Table 1.

Available agents for management of head lice^*

Generic	Brand	Availability	Directions	Repeat application	Side effects
Recommended agents
Permethrin 1%	Cream: NIX® Creme Rinse	Over the counter	Hair should be washed and towel dried. Apply sufficient amount to hair and leave for 10 minutes. Rinse.	May not be necessary. Repeat dose if live lice are observed 7 days or more after initial treatment to kill any newly hatched lice.	Itching, redness, or swelling of scalp may occur; may cause eye irritation; avoid in patients with history of allergy to chrysanthemum or ragweed.
Pyrethrins 0.33% and piperonyl butoxide 4%	Shampoo: RID®, Pronto®, A-200® (various manufacturers & formulations available)	Over the counter	Apply sufficient amount to dry hair and leave for 10 minutes. Add enough water to form lather. Rinse.	Repeat dose is necessary in 7 to 10 days to kill any newly hatched lice.	Itching, redness, or swelling of scalp may occur; may cause eye irritation; avoid in patients with history of allergy to chrysanthemum or ragweed.
Lindane 1%	Shampoo (various manufacturers)	Prescription only	Apply sufficient amount to dry hair and leave for 4 minutes. Add enough water to form lather. Rinse.	Repeat dose if live lice are observed 7 days or more after initial treatment to kill any newly hatched lice.	Use with caution. Potential for systemic absorption and central nervous system side effects: seizures, dizziness.
Malathion 0.5%	Lotion: Ovide®	Prescription only	Apply lotion to dry hair until thoroughly moistened. Rinse off after 8 to 12 hours.	Repeat dose if live lice are observed 7 days or more after initial treatment to kill any newly hatched lice.	Strong odor; alcohol vehicle is flammable and may cause irritation to eyes.
Alternative agents for consideration
Permethrin 5%	Cream: Elimite®	Prescription only	Apply to dry hair and allow to remain overnight under shower cap	Not approved by the FDA for treatment of head lice.
Ivermectin	Tablets (3 mg, 6 mg): Stromectol® (topical formulation not commercially available)	Prescription only	200 μg/kg by mouth as a single dose have been used for treatment of lice.	Not approved by the FDA for treatment of head lice.
FDA = Food and Drug Administration.

^*All treatments should be accompanied by physical removal with a fine-tooh comb to remove eggs and nits.