Share this page
Indications
Elimate Plus is used to treat scabies and relieve associated itching.
- Scabies: Treatment of Sarcoptes scabiei infestation, including typical scabies and crusted scabies. The combination enhances anti-parasitic and antipruritic effects.
- Pediculosis (Lice): Management of head lice infestation caused by Pediculus humanus capitis.
- Pruritus (Itching): Relief of itching associated with scabies or other dermatological conditions due to crotamiton’s antipruritic properties.
- Off-label uses: Sometimes used in combination to improve patient compliance and symptom relief in ectoparasitic infestations with intense itching.
Dosage & Administration
- Adults and Children (≥2 years):
- Apply permethrin 5% cream, combined with crotamiton 10% cream, thoroughly over the entire body from the neck down, including under the fingernails and toenails.
- Leave the cream on for 8 to 14 hours (typically overnight).
- Wash off with water afterward.
- Repeat application after 7 days if symptoms persist or reinfestation occurs.
- For head lice:
- Apply the combination cream or lotion to the affected areas as directed, typically leaving it on for 10 minutes before rinsing.
- Repeat in 7 to 10 days if necessary.
- Pediatrics: Safe for children aged 2 years and above with the same dosing regimen; use cautiously in younger children after medical consultation.
- Elderly: No specific dose adjustments; monitor for skin sensitivity.
- Renal/Hepatic Impairment: No systemic absorption expected; no dose adjustment necessary.
Mechanism of Action (MOA)
Permethrin acts as a synthetic pyrethroid neurotoxin that disrupts sodium ion channels in the nerve cells of parasites such as mites and lice, causing prolonged depolarization, paralysis, and death of the parasites. Crotamiton has antipruritic and scabicidal properties by inhibiting the proliferation and activity of mites, and it also provides symptomatic relief from itching by exerting anti-inflammatory and local anesthetic effects on skin nerve endings. The combination thus offers both effective eradication of ectoparasites and reduction in pruritus.
Pharmacokinetics
- Absorption: Minimal systemic absorption through intact skin for both agents; crotamiton may have slightly higher percutaneous absorption but still negligible systemically.
- Distribution: Negligible plasma levels due to topical use.
- Metabolism: If absorbed, metabolized in the liver primarily by hydrolysis and oxidation.
- Elimination: Metabolites excreted via urine and feces.
- Onset: Parasite eradication begins within hours post-application; pruritus relief may be noticeable within minutes to hours.
Pregnancy Category & Lactation
- Pregnancy:
- Permethrin: FDA Pregnancy Category B; limited human data but animal studies show no harm.
- Crotamiton: Limited data; generally advised to use only if benefit justifies potential risk.
- Lactation: Both agents have minimal systemic absorption and are considered relatively safe for use during breastfeeding; avoid application on breast area to prevent infant exposure.
Therapeutic Class
- Primary Class: Topical antiparasitic and antipruritic combination.
- Subclass: Scabicide and pediculicide (permethrin), antipruritic agent (crotamiton).
Contraindications
- Known hypersensitivity to permethrin, crotamiton, or any formulation excipients.
- Infants under 2 years of age (safety not established).
- Open wounds, inflamed, or broken skin at the site of application.
Warnings & Precautions
- Avoid contact with eyes, mouth, and mucous membranes.
- Use with caution in patients with eczema, psoriasis, or extensive skin disease.
- Monitor for hypersensitivity reactions such as rash, swelling, or severe itching.
- Not recommended for use on damaged skin.
- Overuse may cause skin irritation or systemic toxicity.
- Permethrin resistance may reduce efficacy in lice infestations.
Side Effects
- Common:
- Localized skin irritation, redness, burning, or itching.
- Mild dryness or scaling.
- Serious/Rare:
- Allergic contact dermatitis.
- Urticaria or swelling.
- Rare systemic toxicity in case of misuse or ingestion.
Drug Interactions
- No significant systemic drug interactions due to minimal absorption.
- Avoid combining with other topical agents on the same area unless advised by a healthcare professional.
Recent Updates or Guidelines
- Current guidelines recommend permethrin 5% cream as first-line for scabies, with crotamiton 10% used for symptom control.
- Combination formulations are increasingly favored for improved compliance and symptom relief.
- Resistance monitoring in lice populations is ongoing; alternatives may be necessary in resistant cases.
- Safety warnings emphasize avoiding use in very young infants and caution in pregnancy and lactation.
Storage Conditions
- Store at 20°C to 25°C (68°F to 77°F).
- Protect from excessive moisture, heat, and direct sunlight.
- Keep containers tightly closed and out of reach of children.
- Do not freeze.
- Use before expiration date for best efficacy.
Frequently Asked Questions
1. What is Elimate Plus lotion/cream used for?
- It is used for parasitic skin infections, mainly scabies and lice.
2. Is it effective for scabies or lice treatment?
- Yes. Permethrin kills scabies mites and lice, while Crotamiton reduces itching and skin inflammation.
- The combination helps control infection quickly.
3. How does this medicine work? (Mechanism of Action)
- Permethrin: Paralyzes and kills parasites by affecting their nerve cell sodium channels.
- Crotamiton: Reduces itching and inflammation on the skin.
4. How to apply this cream or lotion correctly?
- Apply evenly over the affected area, including neck, arms, legs, and trunk.
- For scabies: apply from neck down.
- For lice: apply to scalp and hair shafts, avoiding eyes and mouth.
- Leave on for 8–14 hours, then wash off.
- Wash hands thoroughly after application.
5. How many days and times should it be used?
- Usually, one application is enough.
- A second application after 7 days may be needed if live mites or lice persist.
6. Is it safe for children?
- Generally safe for children over 2 months.
- For infants younger than 2 months, consult a doctor before use.
7. What are the common side effects?
- Mild itching, redness, rash, or burning sensation.
- Usually temporary and resolves within a few hours to days.
8. Is it normal to have itching, redness, or increased irritation on the skin?
- Yes, mild itching or redness is common, especially in the first 1–2 days.
- Severe or persistent reactions require medical attention.
9. Is it safe during pregnancy or breastfeeding?
- Pregnancy: Generally safe if needed, apply to small areas and avoid prolonged exposure.
- Breastfeeding: Avoid the breast area during application.
10. Do other family members need preventive treatment?
- Yes. Close contacts may need screening or preventive treatment.
- Wash clothes, bedding, and towels in hot water to prevent reinfestation.
Package Image
