Table 1.
Mosquito bite repellants and their safety profile.
| Repellant | Average duration | Reported adverse reactions and toxicity | Special considerations |
|---|---|---|---|
| DEET | 5 hours | Rare: CNS involvement (lethargy, headache, seizures, disorientation, ataxia, tremors, acute encephalopathy with psychosis), allergic or cutaneous manifestations, cardiovascular effects (orthostatic hypotension, bradycardia). a (62, 64) | Not recommended for children under 2 years of age. Maximum concentration of 33% in children (62)Contraindicated in individuals with urea cycle disorders (62)Pregnancy Category N b . Increased risk of toxicity when used in conjunction with retinoids or sunscreen |
| Picaridin | 8-10 hours | Rare: skin irritation (62) | Not recommended in children under 2 years of age (62)Pregnancy Category N b . Odorless |
| Permethrin | 6 weeks or 6 washings | Rare: conjunctivitis, numbness/tingling sensation, dermatitis, air conduction passageway irritation, headache, dizziness, fatigue, excessive salivation, muscle weakness, nausea, vomiting, and neurotoxicity (ataxia, hyperactivity, hyperthermia, seizures, paralysis). May affect male fertility or cause hepatoxicity (62, 65, 66). | Pregnancy Category B c |
| EBAAP | 2-3 hours | Eye irritation | Odorless |
| Thiamine hydrochloride | Under investigation | None reported for topical application (further research needed) | |
| Oil of lemon eucalyptus | 6 hours | Rare: skin irritation in atopic individuals (62) | Not recommended for children under 3 years of age (62)Pregnancy Category N b |
| Citronella | 2 hours | Rare: eye irritation, skin irritation, and allergic symptoms (62) | Pregnancy Category N b |
CNS, central nervous system; DEET, N,N-diethyl-3-methyl-benzamide (formerly N,N-diethyl-meta-toluamide); EBAAP, ethyl butylacetylaminopropionate.
a
Between 1956 and 2008, there were 43 confirmed case reports of DEET toxicity: 25 with CNS involvement, 17 with allergic or dermatologic manifestations, and one with cardiovascular effects. Cutaneous manifestations include urticarial reactions and hemorrhagic vesicobullous erosions after topical exposure of 50% and stronger concentrations (50).
b
This drug’s pregnancy category has not yet been classified by the FDA.
c
No adverse effects demonstrated in animals.