Lindane
Scabicides and pediculicides
Scabicides and pediculicides
An old organochlorine scabicide and pediculicide that can cause seizures and death. Second line only, used once; no longer on the WHO list.
Also called: gamma-hexachlorocyclohexane
Quick facts
- Group
- Scabicides and pediculicides
- Target
- Nervous system of the mite or louse (neuronal overstimulation)
- Used for
- Scabies · Head and pubic lice
- Key effects
- Irritant dermatitis · Dizziness · Hair loss
- Monitor
- Neurological symptoms · Itch afterwards is expected
- ATC
- P03AB02
No doses: the clinician sets them by the current guideline.
Mechanism of action
Lindane is the gamma isomer of hexachlorocyclohexane, an organochlorine. It is absorbed directly into mites, lice and their eggs and overstimulates their neurons until they are paralysed and die. The same property makes it dangerous to people: an important fraction crosses the skin, it concentrates in fatty tissue including the brain, and it can cause CNS stimulation from dizziness to seizures.
- Lindane is absorbed into the parasite and its eggs
- Parasite neurons are overstimulated
- Paralysis and death of mites and lice
- In people, absorbed lindane can reach the brain and cause seizures
Indications
- Scabies, only when safer first-line treatments have failed or are not tolerated Scabies →
- Head and pubic lice (shampoo), second line Pediculosis (head, body and pubic lice) →
Adverse effects
Common
- Irritant dermatitis, itching, rash
- Dizziness, headache, paraesthesia
- Hair loss, urticaria
Contraindications
- Premature infants
- Uncontrolled seizure disorders
- Crusted (Norwegian) scabies and skin conditions that raise absorption (atopic dermatitis, psoriasis)
- Hypersensitivity to lindane
Key interactions
- Drugs that lower the seizure threshold (antipsychotics, antidepressants, theophylline, ciclosporin, mycophenolate, tacrolimus)
- Add to the seizure risk; used with great caution.
- Creams, ointments and oils on the skin
- Increase lindane absorption and neurotoxicity; skin must be clean and dry.
What is monitored
- Neurological symptoms (dizziness, tremor, seizures) after application
- Itch afterwards is expected and is not a reason to re-treat
Administration and safety
- A single thin application from the neck down on clean, dry skin with no other lotion or oil; never repeated for the same episode.
- Washed off completely after the set time; never left on longer, and not covered with occlusive clothing or plastic-lined nappies.
- Caregivers wear nitrile or vinyl gloves (natural latex lets it through) and wash hands afterwards.
- Kept away from the eyes and mouth and off open wounds.
Pregnancy and breastfeeding
Safer alternatives such as permethrin are preferred: lindane is absorbed through the skin and passes into breast milk.
Nursing care
- Confirm that first-line treatment has failed or is not tolerated, and give the medication guide.
- Ask about seizures, HIV, head injury, alcohol use and seizure-lowering drugs before use.
- Teach that itching after a successful treatment is expected and is not a reason to use it again.
- Avoid during breastfeeding; if used, the milk is expressed and discarded for a time.
Pharmacokinetics
- Absorption
- A significant fraction crosses the skin, more through broken, inflamed or infant skin and with oils.
- Distribution
- Lipophilic: concentrates in fat, including the brain; passes into breast milk.
- Elimination
- Excreted in urine over several days.
Test yourself
Think of the answer, then tap the question to see it.
What is the most serious toxicity of lindane?
Neurotoxicity: seizures and deaths, especially after repeated or prolonged use, and in infants, children, older adults and small adults.
Why are oils and creams avoided before lindane?
They increase its absorption through the skin and the risk of seizures.
Why are natural latex gloves avoided when applying lindane?
Lindane passes through natural latex; nitrile or vinyl gloves are used.
Connections
← Back to the class: Scabicides and pediculicides
Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.
Sources: Lindane: MedlinePlus Drug Information (MedlinePlus (U.S. National Library of Medicine), 2026); DailyMed - LINDANE lotion (DailyMed (U.S. National Library of Medicine), 2009).
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Representative model, for educational purposes only.