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ZINC PYRITHIONE SHAMPOOS

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Classification   |    Detailed evidence-based information

Substances Included Synonyms

Therapeutic Toxic Class

    A) Zinc pyrithione, found in shampoos, is a topical antiseborrheic agent.

Specific Substances

    A) CONSTITUENTS OF THE GROUP
    1) 1-hydroxy-2(1H)-pyridinethione ZN
    2) 2-pyridinethiol 1-oxide ZN
    3) 2-mercaptopyridine 1-oxide ZN
    4) Bis(1-hydroxy-2(1H)-pyridinethionato)zinc
    5) Omadine zinc
    6) Vancide P
    7) Zinc PT
    8) Zinc anadine
    9) Zinc omadine
    10) Zinc pyrion
    11) Zincpolyanemine
    12) ZPT
    13) Zinc pyridinethione

Available Forms Sources

    A) SOURCES
    1) These zinc pyrithione shampoos also contain conditioners, creams (Robinson, 1979), nonionic and anionic detergents, and sodium or potassium chloride. Some examples are:
    2) Anti-Dandruff Brylcreem(R) shampoo from Beecham (zinc pyrithione 0.1%)
    3) DHS(Tm) Zinc dandruff shampoo (2% zinc pyrithione)
    4) Breck One(R) cream, lotion, or shampoo from Breck (zinc pyrithione 1%)
    5) Danex(R) shampoo from Herbert (zinc pyrithione 1%)
    6) Head and Shoulders(R) creme shampoo from Procter & Gamble (zinc pyrithione 2%)
    7) Head and Shoulders(R) lotion shampoo from Procter & Gamble (zinc pyrithione 2%)
    8) Zincon(R) shampoo from Lederle (zinc pyrithione 1%)
    B) USES
    1) It is used in non-coloring shampoos, tonics, dressings, and other hair care products (Nikitakis, 1988). It is also found in face, body, and hand creams, lotions and moisturizers.

Overview

Life Support

    A) This overview assumes that basic life support measures have been instituted.

Clinical Effects

    0.2.1) SUMMARY OF EXPOSURE
    A) These shampoos do not produce zinc toxicity. They are irritating to mucous membranes, but are not caustic. When ingested in sufficient amounts there is usually spontaneous emesis.
    0.2.4) HEENT
    A) These shampoos may irritate the mouth, throat, nose and eyes.
    0.2.5) CARDIOVASCULAR
    A) Some products contain sodium or potassium chloride. Large amounts (0.5 to 1 g/kg sodium chloride) may be toxic, producing tachycardia and hypotension.
    0.2.7) NEUROLOGIC
    A) Hypernatremia may produce irritability, restlessness, and seizures.
    0.2.8) GASTROINTESTINAL
    A) Nausea, vomiting, and diarrhea are expected, but no serious caustic effects are anticipated.

Laboratory Monitoring

    A) BLOOD LEVELS are not necessary or useful for either the zinc compounds or detergents.
    B) Sodium levels may be necessary following large ingestions, in which vomiting has not occurred.

Treatment Overview

    0.4.2) ORAL/PARENTERAL EXPOSURE
    A) Gastric decontamination is NOT indicated, because spontaneous emesis generally occurs following ingestion.
    B) If fluid loss is considerable from protracted vomiting or diarrhea consider hydration and monitoring electrolytes.
    0.4.4) EYE EXPOSURE
    A) DECONTAMINATION: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, the patient should be seen in a healthcare facility.

Range Of Toxicity

    A) NONIONIC AND ANIONIC DETERGENTS - Not appreciably absorbed; no toxic dose has been established.
    B) ZINC PYRITHIONE - No toxic dose established.
    C) SODIUM CHLORIDE - Ingestions of 0.5 to 1 g/kg sodium chloride will probably result in toxicity.

Clinical Effects

Summary Of Exposure

    A) These shampoos do not produce zinc toxicity. They are irritating to mucous membranes, but are not caustic. When ingested in sufficient amounts there is usually spontaneous emesis.

Heent

    3.4.1) SUMMARY
    A) These shampoos may irritate the mouth, throat, nose and eyes.
    3.4.3) EYES
    A) Exposure will cause mild to moderate irritation (Grant, 1986).
    B) Systemic administration has caused various ocular reactions in several animal species: (Grant & Schuman, 1993).
    DOGSblindness, associated with retinal detachment
    CATStapetal degeneration and atrophy
    3.4.5) NOSE
    A) Exposure will cause mild to moderate irritation (Grant, 1988).
    3.4.6) THROAT
    A) The mouth and throat mucosa may be irritated.

