Basic Elimite Information

• INN (International Nonproprietary Name): Permethrin
• Brand Names Available In Australia: Elimite; Lyclear (available in some Asia‑Pacific listings); Zalvor (listed for Australia); Nix (1% lotion commonly used internationally)
• ATC Code: P03AC04
• Forms & Dosages: 5% topical cream (scabies) and 1% topical lotion (lice); spray formulations for bedding and fabrics are also available
• Manufacturers In Australia: not specified
• Registration Status In Australia: not specified
• OTC / Rx Classification: 5% cream is prescription only for scabies; 1% lotion is sometimes OTC for head lice in some jurisdictions

Latest Research Highlights

Are you worried permethrin still works for scabies?

Recent surveillance and safety reports continue to support permethrin 5% cream as a first‑line topical scabicide with high initial cure rates.

Australian dermatology surveillance notes good clinical outcomes when the cream is applied correctly and household contacts are treated at the same time.

There are rising reports of focal treatment failures where resistance or improper application is suspected.

International clinical trials and programmatic reports indicate a single application with 8–14 hours contact time eradicates mites for most patients, with repeat application at 7–14 days commonly used to reduce treatment failures.

Oral ivermectin achieves similar population‑level control where available, but permethrin keeps an advantage in pregnancy and breastfeeding when oral agents are avoided.

TGA and safety datasets show low systemic absorption of topical permethrin and mostly local skin reactions such as burning, stinging and transient itch.

Recent papers emphasise treating household contacts and decontaminating bedding and clothing to prevent reinfestation.

Clinical Effectiveness In Australia

Can I expect permethrin to work if I follow the instructions?

Permethrin 5% cream is widely used in Australian practice and performs well when applied correctly from the neck down for 8–14 hours.

TGA‑aligned regimens match international guidance and are effective for the majority of patients when household contacts are treated together.

Real‑world reporting to public health units and the TGA shows most patients clear infestation after one application, though retreatment at day 7–14 is frequently needed when live mites persist.

Groups with higher relapse rates include overcrowded households, remote Indigenous communities and institutional settings where coordinated mass treatment is required.

Standard scabies regimen: apply from neck down, leave for 8–14 hours, and repeat in 7 days if live mites are seen.

Indications And Expanded Uses

What is permethrin approved for and how is it used beyond that?

• Approved (TGA/Evidence): 5% topical cream for scabies; 1% lotion commonly used for head lice.
• Common Off‑Label Uses: Adjuncts in crusted (hyperkeratotic) scabies, targeted outbreak control in aged‑care or residential facilities, and combined regimens with oral ivermectin in refractory or widespread cases.
• Contraindicated Or Caution: Use in premature infants and infants under 2 months should be avoided unless specialist advice; pregnancy and breastfeeding require careful consideration.

Forms and dosages from clinical guidance: 5% cream for scabies (Elimite/Lyclear/Zalvor), 1% lotion for lice (Nix or equivalent).

Composition And Brand Landscape

Which brands and forms should pharmacists expect to see?

The active ingredient is permethrin, a synthetic pyrethroid with ATC code P03AC04.

Branded names seen internationally include Elimite, Acticin, Lyclear, Kwellada‑P, Scaboma and Zalvor in Australian listings.

Common dosage forms are 5% topical cream for scabies and 1% lotion for lice, with sprays for bedding available as ancillary products.

Major global manufacturers include Allergan, Perrigo and Omega Pharma, with various generics supplied by multinational and regional companies.

Pharmacists should verify current TGA ARTG entries and supply notes when ordering stock.

Contraindications And Special Precautions

Who should not use permethrin, and what practical advice matters?

• Absolute Contraindication: Known hypersensitivity to permethrin, pyrethroids or any excipient.
• Relative Cautions: Premature infants, infants under 2 months, broken or inflamed skin, pregnancy and breastfeeding—use only if clearly needed.

Avoid contact with eyes and mouth and wash hands after application if hands are treated for scabies and duties involve food handling or hand sensitivity.

In Indigenous and remote community settings, obtain culturally safe consent and assess for comorbid skin disease such as secondary impetigo before mass application.

Typical side effects are local burning, stinging, itching and redness; systemic events are rare.

