Usage
Cetrimide + Menthol + Permethrin is primarily prescribed for the treatment of scabies and head lice infestations. It can also be used for other skin infections or infestations, as determined by a doctor.
Pharmacological Classification: This combination product falls into multiple categories:
- Permethrin: Antiparasitic (specifically a scabicide and pediculicide)
- Cetrimide: Antiseptic, disinfectant, and cationic surfactant
- Menthol: Topical anesthetic and counterirritant
Mechanism of Action:
- Permethrin: Disrupts the sodium channels in the nerve cell membranes of parasites like scabies mites and lice, leading to paralysis and death.
- Cetrimide: Disrupts the cell membranes of bacteria and other microorganisms, preventing secondary skin infections.
- Menthol: Provides a cooling and soothing effect, relieving itching and discomfort.
Alternate Names
- Permethrin/Cetrimide/Menthol
- Brand names include: SCABY SAOP, Permimite, Cumide P Soap, Exo Soap, Permo C Soap, Scabal P Soap, Scrabic Soap.
How It Works
Pharmacodynamics:
- Permethrin: Acts on the nerve cell membranes of parasites causing paralysis and death.
- Cetrimide: Acts as an antiseptic by disrupting bacterial cell membranes.
- Menthol: Provides a cooling sensation and relieves itching.
Pharmacokinetics:
- Permethrin: Poorly absorbed through intact skin; metabolized by ester hydrolysis to inactive metabolites, primarily excreted in the urine.
- Cetrimide: Minimally absorbed systemically when used topically.
- Menthol: Minimally absorbed systemically when used topically.
Mode of Action: (As described in Usage Section)
Elimination Pathways:
- Permethrin: Primarily urinary excretion.
- Cetrimide and Menthol: Metabolized and eliminated via renal and hepatic pathways.
Dosage
Standard Dosage
Adults:
- Cream (5% Permethrin): Apply a thin layer to the entire body from the neck down, including soles of feet and palms of hands. Leave on for 8-14 hours, then rinse thoroughly. A repeat application may be necessary after 7 days if live mites are still present.
- Lotion (1% Permethrin): For head lice, apply to washed, towel-dried hair. Leave on for 10 minutes, then rinse and comb out nits. Repeat after 7 days if live lice are still present.
- Soap: Apply to wet skin/scalp, lather, leave on as per product instructions (typically a few minutes), and rinse thoroughly.
Children:
- 2 months to <1 year (scabies): Up to 3.75g of 5% cream or 1/8 of a 50 mL bottle of 1% lotion.
- 2 months to <1 year (head lice): Up to 1/8 of a 50 mL bottle of 1% lotion.
- 1-5 years (scabies): Up to 7.5g of 5% cream or 1/4 of a 50 mL bottle of 1% lotion.
- 1-5 years (head lice): Up to 1/4 of a 50 mL bottle of 1% lotion.
- 6-12 years (scabies): Up to 15g of 5% cream or 1/2 of a 50 mL bottle of 1% lotion.
- 6-12 years (head lice): Up to 1/2 of a 50 mL bottle of 1% lotion.
- >12 years: Same as adult dose.
Special Cases:
- Elderly Patients: Same as adult dose. For scabies, also apply to the scalp, hairline, forehead, temples, ears, and face.
- Patients with Renal Impairment: No specific dose adjustments are typically necessary.
- Patients with Hepatic Dysfunction: No specific dose adjustments are typically necessary.
- Patients with Comorbid Conditions: Consider pre-existing skin conditions like eczema or psoriasis, as Cetrimide + Menthol + Permethrin might exacerbate these conditions.
Clinical Use Cases
The combination of Cetrimide, Menthol, and Permethrin is primarily used for topical treatment of scabies and head lice infestations. The clinical use cases in settings such as intubation, surgical procedures, mechanical ventilation, ICU, and emergencies are not relevant for this combination.
Dosage Adjustments
Consult product-specific guidelines or a healthcare professional for any necessary modifications based on patient factors.
Side Effects
Common Side Effects
- Burning/stinging at the application site
- Itching
- Redness
- Dry skin
- Rash
Rare but Serious Side Effects
- Severe allergic reactions (e.g., difficulty breathing, swelling of the face, lips, tongue, or throat)
Long-Term Effects
No specific long-term effects have been reported with topical use as directed.
Adverse Drug Reactions (ADR)
Any severe or persistent skin reactions should be reported to a healthcare professional.
Contraindications
- Hypersensitivity to any of the components (permethrin, cetrimide, menthol), synthetic pyrethroids, or pyrethrins.
- Infants younger than two months for over-the-counter permethrin products (prescription formulations may be used under strict medical supervision).
- Application to broken or secondarily infected skin.
Drug Interactions
No significant drug interactions have been reported with topical application of Cetrimide + Menthol + Permethrin. However, always inform patients to disclose all medications and supplements they are using.
Pregnancy and Breastfeeding
The safety of using Cetrimide + Menthol + Permethrin during pregnancy or breastfeeding has not been definitively established. Consult a physician before use if pregnant, planning to become pregnant, or breastfeeding.
Drug Profile Summary
- Mechanism of Action: Permethrin: Insecticidal; Cetrimide: Antiseptic; Menthol: Topical anesthetic.
- Side Effects: Burning/stinging, itching, redness, dry skin, rash.
- Contraindications: Hypersensitivity, infants <2 months (OTC), broken/infected skin.
- Drug Interactions: None reported.
- Pregnancy & Breastfeeding: Consult physician.
- Dosage: See “Dosage” section.
- Monitoring Parameters: Observe for skin reactions and signs of allergic reactions.
Popular Combinations
This combination itself is commonly used. There aren’t widely recognized further combinations with other drugs.
Precautions
- General Precautions: Pre-screening for allergies is essential.
- Specific Populations: See contraindications and pregnancy/breastfeeding information.
- Lifestyle Considerations: No specific restrictions on alcohol, smoking, diet or driving are typically associated with this medication.
FAQs (Frequently Asked Questions)
Q1: What is the recommended dosage for Cetrimide + Menthol + Permethrin?
A: Refer to the detailed “Dosage” section above, covering adult, pediatric, and special populations.
Q2: How long does it take for Cetrimide + Menthol + Permethrin to work?
A: For scabies, a single application is usually sufficient, but itching may persist for several weeks. For head lice, a repeat application may be necessary after 7 days.
Q3: Can I use this combination on broken skin?
A: No, it is contraindicated for use on broken or infected skin.
Q4: What should I do if I accidentally get the product in my eyes?
A: Flush the eyes thoroughly with water immediately.
Q5: Are there any drug interactions I should be aware of?
A: No significant drug interactions have been reported with topical use. However, always advise patients to inform you of all medications they are using.
Q6: Can I use this product if I’m pregnant or breastfeeding?
A: Consult a physician before use during pregnancy or breastfeeding, as safety hasn’t been definitively established.
Q7: What are the common side effects?
A: Common side effects include burning/stinging, itching, redness, dry skin, and rash at the application site.
Q8: What should I do if the itching doesn’t go away after treatment for scabies?
A: Itching can persist for several weeks after successful scabies treatment. Consult a physician if the itching is severe or doesn’t improve.
Q9: Can this combination be used for other skin conditions besides scabies and lice?
A: While primarily used for scabies and lice, it can be used for other skin infections at the discretion of a doctor.
