General considerations
It is important to complete an individual risk assessment for your patient and to apply the principles of prescribing in breastfeeding when looking at the available information and making treatment decisions.
This article includes the most commonly used head and pubic lice treatments. Other treatment options are available, and may need to be used for more specialist situations. Contact our specialist service, UK Drugs In Lactation Advisory Service (UKDILAS), for further advice.
Recommendations
Different treatments are used depending on whether it’s head lice or pubic (crab) lice infestation. Choice of preparation should therefore primarily be directed at adequately treating the condition first and preference of application method.
Head Lice
Wet combing or dimeticone are the preferred choices to treat head lice in breastfeeding.
Malathion may also be used as an alternative.
Other preparations (isopropyl myristate/cyclomethicone or isopropyl myristate/isopropyl alcohol) can be considered after other treatment options have failed.
Pubic Lice
Malathion and permethrin can be used to treat pubic lice in breastfeeding.
Clinical considerations
Lice are parasitic insects that infest human hairs. Head lice and pubic lice are different and infest different areas. Any hair on the body can become infested.
Some of the commonly-used products for lice (e.g. Vamousse ®, Derbac M Liquid ®, Full Marks Solution® Lyclear® Dermal Cream) also contain additional ingredients. However, due to treatment being topical, and minimal systemic absorption, transfer into breast milk is not expected. They are therefore considered compatible with breastfeeding when used in the short-term.
Keep hair short or tied up to prevent infant from sucking hair during treatment.
Specific Recommendations
Patient Information
The NHS website provides advice for patients on head lice and pubic lice.
Contact us
Get in touch with the UK Drugs In Lactation Advisory Service (UKDILAS), our specialist breastfeeding medicines advice service if you need support in the following situations:
- the infant is unwell or premature
- other lice infestations need to be treated
- the medicine in question is not included in our advice
- you need further advice
About our recommendations
Recommendations are based on published evidence where available. However, evidence is generally very poor and limited, and can require professional interpretation. Assessments are often based on reviewing case reports which can be conflicting and lack detail.
If there is no published clinical evidence, assessments are based on: pharmacodynamic and pharmacokinetic principles, extrapolation from similar drugs, risk assessment of normal clinical use, expert advice, and unpublished data. Simulated data is now increasingly being used due to the ethical difficulties around gathering good quality evidence in this area.
Bibliography
References are available on request.