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Recent Developments in Poison Control

Vol. No: 31:03 Posted: 3/15/2006

by W. Steven Pray, PhD, DPh
Bernhardt Professor of Nonprescription Drugs and Devices
College of Pharmacy, Southwestern Oklahoma State University, Weatherford

Lindane was once considered appropriate therapy for pediculosis (head lice). However, it was shifted by the FDA to second-line therapy in 1995.20,21 At that time, because of toxicity issues, the agency limited package sizes, required a boxed warning, and required the dissemination of a medication guide with each new prescription. There are an estimated one million prescriptions written for lindane each year. In 2005, the Centers for Disease Control and Prevention published a review of unintentional ingestions of topical lindane, spanning the years from 1998 to 2003.22 The research uncovered 857 cases, with 8% suffering adverse effects of moderate severity and 1% experiencing effects of high severity. Signs and symptoms included vomiting (59%), nausea (18%), oral irritation (19%), and abdominal cramping, cough, and seizure in 3% to 4% of cases.

Adults mistook lindane for cough syrup in many cases. In one, a pharmacy misfilled a prescription for albuterol syrup with lindane. In another, a 47-year-old Texas man ingested 1 ounce of lindane in the mistaken belief it was cough syrup.22 He experienced vomiting. Also, a 3-year-old boy ingested 1 teaspoonful of 1% lindane shampoo.22 The mother induced vomiting twice. Despite this, he collapsed one hour postingestion and experienced a tonic-clonic seizure that was four to five minutes in duration. He was discharged in stable condition from the emergency department three hours after admission. Lindane alternatives for head lice include synergized pyrethrins, permethrin, and malathion. Those substances were responsible for an additional 523 unintentional poisoning cases during the years included in the study.

The agency concluded that declining use of lindane will ameliorate the danger somewhat, but pharmacists should never transfer lindane from its manufacturer-supplied 1- or 2-ounce bottles into pharmacy bottles that are identical to those used for oral medications, such as cough syrups. It might be advisable to ensure that lindane and other pesticides are not in the house to prevent causing accidental ingestion.20 The pharmacist can aid in this effort by educating physicians and consumers about nontoxic, environmentally safe alternatives to pediculosis, like thorough combing with specially designed combs that remove live lice and nits.

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