Dosage Guidelines

How should patients apply permethrin for the best result?

For scabies, apply 5% cream from the neck down, include the scalp in infants and elderly when clinically indicated, leave for 8–14 hours then wash off.

Repeat application at 7 days if live mites are observed or new burrows appear.

For head lice, use 1% lotion on dry hair, leave for about 10 minutes then rinse, and repeat in 7–14 days if needed.

Children from 2 months of age follow the same topical regimens with appropriate supervision.

No formal hepatic or renal dosing adjustments are required since systemic absorption is minimal.

1. Patient assessment: confirm diagnosis and check allergies and pregnancy/breastfeeding status.
2. Correct application: apply cream from neck down; ensure adequate coverage.
3. Household management: treat contacts simultaneously and decontaminate bedding.
4. Follow‑up timing: review at 7–14 days and repeat only if live mites persist.

Interactions Overview

Will permethrin interact with other medicines?

Topical permethrin has negligible systemic absorption, so clinically significant drug–drug interactions are uncommon.

Avoid concurrent use with other topical insecticides or essential oils that can irritate the skin.

Caution using occlusive dressings or heavy emollients over treated areas unless instructed, as these may alter absorption.

Avoid combining with strong topical corticosteroids on inflamed skin without medical advice because they can mask infection and change penetration.

Cultural Perceptions And Patient Habits

Do people delay treatment or try home remedies?

Scabies carries stigma in many Australian communities and some patients delay seeking care or try home remedies such as tea tree oil or over‑the‑counter creams.

Rural and remote communities, including many Indigenous populations, face barriers including fewer GPs, intermittent pharmacy supply and household overcrowding that drives reinfestation.

Urban patients increasingly use telehealth and online pharmacy services for quick access and cheaper private purchase when PBS subsidy is not available.

Culturally safe approaches that involve Aboriginal Health Workers and clear household instructions improve uptake and completion of treatment.

Availability And Pricing Patterns

How easy is it to get elimite and what will it cost?

In Australia, permethrin 5% cream is generally prescription only and availability depends on ARTG registration and wholesalers.

Major retail chains and independent pharmacies stock branded and generic permethrin, but supply can vary and occasional shortages occur.

For convenience, online pharmacies and telehealth providers often issue e‑prescriptions and arrange postage to the home.

In our online pharmacy, elimite is available without a prescription, with discreet delivery to Australia in 5–14 days.

PBS subsidisation for 5% cream varies by listing and indication; many patients pay privately if not covered.

Comparable Medicines And Preferences

What are the alternatives if permethrin is not suitable?

Specialist advice may recommend rotating agents or adding oral ivermectin for refractory clusters where resistance is suspected.

Frequently Asked Questions

Can I get permethrin on the PBS?

PBS listing for 5% cream varies by indication and current schedule; check with your GP or pharmacist as many patients pay privately if not subsidised.

Is permethrin safe for babies and pregnant women?

Topical permethrin is considered safe from 2 months of age; pregnancy and breastfeeding use should be a clinical decision and only if necessary.

What if I am still itchy after treatment?

Post‑treatment itch may persist for up to two weeks even when mites are eradicated; repeat treatment is recommended only if live mites are confirmed.

When should I see a GP or dermatologist?

Seek review if treatment fails, crusted scabies is suspected, severe skin reaction occurs, or the patient is immunocompromised—earlier referral is warranted in these cases.

Guidelines For Proper Use

What should pharmacists tell patients when dispensing permethrin?

Confirm the diagnosis and check for allergies, pregnancy and breastfeeding status before supplying treatment.

Provide clear written instructions and a timetable for follow‑up at 7–14 days.

Advise the patient to apply 5% cream from the neck down, including hands and feet, and to leave it on for 8–14 hours before washing.

Treat household contacts simultaneously and recommend laundering bedding and clothing in hot water or sealing items for 72 hours.

Advise not to re‑treat for post‑treatment itch alone and to return to the GP if live mites are seen.

• Storage: store at 20–25°C and keep out of reach of children.
• Telehealth note: if using an e‑prescription, advise on collection times and possible postage delays to remote addresses.

Delivery Across Australia