A200 Maximum Strength Topical

Name: A200 Maximum Strength Topical

Proper Use of pyrethrum extract and piperonyl butoxide

This section provides information on the proper use of a number of products that contain pyrethrum extract and piperonyl butoxide. It may not be specific to A200 Maximum Strength. Please read with care.

Pyrethrins and piperonyl butoxide combination medicine usually comes with patient directions. Read them carefully before using this medicine.

Use this medicine only as directed. Do not use more of it and do not use it more often than recommended on the label. To do so may increase the chance of absorption through the skin and the chance of side effects.

Keep pyrethrins and piperonyl butoxide combination medicine away from the mouth and do not inhale it. This medicine is harmful if swallowed or inhaled.

To lessen the chance of inhaling this medicine, apply it in a well-ventilated room (for example, one with free flowing air or with a fan turned on).

Keep this medicine away from the eyes and other mucous membranes, such as the inside of the nose, mouth, or vagina, because it may cause irritation. If you accidentally get some in your eyes, flush them thoroughly with water at once.

Do not apply this medicine to the eyelashes or eyebrows . If they become infected with lice, check with your doctor.

To use the gel or solution form of this medicine:

  • Apply enough medicine to thoroughly wet the dry hair and scalp or skin. Allow the medicine to remain on the affected areas for exactly 10 minutes.
  • Then, thoroughly wash the affected areas with warm water and soap or regular shampoo. Rinse thoroughly and dry with a clean towel.

To use the shampoo form of this medicine:

  • Apply enough medicine to thoroughly wet the dry hair and scalp or skin. Allow the medicine to remain on the affected areas for exactly 10 minutes.
  • Then use a small amount of water and work shampoo into the hair and scalp or skin until a lather forms. Rinse thoroughly and dry with a clean towel.

After rinsing and drying, use a nit removal comb (special fine-toothed comb, usually included with this medicine) to remove the dead lice and eggs (nits) from hair.

Immediately after using this medicine, wash your hands to remove any medicine that may be on them.

This medicine should be used again in 7 to 10 days after the first treatment in order to kill any newly hatched lice.

Lice can easily move from one person to another by close body contact. This can happen also by direct contact with such things as clothing, hats, scarves, bedding, towels, washcloths, hairbrushes and combs, or the hair of infected persons. Therefore, all members of your household should be examined for lice and receive treatment if they are found to be infected.

To use this medicine for pubic (crab) lice:

  • Your sexual partner may also need to be treated, since the infection may spread to persons in close contact. If your partner is not being treated or if you have any questions about this, check with your doctor.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For topical dosage forms (gel, solution shampoo, and topical solution):
    • For head, body, or pubic lice:
      • Adults and children—Use one time, then repeat one time in seven to ten days.

Storage

Store the medicine in a closed container at room temperature, away from heat, moisture, and direct light. Keep from freezing.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Precautions While Using A200 Maximum Strength

To prevent reinfection or spreading of the infection to other people, good health habits are also required. These include the following:

  • For head lice
    • Machine wash all clothing (including hats, scarves, and coats), bedding, towels, and washcloths in very hot water and dry them by using the hot cycle of a dryer for at least 20 minutes. Clothing or bedding that cannot be washed should be dry-cleaned or sealed in a plastic bag for 2 weeks.
    • Shampoo all wigs and hairpieces.
    • Wash all hairbrushes and combs in very hot soapy water (above 130 °F) for 5 to 10 minutes and do not share them with other people.
    • Clean the house or room by thoroughly vacuuming upholstered furniture, rugs, and floors.
  • For body lice
    • Machine wash all clothing, bedding, towels, and washcloths in very hot water and dry them by using the hot cycle of a dryer for at least 20 minutes. Clothing or bedding that cannot be washed should be dry-cleaned or sealed in a plastic bag for 2 weeks.
    • Clean the house or room by thoroughly vacuuming upholstered furniture, rugs, and floors.
  • For pubic lice
    • Machine wash all clothing (especially underwear), bedding, towels, and washcloths in very hot water and dry them by using the hot cycle of a dryer for at least 20 minutes. Clothing or bedding that cannot be washed should be dry-cleaned or sealed in a plastic bag for 2 weeks.
    • Scrub toilet seats frequently.

How is this medicine (Pyrethrins and Piperonyl Butoxide Gel and Liquid) best taken?

Use this medicine as ordered by your doctor. Read all information given to you. Follow all instructions closely.

  • Follow how to use as you have been told by the doctor or read the package insert.
  • Do not take pyrethrins and piperonyl butoxide gel and liquid by mouth. Use on your skin only. Keep out of your mouth, nose, and eyes (may burn).
  • If you get this medicine in any of these areas, rinse well with water.
  • Wash your hands before and after use.
  • Do not wet hair or affected part with water before putting on.
  • Lightly coat hair or affected part.
  • Work into hair and scalp or affected skin gently.
  • Leave on for 10 minutes.
  • Do not cover while pyrethrins and piperonyl butoxide gel and liquid is on.
  • After 10 minutes, use a little warm water and soap or shampoo on hair and lather.
  • Rinse fully.
  • Dry with a towel.
  • Use special nit comb or tweezers to get rid of dead nits (lice eggs) from hair.
  • Wash all bedding, towels, and recently worn clothes in hot water or have them dry cleaned.

