, follow your doctor's instructions and read all the information provided. It is essential to use this medication as directed.
Application Instructions
Apply this medication only to your skin. Do not take it by mouth.
Avoid getting the medication in your mouth, nose, or eyes, as it may cause burning. If accidental contact occurs, rinse the affected area thoroughly with water.
Wash your hands before and after applying the medication.
Apply a thin layer of the medication to your skin, covering the area from the neck to the toes. Be sure to include the skin folds, creases, spaces between the fingers and toes, and the soles of the feet.
Trim your fingernails short before application.
Use a toothbrush to apply the medication under your nails. Dispose of the toothbrush after use to prevent reuse.
Precautions and Safety Measures
Wear lightweight clothing while the medication is on your skin.
Avoid direct skin-to-skin contact with others while wearing the medication.
Removing the Medication
After 8 to 14 hours, wash the medication off your skin using warm, soapy water.
Wash all bedding, towels, and recently worn clothing in hot water or have them dry cleaned.
Storage and Disposal
Store the medication at room temperature.
Discard any unused portion of the medication after use.
Missed Dose
* If you miss a dose, apply it as soon as you remember.
Lifestyle & Tips
- Before applying, ensure skin is clean, dry, and cool. Do not apply immediately after a hot bath or shower.
- Apply cream to all skin surfaces from the neck down to the soles of the feet. For infants and the elderly, also apply to the scalp, hairline, temples, and forehead.
- Pay special attention to areas between fingers and toes, wrists, armpits, external genitalia, buttocks, and under fingernails.
- Do not apply to open wounds or mucous membranes (eyes, mouth, nose, vagina).
- Leave the cream on for 8 to 14 hours (e.g., overnight), then wash off thoroughly with water.
- After treatment, wash all clothing, bedding, and towels used by the infested person in hot water and dry in a hot dryer, or dry clean. Items that cannot be washed should be sealed in a plastic bag for at least 72 hours.
- Itching may persist for up to 2-4 weeks after successful treatment due to allergic reaction to dead mites. This does not necessarily mean treatment failure.
- Treat all household members and close contacts simultaneously, even if asymptomatic, to prevent re-infestation.
Available Forms & Alternatives
Available Strengths:
Generic Alternatives:
Dosing & Administration
Adult Dosing
Standard Dose:
Apply a thin layer of cream to the entire body from the neck down to the soles of the feet. Leave on for 8-14 hours, then wash off thoroughly. A single application is usually curative. If live mites are seen or new lesions appear, re-treatment may be necessary after 7-14 days.
Condition-Specific Dosing:
scabies:
Apply once, leave for 8-14 hours, then wash off. May repeat in 7-14 days if necessary.
Pediatric Dosing
Neonatal:
Not established for infants younger than 2 months. Use with caution and under medical supervision for infants 2 months to 2 years, applying to the entire body including the head and neck.
Infant:
For infants 2 months to 2 years: Apply to the entire body from the head to the soles of the feet. Leave on for 8-14 hours, then wash off. A single application is usually curative. If live mites are seen or new lesions appear, re-treatment may be necessary after 7-14 days.
Child:
For children 2 years and older: Apply to the entire body from the neck down to the soles of the feet. Leave on for 8-14 hours, then wash off. A single application is usually curative. If live mites are seen or new lesions appear, re-treatment may be necessary after 7-14 days.
Adolescent:
Same as adult dosing.
Dose Adjustments
Renal Impairment:
Mild:
No adjustment needed
Moderate:
No adjustment needed
Severe:
No adjustment needed
Dialysis:
No specific considerations due to minimal systemic absorption.
Hepatic Impairment:
Mild:
No adjustment needed
Moderate:
No adjustment needed
Severe:
No adjustment needed
Pharmacology
Mechanism of Action
Permethrin is a synthetic pyrethroid that acts as a neurotoxin, disrupting the sodium channel current that regulates the polarization of the neuronal membrane in arthropods. This leads to delayed repolarization and paralysis of the pests (mites and lice), ultimately causing their death.
