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Pyrethrin with piperonyl butoxide kills parasites and their eggs. It is used to treat scabies (a skin infestation) and lice infestations of the head, body, and pubic area ('crabs'). Pyrethrin with piperonyl butoxide does not prevent these infestations.

The pyrethrin and piperonyl butoxide combination comes in liquid, gel, and shampoo form. Usually, one application of pyrethrin with piperonyl butoxide is effective. However, the treatment may need to be repeated after 1 week; call your doctor if signs of infestation (live parasites) reappear. Follow the directions on the package or on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use pyrethrin and piperonyl butoxide exactly as directed. Do not use more or less of it or use it more often than directed by your doctor.

Wear rubber gloves when applying it if you have open cuts or scratches on your hands. If this medication accidentally gets in your eyes, rinse them thoroughly with water for at least 5 minutes.

To use the liquid or gel, follow these steps:

1. Use enough medication to cover the affected hairy area and adjacent areas. Ask your pharmacist or doctor any questions you have about where to apply the medication.
2. Leave the medication on for exactly 10 minutes.
3. Thoroughly wash the area with warm water and soap or regular shampoo.
4. Dry with a clean towel.
5. Wash your hands to remove the medication.
6. Dress in clean clothes.

To use the shampoo, follow these steps:

1. Shake the shampoo before using it. Then thoroughly cover your dry hair and scalp or skin with shampoo.
2. Use a small amount of water to work the shampoo into your hair until a lather forms.
3. Leave the shampoo on for exactly 10 minutes.
4. Rinse your hair thoroughly with water.
5. Dry your hair with a clean towel.
6. Comb your hair with a fine tooth comb to remove nits (lice eggs and larvae).
7. Wash your hands to remove the medication.

If you have head lice, wash combs and brushes with the liquid, gel, or shampoo and rinse them thoroughly with water to remove the drug.

Pyrethrin and piperonyl butoxide may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• skin irritation
• rash
• redness
• swelling

• tell your doctor and pharmacist if you are allergic to pyrethrin, piperonyl butoxide, ragweed, petroleum products, or any other drugs.
• tell your doctor and pharmacist what prescription and nonprescription medications you are taking, including vitamins.
• tell your doctor if you are pregnant or are breast-feeding. If you are pregnant, wear gloves when applying this medication to another person to prevent its absorption through your skin.

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

Keep all appointments with your doctor. Pyrethrin and piperonyl butoxide is for external use only. Do not let pyrethrin and piperonyl butoxide get into your eyes, nose, or mouth, and do not swallow it. Do not apply dressings, bandages, cosmetics, lotions, or other skin medications to the area being treated unless your doctor tells you.

After using pyrethrin and piperonyl butoxide, machine-wash (or dry clean) all clothing, bed linen, and towels that you have used in the last 2 days. Use hot water. Dry everything in a hot dryer for at least 20 minutes. Thoroughly clean all bathtubs, showers, and toilets in your home with rubbing alcohol.

You may have transmitted the parasites to family members and close contacts (including sexual contacts); advise them to see a doctor if they develop symptoms of infestation.

If you have scabies and your skin has become sensitive to the parasite, itching may persist for several weeks after the treatment. However, this itching does not mean that the treatment was a failure. Call your doctor if you have questions.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about pyrethrin and piperonyl butoxide.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.