Permethrin Use During Breastfeeding
Permethrin is safe and recommended for use in breastfeeding women. 1, 2, 3
Safety Profile
Permethrin has several characteristics that make it safe for use during breastfeeding:
- Low systemic absorption: Permethrin is absorbed percutaneously in only small amounts and is rapidly metabolized in the skin 4
- Minimal excretion in breast milk: According to the FDA label, while it is not definitively known if permethrin is excreted in human milk, its rapid metabolism and excretion as inactive metabolites reduces potential risk 3
- Low mammalian toxicity: Permethrin has low toxicity to humans with minimal allergic side effects 4
Guidelines for Use During Breastfeeding
The CDC and other authoritative guidelines specifically recommend permethrin for breastfeeding women:
- CDC Guidelines: Explicitly state that "pregnant and lactating women should be treated with either permethrin or pyrethrins with piperonyl butoxide" 1
- Scabies Management Guidelines: Recommend permethrin 5% cream as the first-choice treatment for scabies in breastfeeding women 2
Application Instructions
When using permethrin while breastfeeding:
- For scabies: Apply permethrin 5% cream to all areas of the body from the neck down and wash off after 8-14 hours 1, 2
- For pediculosis (lice): Apply permethrin 1% creme rinse to affected areas and wash off after 10 minutes 1
- Avoid eye contact: If contact occurs, flush immediately with water 3
Important Considerations
- Temporary symptom exacerbation: Treatment may temporarily worsen itching, edema, and erythema 3
- Environmental measures: Decontaminate bedding and clothing by machine washing and drying using hot cycle, or remove from body contact for at least 72 hours 1, 2
- Follow-up: Evaluate after 1 week if symptoms persist; retreatment may be necessary 1, 2
Comparison to Alternatives
When comparing permethrin to other treatment options for breastfeeding women:
- Preferred over lindane: Lindane is explicitly not recommended for lactating women due to potential neurotoxicity 1, 2, 4
- Alternative to ivermectin: While ivermectin is effective, permethrin is generally preferred during breastfeeding due to more established safety data 2
Conclusion
Permethrin is the treatment of choice for ectoparasitic infections in breastfeeding women due to its established safety profile, low systemic absorption, and minimal risk to the nursing infant. The benefits of treating the infection with permethrin while continuing breastfeeding far outweigh any theoretical risks.