Precautions and Warnings

Benzyl benzoate is not a first-choice treatment for scabies as it is an irritant and is less effective than malathion and permethrin.

Pregnancy - (see Pregnancy).

Breastfeeding - (See Lactation).

Children under 18 years - although not generally recommended for use in children and infants - the emulsion should be diluted with water before application. Consult product literature.

In the event of severe skin reactions, the emulsion should be washed off using soap and warm water.

If benzyl benzoate is being applied to the scalp or face, care should be taken to protect the eyes.

When applying the emulsion, contact with mucous membranes should be avoided.

Benzyl benzoate should not be applied to broken or secondarily infected skin.

Benzyl benzoate emulsion may damage plastic or acrylic surfaces. Care should be taken to avoid the emulsion coming into contact with such surfaces.

Although acaricides have traditionally been applied after a hot bath, this is not necessary. There is evidence that a hot bath may increase absorption into blood, removing them from their site of action on the skin.

For the treatment of scabies, all members of the affected household (including close contacts and sexual contacts) should be treated simultaneously. Scabies is highly contagious and there is a latent period before symptoms develop. Advise the individual to avoid close body contact with others until their partners and close contacts been been treated.

For the treatment of scabies, patients should be instructed to change clothes and bed linen on the day of first application of benzyl benzoate emulsion. Mites on clothes, bed linen, or towels can be killed by machine washing (at 50 degrees C or above).

For the treatment of scabies, advise patients to reapply treatment to the hands if they are washed.

Advise patients that the itch and eczema of scabies persists for some weeks after infestation has been eliminated and treatment for pruritus and eczema may be required.

Pregnancy and Lactation

Pregnancy

Manufacturers advise that benzyl benzoate emulsion should not be used during pregnancy.
Some percutaneous absorption of benzyl benzoate can occur but this has not been quantified. If any benzyl benzoate is absorbed, it is rapidly hydrolysed to benzoic acid and benzyl alcohol.
Schaefer states that apart from local irritation, there has been no substantial toxicity after topical application of benzyl benzoate and no teratogenic effects after normal usage.
Schaefer recommends that scabies should be treated with benzyl benzoate or crotamiton, and lice infestation with coconut oil or pyrethrum extract.
NHS Clinical Knowledge Summary recommends to treat scabies on women who are pregnant with permethrin 5% dermal cream or malathion 0.5% aqueous liquid if permethrin is not appropriate (e.g. the person has an allergy to chrysanthemums).

The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14-17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).

Lactation

There is insufficient data on the use of benzyl benzoate emulsion in breastfeeding women. Manufacturers recommend to avoid.
Some percutaneous absorption of benzyl benzoate can occur but this has not been quantified. If any benzyl benzoate is absorbed, it is rapidly hydrolysed to benzoic acid and benzyl alcohol.
Breastfeeding should be suspended until benzyl benzoate emulsion has been washed off.
NHS Clinical Knowledge Summary recommends to treat scabies on women who are breastfeeding with permethrin 5% dermal cream or malathion 0.5% aqueous liquid if permethrin is not appropriate (e.g. the person has an allergy to chrysanthemums). Breastfeeding mothers should remove the liquid or cream from the nipples before breastfeeding, and reapply treatment afterwards.

Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
Specialist advice is available from the UK Drugs in Lactation Advisory Service at https://www.midlandsmedicines.nhs.uk/content.asp?section=6&subsection=17&pageIdx=1

Presentation

Emulsion containing benzyl benzoate 25% w/v

Drugs List

benzyl benzoate 25% application

Therapeutic Indications

Uses

For the treatment of scabies and pediculosis.

Dosage

Adults

Treatment of scabies:
Apply 25% benzyl benzoate emulsion to the whole body, usually from the neck down (although some sources suggest that application should be extended to the scalp, neck, face, and ears). Particular attention should be paid to the webs of the fingers and toes, nails, wrists, ankles, armpits, buttocks and groins.
One treatment should be sufficient but the emulsion may be re-applied within 5 days to reduce possibility of treatment failure.
OR
Benzyl benzoate emulsion may be applied to the whole body on 3 occasions at 12- hourly intervals without bathing. The patient should have a hot bath 12 hours after the last application.
OR
One application to the whole body, repeated, without bathing on the following day, and washed off 24 hours later; a third application may be required in some cases.

Treatment of pediculosis:
The affected area should be treated with 25% benzyl benzoate emulsion, and then washed off 24 hours later with soap and water. In severe cases, this procedure may need to be repeated 2 or 3 times.
The patient should be examined 1 week after the last treatment to confirm disinfestation.

Elderly

No dose adjustment is necessary. See Adult dose.

Children

Benzyl benzoate is an irritant and is generally not recommended for use in infants and children. If used the application should be diluted with water to minimise the risk of irritation, although this reduces efficacy. Consult product literature.

Additional Dosage Information

Care should be taken to avoid contact with the eyes, mucous membranes and broken skin.

Administration

For topical administration.
Shake bottle before use.

Contraindications

Hypersensitivity to benzyl alcohol

Hypersensitivity to benzoic acid