Cardiovascular

    3.5.1) SUMMARY
    A) Some products contain sodium or potassium chloride. Large amounts (0.5 to 1 g/kg sodium chloride) may be toxic, producing tachycardia and hypotension.
    3.5.2) CLINICAL EFFECTS
    A) TACHYARRHYTHMIA
    1) Some products may contain sodium chloride. Large amounts (0.5 to 1 g/kg NaCl or 10 to 20 mL of shampoo/kg) of these shampoos, IF RETAINED, will probably be toxic, producing hypernatremia, tachycardia, and hypotension.

Neurologic

    3.7.1) SUMMARY
    A) Hypernatremia may produce irritability, restlessness, and seizures.
    3.7.2) CLINICAL EFFECTS
    A) SEIZURE
    1) These shampoos may produce irritability, restlessness, and seizures. Hypernatremia is rare, and only expected with large amounts.
    B) PARESTHESIA
    1) Prolonged topical use has been associated with peripheral neuritis, paresthesias, and muscular weakness (Beck, 1978).

Gastrointestinal

    3.8.1) SUMMARY
    A) Nausea, vomiting, and diarrhea are expected, but no serious caustic effects are anticipated.
    3.8.2) CLINICAL EFFECTS
    A) NAUSEA, VOMITING AND DIARRHEA
    1) Nausea, vomiting, and diarrhea might be expected.

Dermatologic

    3.14.2) CLINICAL EFFECTS
    A) DERMATITIS
    1) Contact dermatitis has been reported from zinc pyrithione (Calnan, 1976; Muston et al, 1979; Goh & Lim, 1984).
    B) PHOTOSENSITIVITY
    1) CASE REPORT - A 61-year-old male developed persistent photosensitivity associated with use of zinc pyrithione-containing shampoos (Yates & Finn, 1980).
    3.14.3) ANIMAL EFFECTS
    A) ANIMAL STUDIES
    1) SKIN DISORDER
    a) EPITHELIAL CELLS - Concentrations of 0.1 to 0.5 mcg/mL of zinc pyrithione had a cytotoxic effect on rapidly proliferating NCTC 2544 human skin epithelial cell and normal skin fibroblasts in vitro (Priestley & Brown, 1980).

Laboratory Monitoring

Monitoring Parameters Levels

    4.1.1) SUMMARY
    A) BLOOD LEVELS are not necessary or useful for either the zinc compounds or detergents.
    B) Sodium levels may be necessary following large ingestions, in which vomiting has not occurred.
    4.1.2) SERUM/BLOOD
    A) BLOOD/SERUM CHEMISTRY
    1) Obtain serum sodium levels following large ingestions.
    2) BLOOD LEVELS are not necessary, or useful for either the zinc compounds or detergents.

Treatment

Life Support

    A) Support respiratory and cardiovascular function.

Monitoring

    A) BLOOD LEVELS are not necessary or useful for either the zinc compounds or detergents.
    B) Sodium levels may be necessary following large ingestions, in which vomiting has not occurred.

Oral Exposure

    6.5.1) PREVENTION OF ABSORPTION/PREHOSPITAL
    A) SUMMARY -
    1) Gastric decontamination is NOT indicated, because spontaneous emesis generally occurs following ingestion.
    6.5.2) PREVENTION OF ABSORPTION
    A) SUMMARY
    1) Gastric decontamination is NOT indicated, because spontaneous emesis generally occurs following ingestion.
    6.5.3) TREATMENT
    A) FLUID/ELECTROLYTE BALANCE REGULATION
    1) Fluid replacement and electrolyte monitoring is indicated in cases of protracted vomiting or diarrhea.
    B) EXPERIMENTAL THERAPY
    1) ANIMAL STUDY - Data observed in rats, suggested d-penicillamine might protect against zinc pyrithione toxicity. Additional studies are needed (LoPachin et al, 1984).

Eye Exposure

    6.8.1) DECONTAMINATION
    A) EYE IRRIGATION, ROUTINE: Remove contact lenses and irrigate exposed eyes with copious amounts of room temperature 0.9% saline or water for at least 15 minutes. If irritation, pain, swelling, lacrimation, or photophobia persist after 15 minutes of irrigation, an ophthalmologic examination should be performed (Peate, 2007; Naradzay & Barish, 2006).

Enhanced Elimination

    A) SUMMARY
    1) Generally, not indicated. There have been no cases of significant zinc absorption.

