Gamma Benzene Hexachloride 1% Lotion (Lindane)

Introduction

Gamma Benzene Hexachloride, in short GBH, is an organochlorine insecticide. It has been used topically in a concentration of 1% for scabies and head lice.

However, it is no longer favoured due to

In fact, Lindane use is banned in California, United Kingdom, Australia and many Western countries.



Dosing

The recommended duration of GBH 1% lotion application differs, depending on the indication:

  • Scabies: Apply a thin layer of lotion and massage it on skin from the neck to the toes; after 8-12 hours, bathe and remove the drug; most patients will require 30 ml; larger adults may require up to 60 ml. Do not re-treat. Do not leave on for more than 12 hours. CDC STD guidelines recommend an 8 hour application.
  • Head lice, crab lice: Apply shampoo to dry hair and massage into hair for 4 minutes; add small quantities of water to hair until lather forms, then rinse hair thoroughly and comb with a fine tooth comb to remove nits. Amount of shampoo needed is based on length and density of hair; most patients will require 30 ml (maximum: 60 ml). Do not re-treat.



Precautions

Seizures and death have been reported following lindane use with repeat or prolonged application, but also in rare cases following a single application used according to directions.

Comments

  1. What about GBH 0.1%? I got confused between these two concentrations, for what indication and to which population (adult or paeds)

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    Replies
    1. MOH formulary 2022 and Topical Preparations Counselling Guide for Pharmacist 2018 suggested GBH 0.1% is indicated for head lice (by leaving on the hair for 4 minutes before rinsing). I personally felt this is probably a misinformation.

      The lindane concentration highlighted in Lexicomp, Micromedex and Martindale for head lice or scabies is 1%. Even so, the use of lindane 1% is now restricted by resistance and neurotoxicity.

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    2. Means we use the same concentration of GBH 1% for adult and children for both scabies and head lice?

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    3. Although FDA approved, lindane is not recommended as a treatment option for head lice in pediatric patients <50 kg due to the risk of serious neurotoxicity and use should be avoided if possible. On the other hand, may consider permethrin (5% for scabies or 1% for head lice) for children.

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