What do I do if I miss a dose?

  • Put on a missed dose as soon as you think about it.

How do I store and/or throw out Pyrethrins and Piperonyl Butoxide Gel and Liquid?

  • Store at room temperature.
  • Protect from heat.
  • Store in a dry place. Do not store in a bathroom.
  • Keep all drugs in a safe place. Keep all drugs out of the reach of children and pets.
  • Check with your pharmacist about how to throw out unused drugs.

Uses for Pyrethrins with Piperonyl Butoxide

Pediculosis

Topical treatment of pediculosis capitis (head lice infestation).103 104 107 112 117 120 121 122 123

An alternative rather than a preferred treatment for pediculosis capitis.107 108 Permethrin 1% generally considered the treatment of choice, and malathion 0.5% is recommended when permethrin resistance is suspected.103 107 108 113 114 116 117 125

Base selection of a pediculicide on efficacy (including both pediculicidal and ovicidal activity), safety, cost, availability, ease of application, age of patient, presence of other scalp infections, patient preference, severity of the infestation, potential for transmission, number of recurrences, and the pattern of resistance in the geographic region.113

Topical treatment of pediculosis pubis (pubic lice infestation).101 104 112 115 120 121 122 123 Considered a pediculicide of choice by CDC and others for treatment of pediculosis pubis, including in HIV-infected patients.101 104 112 115

Topical treatment of pediculosis corporis (body lice infestation).103 120 121 122 123 124 125 In some cases, body louse infestations may be treated by improved hygiene and by decontaminating clothes and bedding by washing at temperatures that kill lice.103 125 If the infestation is severe, a pediculicide should also be used (e.g., topical permethrin, topical pyrethrins with piperonyl butoxide, topical malathion, oral ivermectin).124 125

One of several options recommended for treatment of pediculosis corporis in the adjunctive treatment of epidemic (louse-borne) typhus.103 The causative agent of epidemic typhus (Rickettsia prowazekii) is transmitted person-to-person by Pediculus humanus corporis and thorough delousing (especially among exposed contacts of individuals with typhus) is recommended in epidemic situations.103

Scabies

Not effective for treatment of scabies (mite infestation).a

Stability

Storage

Topical

Shampoo

Well-closed containers at <40°C, preferably between 15–30°C.a

Actions and Spectrum

  • Pyrethrins (also known as pyrethrum extract) contains the purified derivatives of pyrethrum flowers (Chrysanthemum cinerariaefolium) and is a complex of substances that includes the alcohols and esters of pyrethrolone and cinerolone, the alcohol of chrysanthemic acid, and the ester of pyrethric acid.a Piperonyl butoxide is a synthetic piperic acid derivative.a

  • Following absorption through the chitinous exoskeleton of arthropods, pyrethrins stimulates the nervous system and blocks nerve impulse transmissions, resulting in paralysis and death.a

  • Piperonyl butoxide has little or no insecticidal activity, but potentiates that of pyrethrins by inhibiting the hydrolytic enzymes responsible for metabolism of pyrethrins in arthropods.a

  • Pyrethrins is active against Pediculus humanus var. capitis (head louse), P. humanus var. corporis (body louse), and Phthirus pubis (pubic or crab louse), and may have some activity against their nits (eggs).a Pyrethrins also is toxic to houseflies, fleas, chiggers, and mosquitoes.a

  • Therapeutic failure and resistance to pyrethrins has been reported in P. humanus.107 116 The prevalence of resistance in the US is unclear.103 116

  • Treatment failures do not necessarily mean resistance is present since failures can also be related to misdiagnosis, noncompliance with the treatment regimen, and reinfestation.108 116

Preparations

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.

Pyrethrins with Piperonyl Butoxide

Routes

Dosage Forms

Strengths

Brand Names

Manufacturer

Topical

Shampoo

Pyrethrins 0.33% with Piperonyl Butoxide 4%

A200 Lice Killing Shampoo (with benzyl alcohol and isopropyl alcohol)

Hogil

A200 Lice Treatment Kit (with benzyl alcohol and isopropyl alcohol; with comb and lice control spray)

Del

Licide (with benzyl alcohol 2.4% and petroleum distillate 1.2%)

Reese

Pronto Plus Lice Killing Mousse Shampoo Plus Vitamin E (with benzyl alcohol and isopropyl alcohol)

Del

Pronto Plus Lice Killing Shampoo (with benzyl alcohol and isopropyl alcohol)

Del

RID Maximum Strength Lice Killing Shampoo (with isopropyl alcohol)

Bayer

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