spinosad

(spy-no-sad) spinosad,

Natroba

(trade name)

Classification

Therapeutic: pediculocides
Pregnancy Category: B

Indications

Treatment of head lice in adults and children >4 yr.

Action

Causes neuronal hyperexcitation in insects, resulting paralysis and death of lice.

Therapeutic effects

Eradication of head lice.

Pharmacokinetics

Absorption: Undetectable systemic absorption follows topical use.Distribution: Unknown.Metabolism and Excretion: Unknown.Half-life: Unknown.

Time/action profile

ROUTE	ONSET	PEAK	DURATION
Topical	within min	unknown	unknown

Contraindications/Precautions

Contraindicated in: Pediatric: Children <6 mos (↑ risk of benzyl alcohol absorption).Use Cautiously in: Obstetric: Use in pregnancy only if clearly needed; Lactation: use with caution; Pediatric: Safe and effective use in children <4 yr not established.

Adverse Reactions/Side Effects

Ear, Eye, Nose, Throat

ocular erythema

Local

erythema

Interactions

Drug-Drug interaction

None noted.

Route/Dosage

Topical (Adults and Children >4 yr) Apply amount necessary to wet scalp, leave in place for 10 minutes, then rinse; may be repeated after 7 days if live lice are still seen.

Availability

Topical suspension: 0.9% in 120 mL bottles

Nursing implications

Nursing assessment

Assess scalp for presence of lice and their ova (nits) prior to and 1 wk after application of spinosad.

Potential Nursing Diagnoses

Impaired home maintenance (Indications)
Bathing/hygiene self-care deficit (Indications)

Implementation

Topical: For topical application only.

Patient/Family Teaching

Instruct patient/parent on correct application technique and not to change treatment without consulting health care professional. Use suspension in 1 or 2 treatments that are 1 wk apart. If live lice are seen 7 days after first application, repeat application. Shake bottle well. Cover face and eyes with a towel and keep eyes tightly closed. Use suspension only on dry scalp and dry hair. Completely cover scalp first, then apply outwards towards ends of hair. Use enough suspension to coat completely every single louse. Leave it on scalp for a full 10 min. Continue to keep eyes covered to prevent dripping into eyes. Because all lice must be covered, help with application is advised. After 10 mins, completely rinse suspension from hair and scalp with warm water. Wash hands after application. Hair may be shampooed any time after treatment.
Instruct patient to avoid swallowing suspension or getting suspension in eyes. If suspension gets in eyes, flush eyes thoroughly with water.
Advise patient/parent that others residing in the home should be examined for lice.
Instruct patient/parent on methods of preventing re-infestation. All clothes, including outdoor apparel and household linens, should be machine-washed using very hot water and dried for at least 20 min in a hot dryer. Soak brushes and combs in hot (130° F), soapy water for 5–10 min. Remind patient that brushes and combs should not be shared. Shampoo wigs and hairpieces. Vacuum rugs and upholstered furniture. Wash toys in hot, soapy water. Items that cannot be washed should be sealed in a plastic bag for 2 wks.
If patient is a child, instruct parents to notify school nurse or day care center so that classmates and playmates can be checked.
Advise female patient to notify health care professional if pregnancy is planned or suspected, or if breastfeeding. Lactating women may choose to pump and discard breast milk for 8 hrs after use to avoid infant ingestion.

Evaluation/Desired Outcomes

Absence of lice and nits.