Pharmacokinetics
Absorption:
Bioavailability:
<2% (systemic absorption after topical application)
Tmax:
Not applicable (minimal systemic absorption)
FoodEffect:
Not applicable
Distribution:
Vd:
Not applicable (minimal systemic absorption)
ProteinBinding:
Not applicable (minimal systemic absorption)
CnssPenetration:
Limited (minimal systemic absorption)
Elimination:
HalfLife:
Not applicable (minimal systemic absorption)
Clearance:
Not applicable (minimal systemic absorption)
ExcretionRoute:
Renal (as inactive metabolites)
Unchanged:
<1% (in urine)
Pharmacodynamics
OnsetOfAction:
Rapid (within hours of application)
PeakEffect:
Not applicable (single application for eradication)
DurationOfAction:
Effective for the duration of the 8-14 hour application period; residual activity may persist for several days.
Safety & Warnings
Side Effects
Urgent Side Effects: Seek Medical Attention Immediately
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical help right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Eye irritation
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or do not go away, contact your doctor for advice:
Itching or redness
Burning or stinging
Note: This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Although rare, some people may experience severe and potentially life-threatening side effects while taking this medication. If you notice any of the following symptoms, contact your doctor or seek medical help right away:
Signs of an allergic reaction, such as:
+ Rash
+ Hives
+ Itching
+ Red, swollen, blistered, or peeling skin with or without fever
+ Wheezing
+ Tightness in the chest or throat
+ Trouble breathing, swallowing, or talking
+ Unusual hoarseness
+ Swelling of the mouth, face, lips, tongue, or throat
Eye irritation
Other Possible Side Effects
Like all medications, this drug can cause side effects. While many people may not experience any side effects or only minor ones, it's essential to discuss any concerns with your doctor. If you experience any of the following side effects or any other unusual symptoms that bother you or do not go away, contact your doctor for advice:
Itching or redness
Burning or stinging
Note: This list is not exhaustive, and you may experience other side effects not mentioned here. If you have questions or concerns about side effects, consult your doctor. You can also report side effects to the FDA at 1-800-332-1088 or online at https://www.fda.gov/medwatch.
Seek Immediate Medical Attention If You Experience:
- Severe skin irritation, burning, stinging, or redness after application (rare, discontinue use and consult doctor).
- Signs of allergic reaction (rash, hives, swelling, difficulty breathing).
- Persistent or worsening itching and new lesions after 2-4 weeks post-treatment (may indicate re-infestation or treatment failure).
Before Using This Medicine
Before Taking This Medication: Important Information to Share with Your Doctor
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
If you are allergic to ragweed, as this medication may trigger breathing difficulties or an asthma attack.
Any other medications you are taking, including prescription and over-the-counter drugs, natural products, and vitamins. This is crucial because this medication may interact with other drugs or health conditions.
Any existing health problems you have, as they may affect the safety and efficacy of this medication.
To ensure your safety, it is vital to:
Discuss all your medications and health conditions with your doctor and pharmacist to verify that it is safe to take this medication in conjunction with your other treatments.
Avoid starting, stopping, or changing the dosage of any medication without first consulting your doctor.
It is essential to inform your doctor about the following:
Any allergies you have, including allergies to this medication, its components, or other substances, such as foods or drugs. Be sure to describe the allergic reaction and its symptoms.
If you are allergic to ragweed, as this medication may trigger breathing difficulties or an asthma attack.
Any other medications you are taking, including prescription and over-the-counter drugs, natural products, and vitamins. This is crucial because this medication may interact with other drugs or health conditions.
Any existing health problems you have, as they may affect the safety and efficacy of this medication.
To ensure your safety, it is vital to:
Discuss all your medications and health conditions with your doctor and pharmacist to verify that it is safe to take this medication in conjunction with your other treatments.
Avoid starting, stopping, or changing the dosage of any medication without first consulting your doctor.
