From the FDA Drug Label
This drug is known to be substantially excreted by the kidney However, since topical permethrin is metabolized in the liver and excreted in the urine as inactive metabolites, there does not appear to be an increased risk of toxic reactions in patients with impaired renal function when used as labeled. The use of permethrin in patients with kidney disease, including those on hemodialysis, is considered to be safe when used as labeled, as the drug is metabolized in the liver and excreted in the urine as inactive metabolites, suggesting no increased risk of toxic reactions in patients with impaired renal function 1.
- Key points:
- Topical permethrin is metabolized in the liver
- Excreted in the urine as inactive metabolites
- No increased risk of toxic reactions in patients with impaired renal function when used as labeled
From the Research
Permethrin can be safely used in hemodialysis patients with kidney disease, as it is primarily metabolized by the liver and has minimal systemic absorption, making it a preferred treatment option for scabies in this population. The standard 5% permethrin cream should be applied to the entire body from the neck down, left on for 8-14 hours, and then washed off. No dose adjustment is necessary for patients on hemodialysis. For patients with scabies, a second application is typically recommended 7-10 days after the first treatment to kill newly hatched mites. When applying, special attention should be given to areas between fingers and toes, wrist and axillary folds, belt line, groin, and under fingernails. Permethrin is preferred over other scabicides in kidney disease patients because it has limited systemic effects and doesn't accumulate in patients with impaired kidney function, as noted in a study on current treatments for scabies and pediculosis 2. Common side effects may include mild burning, stinging, or itching, which are typically transient. Patients should be advised that itching may persist for 2-4 weeks after successful treatment due to the body's immune response to dead mites.
Some studies have discussed the use of other treatments, such as ivermectin, in patients with kidney disease, including a case report on a renal transplant recipient treated with daily ivermectin for crusted scabies 3. However, permethrin remains a safe and effective option for hemodialysis patients with kidney disease. Other evidence on immunosuppressive treatment in dialysis patients 4 and the effects of disinfectants in renal dialysis patients 5 is not directly relevant to the use of permethrin in this population. Additionally, a report on opportunities to improve antibiotic prescribing in outpatient hemodialysis facilities 6 is also not relevant to the use of permethrin for scabies treatment.
In terms of treatment approach, it is essential to consider the patient's overall health status and potential interactions with other medications. However, based on the available evidence, permethrin is a safe and effective treatment option for scabies in hemodialysis patients with kidney disease, with minimal risk of adverse effects or interactions.