Range Of Toxicity

Toxicity Information

    7.7.1) TOXICITY VALUES
    A) LD50- (INTRAPERITONEAL)MOUSE:
    1) 26800 mcg/kg (RTECS, 2000)
    B) LD50- (ORAL)MOUSE:
    1) 160 mg/kg (RTECS, 2000)
    C) LD50- (SUBCUTANEOUS)MOUSE:
    1) 730 mg/kg (RTECS, 2000)
    D) LD50- (ORAL)RAT:
    1) 177 mg/kg (RTECS, 2000)

Summary

    A) NONIONIC AND ANIONIC DETERGENTS - Not appreciably absorbed; no toxic dose has been established.
    B) ZINC PYRITHIONE - No toxic dose established.
    C) SODIUM CHLORIDE - Ingestions of 0.5 to 1 g/kg sodium chloride will probably result in toxicity.

Maximum Tolerated Exposure

    A) SPECIFIC SUBSTANCE
    1) DETERGENTS - Nonionic and anionic detergents are not appreciably absorbed, and no toxic dose has been established. Symptom onset and duration is dependent on the patient and percentage of surfactant and NaCl.
    2) ZINC PYRITHIONE - No specific toxic dose has been set. It would appear that a serious toxic dose is likely to be greater than the amount which can be retained.
    3) NACL - Ingestion of 0.5 to 1 gram/kilogram will probably result in toxicity.

Pharmacology Toxicology

Pharmacologic Mechanism

    A) ZINC - An essential mineral found throughout the body. Topically it appears to exert an antiseborrheic effect.
    B) SODIUM CHLORIDE - Plays an important role in the basic internal milieu of mammals. It is a main contributor to the stability of extracellular and intracellular osmolarity.

Toxicologic Mechanism

    A) DETERGENT - Anionic and nonionic shampoos are not well absorbed and exert a primarily irritant effect.

Physicochemical

Physical Characteristics

    A) Off-white powder with a mild odor (HSDB , 2000)

Molecular Weight

    A) 317.7 (HSDB , 2000)

Animal Toxicology

Clinical Effects

    11.1.3) CANINE/DOG
    A) Dogs given oral doses of 0.05 to 5 g/kg of a 2% of commercial shampoo developed emesis without other symptoms (Gosselin et al, 1984).

References

General Bibliography

    1) Beck JE: Zinc pyrithione and peripheral neuritis (letter). Lancet 1978; 1:444.
    2) Calnan CD: Highlights of the first interactional symposium on contact dermatitis. Cutis 1976; 18:645-662.
    3) Goh CL & Lim KB: Allergic contact dermatitis to zinc pyrithione. Contact Dermatitis 1984; 11:120-136.
    4) Gosselin RE, Smith RP, & Hodge HC: Clinical Toxicology of Commercial Products, 5th ed, Williams & Wilkins, Baltimore, MD, 1984.
    5) Grant WM & Schuman JS: Toxicology of the Eye, 4th ed, Charles C Thomas, Springfield, IL, 1993.
    6) Grant WM: Toxicology of the Eye, 3rd ed, Charles C Thomas, Springfield, IL, 1986.
    7) HSDB : Hazardous Substances Data Bank. National Library of Medicine. Bethesda, MD (Internet Version). Edition expires 2000; provided by Truven Health Analytics Inc., Greenwood Village, CO.
    8) Jeffcoat AR, Gibson WB, & Rodriguez PA: Zinc pyridinethione: urinary metabolites of zinc pyridinethione in rabbits, rats, monkeys, and dogs after oral dosing. Toxicol Appl Pharmacol 1980; 56:141-154.
    9) LoPachin KM, Weiler MS, & Williams KD: Evaluation of the ability of d-Penicillamine to protect against the neurotoxicity induced by zinc pyrithione, acrylamide, 2,5-hexanedione and p-Bromophenyacetylurea. Neuro Toxicol 1984; 5:37-42.
    10) Muston HL, Messenger AG, & Byrne JPH: Contact dermatitis from zinc pyrithione, an antidandruff agent. Contact Dermatitis 1979; 5:276-277.
    11) Naradzay J & Barish RA: Approach to ophthalmologic emergencies. Med Clin North Am 2006; 90(2):305-328.
    12) Nikitakis JM: CTFA Cosmetic Ingredient Handbook, 1st Ed, The Cosmetic, Toiletry and Fragrance Association, Inc, Washington, DC, 1988.
    13) Peate WF: Work-related eye injuries and illnesses. Am Fam Physician 2007; 75(7):1017-1022.
    14) Robinson JR: Dry skin, dandruff, seborrhea, psoriasis, and eczema products. In: Handbook of Nonprescription Drugs 6th ed, American Pharmaceutical Association, Washington, DC, 1979.