Head lice:
Children 2 to 5 years: Limited data available: Note: Only use for head lice resistant to permethrin/pyrethrins or previously failed courses: Topical: Apply sufficient amount to cover and thoroughly moisten dry hair and scalp, leave on for 8 to 12 hours (typically overnight application); may shampoo upon completion; during clinical trials, a maximum dose of ~60 mL (2 fl oz) was used (AAP [Devore 2015]). Note: In a blinded, comparative trial with permethrin in older children, a shorter application time of 20 minutes was shown effective (AAP [Devore 2015]; Meinking 2004). Further treatment is generally not necessary.
Children ≥6 years and Adolescents: Topical: Apply sufficient amount to cover and thoroughly moisten dry hair and scalp, leave on for 8 to 12 hours (typically overnight application); may shampoo upon completion; if live lice are observed 7 to 9 days after application, reapply product; during clinical trials, a maximum dose of ~60 mL (2 fl oz) was used. Note: In a blinded, comparative trial with permethrin, a shorter application time of 20 minutes was shown effective (AAP [Devore 2015]; Meinking 2004). Further treatment is generally not necessary.
Pubic lice (Pediculosis pubis) resistant to permethrin/pyrethrins or previously failed courses: Limited data available: Adolescents: Topical: Apply to affected area. Wash off after 8 to12 hours (CDC [Workowski 2015])
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
(For additional information see "Malathion: Drug information")
Head lice (Pediculus humanus capitis): Topical: Apply sufficient amount to cover and thoroughly moisten dry hair and scalp; allow hair to dry naturally and shampoo after 8 to 12 hours. If required, repeat with second application in 7 to 9 days. Further treatment is generally not necessary.
Pubic lice (Pediculosis pubis) (following treatment failure of pediculicides) (off-label use): Topical: Apply to affected area. Wash off after 8 to12 hours (CDC [Workowski 2021]).
There are no dosage adjustments provided in the manufacturer’s labeling.
There are no dosage adjustments provided in the manufacturer’s labeling.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Lotion, External:
Ovide: 0.5% (59 mL) [contains isopropyl alcohol]
Generic: 0.5% (59 mL)
Yes
Topical: For external use only; avoid contact with eyes. Apply to dry hair and scalp and rub gently until thoroughly moistened; pay special attention to the back of the head and neck. Allow hair to dry naturally; do not use heat; leave hair uncovered; after 8 to 12 hours, wash hair with a nonmedicated shampoo; rinse and use a fine-toothed (nit) comb to remove dead lice and eggs. Wash hands immediately after use.
Malathion should be a portion of a whole lice removal program, which should include washing or dry cleaning all clothing, hats, bedding, and towels recently worn or used by the patient and washing combs, brushes, and hair accessories in hot, soapy water.
Topical lotion. For external use only; avoid contact with eyes. Apply to dry hair and scalp and rub gently until thoroughly moistened; pay special attention to the back of the head and neck. Allow hair to dry naturally; do not use heat; leave hair uncovered. After 8-12 hours, the hair should be washed with a nonmedicated shampoo; rinse and use a fine-toothed (nit) comb to remove dead lice and eggs. Evaluate other family members to determine if infested and require treatment. Wash hands immediately after use.
Malathion should be a portion of a whole household lice removal program, which should include washing or dry cleaning all clothing, hats, bedding, and towels recently worn or used by the patient and washing combs, brushes, and hair accessories in hot soapy water.
Store at room temperature 20°C to 25°C (68°F to 77°F). Do not expose to heat and open flames.
Treatment of Pediculus humanus capitis (head lice and their ova) (FDA approved in ages ≥6 years and adults)
KIDs List: Malathion, when used in infants <1 year of age, is identified on the Key Potentially Inappropriate Drugs in Pediatrics (KIDs) list and should be avoided due to risk of increased absorption (organophosphate poisoning) (weak recommendation; very low quality of evidence) (PPA [Meyers 2020]).
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified. Frequency not defined.
Dermatologic: Skin irritation (including scalp irritation), stinging of the skin
Ophthalmic: Conjunctivitis (following contact with eyes)
Miscellaneous: Burn (chemical; including second-degree burns)
Hypersensitivity to malathion or any component of the formulation; use in neonates and/or infants
Concerns related to adverse effects:
• Dermatologic effects: Discontinue use temporarily if skin irritation occurs. Chemical burns, including second-degree burns, and stinging sensations may occur with use.
Other warnings/precautions:
• Appropriate use: For topical use on scalp hair only; leave hair uncovered after application (allow hair to dry naturally). Avoid contact with eyes; flush immediately with water if eye contact occurs. Wash hands immediately after application.
• Flammable: Lotion is flammable; do not expose lotion or hair wetted with malathion to open flames or electric heat sources (eg, hair dryer, curling iron, flat iron). Do not smoke while applying lotion or while hair is wet.
Systemic absorption may be increased in infants and neonates due to higher skin surface area to body mass ratio and immature skin barrier; risk for malathion toxicity potentially increased; use is contraindicated in these patients.
None known.
There are no known significant interactions.
Agents other than malathion are recommended for the treatment of pediculosis pubis during pregnancy (CDC [Workowski 2021]).
Organophosphate that acts as a pediculicide by inhibiting cholinesterase activity in Pediculus humanus capitis (head lice and their ova)
Lotion (Malathion External)
0.5% (per mL): $4.51
Lotion (Ovide External)
0.5% (per mL): $5.22
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