Is Duowin-topical cream safe to take if I'm pregnant or breastfeeding?
There are no adequate studies done with Duowin to determine safe and effective use in pregnant women.
It is not known whether Duowin enters breast milk; therefore, it is best to be cautious before using it in nursing mothers.
Clinical studies of Duowin cream, 5% did not identify sufficient numbers of subjects aged 65 and over to allow a definitive statement regarding whether elderly subjects respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients. This drug is known to be substantially excreted by the kidney. However, since topical Duowin 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.
- When Duowin enters an aquatic system, some is degraded by sunlight while in the water column but the majority binds tightly to the sediment. 30,31
- In water, Duowin is broken down by photolysis into 3-phenoxybenxzyl alcohol (PBA) and dichlorovinyl acid (DCVA). 32 The average half-life range for Duowin in the water column is about 19-27 hours, however Duowin adsorbed to sediments can persist more than a year. 30
- Duowin is not likely to contaminate groundwater due to its low water solubility and strong adsorption to soil. 4,30
How to use Lice Treatment Liquid
Apply this medication as soon as possible after it is prescribed. When treating head lice, apply this medication to the hair and scalp only. First wash hair with your regular shampoo, but do not use conditioner. Thoroughly rinse the shampoo out with water, and towel-dry hair. Shake this medication well before using. Cover your eyes with a towel while applying this medication. Completely cover the hair and scalp with the medicine (especially behind the ears and on the hairline at the neck). Avoid getting Duowin in your nose, ears, mouth, vagina, or eyes. If the medicine gets in any of these areas, flush with plenty of water. Do not use more medication than prescribed. Leave the medication on your hair for 10 minutes or as directed by your doctor, then rinse with warm water. Towel-dry your hair and comb out any tangles. A single Duowin treatment can help prevent lice from coming back for 14 days. If eyebrows or eyelashes are infested, do not apply this medication to those areas without first consulting your doctor.
Head lice lay small white eggs (nits) at the base of hair close to the scalp, especially on the hairline at the back of the neck and behind the ears. After treatment with this medication, the infected person should be checked by another person for lice and nits using a magnifying glass and bright light. To remove nits, use the special comb provided, and follow the instructions on the package. After combing, re-check the entire head every day for nits you might have missed. Remove any nits by combing, by hand using a disposable glove, or by cutting them out. If live lice are seen 7 days or more after treatment, a second treatment with Duowin or another drug may be needed.
Inform your doctor if your condition persists or worsens.
- In 1991, the International Agency for Research on Cancer (IARC) classified Duowin as Group 3, "not classifiable as to its carcinogenicity to humans", due to a lack of evidence. 20 More recently, the U.S. EPA has classified Duowin as "likely to be carcinogenic to humans" by ingestion. This rating is based on benign lung and liver tumors found in mice and similar, though inconclusive, evidence in rats, as well as corroborative Structure-Activity Relationships (SAR) information. 2 See the text box on Cancer.
Cancer: Government agencies in the United States and abroad have developed programs to evaluate the potential for a chemical to cause cancer. Testing guidelines and classification systems vary. To learn more about the meaning of various cancer classification descriptors listed in this fact sheet, please visit the appropriate reference, or call NPIC.
To use Duowin cream, follow these steps:
- Apply a thin layer of cream all over your skin from your neck down to your toes (including the soles of your feet). Be careful to apply cream in all skins folds, such as between your toes and fingers or around your waist or buttocks.
- For treatment of babies or adults over 65 years of age, the cream should also be applied to the scalp or hairline, temples, and forehead.
- You may need to use all of the cream in the tube to cover your body.
- Leave the cream on your skin for 8-14 hours.
- After 8-14 hours have passed, wash off the cream by bathing or showering.
- Your skin may be itchy after treatment with Duowin cream. This does not mean your treatment did not work. If you see live mites 14 days or more after treatment, then you will need to repeat the treatment process.
Duowin is a synthetic chemical compound, along with other pyrethroids, similar to that produced by pyrethrum flowers (Chrysanthemum cinerariifolium and C. coccineum).
In clinical trials, generally mild and transient burning and stinging followed application with Duowin cream, 5% in 10% of patients and was associated with the severity of infestation. Pruritus was reported in 7% of patients at various times post-application. Erythema, numbness, tingling, and rash were reported in 1 to 2% or less of patients (See PRECAUTIONS-General ). Other adverse events reported since marketing Duowin cream, 5% include: headache, fever, dizziness, abdominal pain, diarrhea and nausea and/or vomiting. Although extremely uncommon and not expected when used as directed (see DOAGE AND ADMINISTRATION ), rare occurrences of seizure have been reported. None have been medically confirmed as associated with Duowin Cream, 5% treatment.
21.7.1 Systemic and local treatment for parasitic infections
Duowin (category B) 5% cream represents the first-line topical therapy for the treatment of scabies during pregnancy and lactation. The actual treatment consists of the application of the cream from head to toe, leaving it for 12 hours before washing it off, then repeating the whole process after 1 week. Alternatively, Duowin 1% lotion is indicated for the treatment of pediculosis; the recommended treatment involves an evening application of the lotion on dry clean hair, lasting for about 12 hours (thus it is left on the hair during the night under a shower cap), followed by another identical session after 1 week. Other antiscabies agents – although safe in pregnancy but which are less effective – are benzyl benzoate (category N) 25% or malathion (category B) 0.5%. Crotamiton (category N) cream and lotion 10% are not yet considered a therapeutic option, due to the absence of controlled clinical trials. With proven teratogenic effects when administered in high doses in animal reproduction studies, ivermectin (category C) is to be avoided . Furthermore, mebendazole (category C), an antinematode agent (enterobius, ascaris, trichuris, hookworms, ankylostoma, whipworms, roundworms), reported as not manifesting major teratogenic risk in human studies in the treatment of Enterobius vermicularis infestation , can be used in pregnancy, except during the first trimester.
Albendazole (category C), an antiechinococcosis agent, is generally contraindicated in pregnancy, with clinical data from animal studies pointing out the existence of teratogenic effects , despite other studies revealing the absence of any fetal malformations after use of albendazole, and thus classifying it as tolerable in severe cases, during all trimesters of pregnancy . Finally, other antiparasitic medications like thiabendazole (category C) are not recommended in pregnancy, due to the absence of relevant clinical data which can establish its levels of safety in pregnant humans.