Precautions & Cautions
It is essential to inform all your healthcare providers, including doctors, nurses, pharmacists, and dentists, that you are taking this medication. If you accidentally ingest this drug, seek immediate medical attention or contact a poison control center right away. This medication is not recommended for children under 2 months of age unless explicitly advised by a doctor. If you are pregnant, planning to become pregnant, or breastfeeding, consult your doctor to discuss the potential benefits and risks of this medication to both you and your baby.
Overdose Information
Overdose Symptoms:
- Excessive skin irritation
- Burning sensation
- Stinging
- Numbness
- Tingling
What to Do:
If ingested, seek immediate medical attention or call a poison control center (1-800-222-1222). For topical overdose, wash off thoroughly with soap and water. Symptomatic and supportive care.
Drug Interactions
Monitoring
Routine Monitoring
Resolution of itching and skin lesions
Frequency: Daily for first few days, then weekly
Target: Absence of new lesions and decreasing pruritus
Action Threshold: Persistent or worsening symptoms, or appearance of new lesions after 14 days post-treatment, may indicate treatment failure or re-infestation.
Symptom Monitoring
- Persistent itching
- New skin lesions (burrows, papules, vesicles)
- Signs of secondary bacterial infection (redness, warmth, pus)
Special Patient Groups
Pregnancy
Permethrin is generally considered safe for use during pregnancy (Pregnancy Category B) due to minimal systemic absorption. Consult a healthcare provider.
Trimester-Specific Risks:
First Trimester:
Low risk, minimal systemic absorption.
Second Trimester:
Low risk, minimal systemic absorption.
Third Trimester:
Low risk, minimal systemic absorption.
Lactation
Permethrin is considered compatible with breastfeeding (Lactation Risk L2) due to minimal systemic absorption. It is unlikely to be excreted in breast milk in clinically significant amounts. If applied to the breast area, ensure it is thoroughly washed off before nursing.
Infant Risk:
Low risk to breastfed infant.
Pediatric Use
Safe and effective for infants 2 months of age and older. For infants younger than 2 months, safety and efficacy have not been established; use only under strict medical supervision if benefits outweigh risks.
Geriatric Use
No specific dose adjustments are required. Elderly patients should follow the same application instructions as adults, ensuring thorough coverage of all affected areas, including the scalp and hairline if necessary.
Clinical Information
Clinical Pearls
- Permethrin 5% cream is the first-line treatment for scabies.
- Itching may persist for several weeks after successful treatment (post-scabetic itch) and does not indicate treatment failure. This is due to an allergic reaction to dead mites and their products.
- Treat all household members and close contacts simultaneously, even if asymptomatic, to prevent re-infestation.
- Ensure thorough application to all skin surfaces, including difficult-to-reach areas and under nails.
- Re-treatment is typically only needed if live mites are observed or new lesions appear 7-14 days after the initial treatment.
- Environmental decontamination (washing clothes, bedding) is crucial to prevent re-infestation.
Alternative Therapies
- Oral Ivermectin (off-label for scabies, especially crusted scabies or widespread outbreaks)
- Crotamiton cream/lotion (Eurax)
- Sulfur ointment
- Benzyl benzoate lotion
- Lindane lotion (second-line due to potential neurotoxicity, especially in children and those with extensive dermatitis)
Cost & Coverage
Average Cost:
$20 - $50 per 60gm tube
Generic Available:
Yes
Insurance Coverage:
Tier 1 or Tier 2 (for generic)
General Drug Facts
If your symptoms or health issues persist or worsen, it's essential to contact your doctor for further guidance. To ensure your safety, never share your medication with others or take someone else's medication. Some medications may come with an additional patient information leaflet, so be sure to check with your pharmacist for more information. If you have any questions or concerns about your medication, don't hesitate to reach out to your doctor, nurse, pharmacist, or other healthcare provider. In the event of a suspected overdose, immediately call your local poison control center or seek emergency medical attention. When seeking help, be prepared to provide details about the medication taken, the amount, and the time it happened.