SCABENE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for SCABENE (SCABENE).

How it works

Scabene (Lindane) is an organochlorine insecticide that acts on the gamma-aminobutyric acid (GABA) receptor-chloride channel complex, causing neuronal hyperexcitation and death in arthropods. In scabies mites, it disrupts nervous system function leading to paralysis and death.

What the body does with it

Metabolism	Lindane is metabolized in the liver primarily by cytochrome P450 enzymes (CYP2B6, CYP3A4) via oxidative and dehydrochlorination pathways, producing metabolites excreted in urine and feces.
Excretion	Primarily renal excretion of unchanged drug and metabolites. Approximately 70-80% of a dose is excreted in urine, with about 10-15% in feces via biliary elimination.
Half-life	Terminal elimination half-life is approximately 14-18 hours. In patients with severe renal impairment (CrCl <30 mL/min), half-life may be prolonged to over 30 hours, requiring dose adjustment.
Protein binding	Approximately 96-98% bound to plasma proteins, primarily albumin and alpha-1-acid glycoprotein.
Volume of Distribution	Volume of distribution is 2.5-4.0 L/kg, indicating extensive tissue distribution. Higher Vd in obese patients (>5 L/kg) due to lipophilicity.
Bioavailability	Oral bioavailability is 40-60% due to first-pass metabolism. Topical bioavailability is approximately 10-15% of applied dose, varying with skin integrity and formulation.
Onset of Action	Oral administration: Onset within 1-2 hours. Topical application: Onset within 8-12 hours due to slow percutaneous absorption.
Duration of Action	Oral: Duration of action is 24-36 hours. Topical: Duration is approximately 24 hours after application, with residual effects lasting up to 48 hours due to skin reservoir.

Classification & Brands

Dosing & administration

Permethrin 5% cream: Apply topically from head to soles of feet, leave on for 8-14 hours, then wash off. Single application for most patients; repeat in 7-14 days if live mites persist.

Dosage form	SHAMPOO
Renal impairment	No dosage adjustment required for topical permethrin. Systemic absorption is minimal (<2%).
Liver impairment	No dosage adjustment required. Topical application results in negligible systemic exposure, so Child-Pugh classification has no effect.
Pediatric use	Permethrin 5% cream: Apply same as adults (head to soles, 8-14 hours). For infants and young children, also apply to scalp, face, and ears (avoid eyes and mouth). Single application; repeat in 7-14 days if needed. Safe for infants older than 2 months.
Geriatric use	Same as adults. No specific dose adjustment needed. Caution with application to frail skin to avoid irritation. Ensure thorough washing of perineal and intertriginous areas.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for SCABENE (SCABENE).

Breastfeeding	Unknown if excreted in human milk; M/P ratio not determined. Due to potential for serious adverse reactions, breastfeeding is not recommended during therapy.
Teratogenic Risk	FDA Pregnancy Category C. First trimester: Insufficient human data; animal studies suggest potential risk. Second and third trimesters: Avoid use as safety not established; may cause fetal bradycardia or metabolic acidosis.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Lindane lotion has a black box warning due to the risk of serious adverse effects including seizures, neurotoxicity, and death, especially with misuse or in patients with low body weight, history of seizures, or compromised blood-brain barrier.

Side Effect Profile

Serious Effects

Absolute Contraindications

Premature infants, uncontrolled seizures, known hypersensitivity to lindane or other organochlorines, crusted scabies with heavy infestation, open wounds or extensive dermatitis.

Clinical Precautions

Precautions

Seizures, neurotoxicity, aplastic anemia, use with caution in patients with <50 kg body weight, history of seizures, or skin conditions (e.g., dermatitis, psoriasis), avoid contact with eyes or mucous membranes, avoid re-treatment within 7 days, use only as second-line therapy.

Clinical Tips & Counseling

Drug interactions

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SCABENE

Clinical safety rating: caution

Comprehensive clinical and safety monograph for SCABENE (SCABENE).

How it works

What the body does with it

Metabolism	Lindane is metabolized in the liver primarily by cytochrome P450 enzymes (CYP2B6, CYP3A4) via oxidative and dehydrochlorination pathways, producing metabolites excreted in urine and feces.
Excretion	Primarily renal excretion of unchanged drug and metabolites. Approximately 70-80% of a dose is excreted in urine, with about 10-15% in feces via biliary elimination.
Half-life	Terminal elimination half-life is approximately 14-18 hours. In patients with severe renal impairment (CrCl <30 mL/min), half-life may be prolonged to over 30 hours, requiring dose adjustment.
Protein binding	Approximately 96-98% bound to plasma proteins, primarily albumin and alpha-1-acid glycoprotein.
Volume of Distribution	Volume of distribution is 2.5-4.0 L/kg, indicating extensive tissue distribution. Higher Vd in obese patients (>5 L/kg) due to lipophilicity.
Bioavailability	Oral bioavailability is 40-60% due to first-pass metabolism. Topical bioavailability is approximately 10-15% of applied dose, varying with skin integrity and formulation.
Onset of Action	Oral administration: Onset within 1-2 hours. Topical application: Onset within 8-12 hours due to slow percutaneous absorption.
Duration of Action	Oral: Duration of action is 24-36 hours. Topical: Duration is approximately 24 hours after application, with residual effects lasting up to 48 hours due to skin reservoir.

Classification & Brands

Dosing & administration

Permethrin 5% cream: Apply topically from head to soles of feet, leave on for 8-14 hours, then wash off. Single application for most patients; repeat in 7-14 days if live mites persist.

Dosage form	SHAMPOO
Renal impairment	No dosage adjustment required for topical permethrin. Systemic absorption is minimal (<2%).
Liver impairment	No dosage adjustment required. Topical application results in negligible systemic exposure, so Child-Pugh classification has no effect.
Pediatric use	Permethrin 5% cream: Apply same as adults (head to soles, 8-14 hours). For infants and young children, also apply to scalp, face, and ears (avoid eyes and mouth). Single application; repeat in 7-14 days if needed. Safe for infants older than 2 months.
Geriatric use	Same as adults. No specific dose adjustment needed. Caution with application to frail skin to avoid irritation. Ensure thorough washing of perineal and intertriginous areas.

Use during pregnancy

1st trimester	Consult provider
2nd trimester	Consult provider
3rd trimester	Consult provider

Clinical note

Comprehensive clinical and safety monograph for SCABENE (SCABENE).

Breastfeeding	Unknown if excreted in human milk; M/P ratio not determined. Due to potential for serious adverse reactions, breastfeeding is not recommended during therapy.
Teratogenic Risk	FDA Pregnancy Category C. First trimester: Insufficient human data; animal studies suggest potential risk. Second and third trimesters: Avoid use as safety not established; may cause fetal bradycardia or metabolic acidosis.
Fetal Monitoring

Warnings & precautions

■ FDA Black Box Warning

Side Effect Profile

Serious Effects

Absolute Contraindications

Premature infants, uncontrolled seizures, known hypersensitivity to lindane or other organochlorines, crusted scabies with heavy infestation, open wounds or extensive dermatitis.