Usage
Cetrimide + Lindane is a topical combination medication primarily prescribed for the treatment of scabies and pediculosis (lice infestation), including head lice and pubic lice. It is classified as an antiparasitic and antiseptic agent.
The Cetrimide component acts as an antiseptic with bactericidal and fungicidal properties, disrupting the cell membranes of microorganisms. Lindane is an insecticide that targets the nervous system of parasites like scabies mites and lice, causing seizures and death.
Alternate Names
Lindane is also known as gamma benzene hexachloride. This combination medication is marketed under various brand names such as Gbhc, Antiscab, and Lupiscab. The specific brand names might vary regionally.
How It Works
Pharmacodynamics: Cetrimide disrupts the cell membranes of bacteria and fungi. Lindane acts as a neurotoxin to insects, causing paralysis and death.
Pharmacokinetics: Cetrimide primarily exerts its effect topically. Lindane, although also applied topically, can be absorbed through the skin. The extent of absorption is increased if applied to broken or irritated skin, or used for prolonged periods. Lindane is metabolized in the liver and excreted by the kidneys. Specific CYP enzyme interactions are not well-defined.
Mode of Action: Cetrimide acts by increasing the permeability of microbial cell membranes, leading to leakage of cellular contents and cell death. Lindane interferes with the GABA-mediated chloride channels in the insect nervous system, leading to uncontrolled neuronal firing, seizures, and death.
Elimination: Cetrimide is primarily removed by washing off the application site. Absorbed Lindane is metabolized in the liver and excreted primarily in urine.
Dosage
Standard Dosage
Adults: A thin layer of lotion or cream is applied to the entire body from the neck down, including the soles of the feet. For shampoo formulations used for lice, apply to the affected area. Typically, 30 mL is sufficient for an average adult, and up to 60 mL may be needed for larger individuals. The application is left on for 8-12 hours, then thoroughly washed off. Only a single application is recommended. Do not retreat without consulting a physician.
Children: Use with extreme caution in children, especially those weighing less than 50 kg. Due to a higher surface area-to-volume ratio, children are at a higher risk of systemic absorption and neurotoxicity. The dosage should be determined by a physician based on the child’s weight and the specific condition being treated. Use is not recommended for premature infants and neonates. For children older than 2 years, the doctor will decide the dose.
Special Cases:
- Elderly Patients: Use with caution due to potential age-related changes in skin integrity and organ function.
- Patients with Renal Impairment: Use with caution. Monitor for signs of toxicity.
- Patients with Hepatic Dysfunction: Use with caution due to the potential for impaired metabolism of Lindane.
- Patients with Comorbid Conditions: Use with extreme caution in patients with seizure disorders, pre-existing skin conditions (atopic dermatitis, psoriasis), or any condition that might increase the risk of seizures.
Clinical Use Cases
The use of Cetrimide + Lindane in clinical settings like intubation, surgical procedures, mechanical ventilation, ICU, and emergency situations is not indicated. Its use is restricted to topical treatment of scabies and lice infestations.
Dosage Adjustments
Dosage adjustments may be necessary for patients with renal or hepatic impairment, and those with pre-existing skin conditions. Always consult with a physician for appropriate dosage adjustments.
Side Effects
Common Side Effects:
- Skin irritation (stinging, burning, itching, dryness, redness)
- Skin rash
- Dizziness
- Drowsiness
Rare but Serious Side Effects:
- Seizures
- Neurotoxicity (e.g., tremors, ataxia)
- Allergic reactions (e.g., hives, difficulty breathing)
Long-Term Effects:
Chronic complications from prolonged use are rare if used as directed. However, Lindane can persist in the body for extended periods, especially in adipose tissue.
Adverse Drug Reactions (ADR):
Seizures and severe neurotoxicity require immediate medical intervention.
Contraindications
- Hypersensitivity to Cetrimide or Lindane
- Uncontrolled seizure disorders
- Premature infants and neonates
- Crusted scabies
- Widespread skin disease or burns
Drug Interactions
- Medications that lower the seizure threshold (e.g., certain antidepressants, antipsychotics)
- Other topical medications
Pregnancy and Breastfeeding
Lindane is not recommended during pregnancy due to potential fetal risks, including neurodevelopmental effects. It’s also not recommended during breastfeeding due to potential excretion in breast milk and neonatal exposure. Consult a physician for safer alternative treatments.
Drug Profile Summary
- Mechanism of Action: Cetrimide: antiseptic, disrupts cell membranes. Lindane: insecticide, neurotoxic to insects.
- Side Effects: Skin irritation, dizziness, drowsiness, rarely seizures.
- Contraindications: Hypersensitivity, seizures, prematurity, crusted scabies, burns.
- Drug Interactions: Medications that lower seizure threshold, other topical medications.
- Pregnancy & Breastfeeding: Not recommended.
- Dosage: Topical, single application, 30-60 mL for adults. Pediatric dose as directed by physician.
- Monitoring Parameters: Observe for skin irritation, neurological symptoms.
Popular Combinations
Cetrimide and Lindane are typically used as a standalone combination. No other popular drug combinations are recommended.
Precautions
- General Precautions: Avoid contact with eyes and mucous membranes. Wash hands thoroughly after application. Do not apply to broken skin. Do not retreat without consulting a physician.
- Specific Populations: Use cautiously in pregnant/breastfeeding women, children, elderly, and those with renal/hepatic impairment.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cetrimide + Lindane?
A: For adults, apply 30-60 mL as a thin layer to skin from neck down; leave on for 8-12 hours, then wash off thoroughly. Pediatric dosage should be determined by a physician based on weight and condition.
Q2: What are the common side effects of this medicine?
A: Common side effects include skin irritation (burning, itching, redness), dizziness, and drowsiness.
Q3: Is it safe to use Cetrimide + Lindane during pregnancy or breastfeeding?
A: No, it is not recommended due to potential fetal and neonatal risks. Consult a doctor for safe alternatives.
Q4: Are there any serious side effects I should be aware of?
A: Rarely, seizures and other neurotoxic effects can occur. Immediate medical attention is required if these occur.
Q5: What should I do if I accidentally get this medicine in my eyes?
A: Rinse the eyes thoroughly with water and contact a physician immediately.
Q6: Can I reapply Cetrimide + Lindane if the itching persists after the first application?
A: No, do not reapply without consulting a physician. Persistent itching can occur even after successful treatment.
Q7: How does Cetrimide + Lindane work to treat scabies and lice?
A: Cetrimide acts as an antiseptic, while Lindane acts as a neurotoxin to the parasites, leading to their death.
Q8: Are there any medications I should avoid while using Cetrimide + Lindane?
A: Consult with your physician about other medications you are taking, especially those that might lower the seizure threshold.
Q9: Can I use this medicine if I have a history of seizures?
A: No, this medicine is contraindicated in patients with uncontrolled seizure disorders.
