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Medical Disclaimer: This information is for educational purposes only and is not a substitute for professional medical advice.
Zinc Oxide, Benzyl Alcohol, And Diphenhydramine Hydrochloride
Brand Name
Ivarest
Generic Name
Zinc Oxide, Benzyl Alcohol, And Diphenhydramine Hydrochloride
Active Ingredient
Benzyl AlcoholCategory
Nitrogen Binding Agent [EPC]
Variants
1
Different strengths and dosage forms
| Strength | Form | Route | NDC |
|---|---|---|---|
| 10.5 g/100g | CREAM | TOPICAL | 10157-9077 |
Detailed information about Ivarest
References used for this content
This page is for informational purposes only and does not replace medical advice. Before using any prescription or over-the-counter medication for Ivarest, you must consult a qualified healthcare professional.
Benzyl alcohol is an aromatic alcohol used primarily as a topical pediculicide for head lice and as a bacteriostatic preservative in various injectable medications. It belongs to the class of nitrogen-binding agents and pediculicides, functioning through physical occlusion of respiratory spiracles.
For the treatment of head lice (Pediculosis capitis), the dosage is determined by hair length rather than weight. The 5% lotion should be applied to dry hair until the scalp and hair are thoroughly saturated.
A second treatment MUST be applied exactly 7 days after the first treatment. This is because Benzyl Alcohol does not kill lice eggs (nits); the second application is required to kill any lice that hatched after the first treatment but before they are old enough to lay new eggs.
Benzyl Alcohol 5% lotion is FDA-approved for use in children as young as 6 months of age. The dosing by hair length is the same as for adults.
No dosage adjustments are typically required for topical application in patients with renal impairment, as systemic absorption is negligible. However, if using medications containing Benzyl Alcohol as a preservative intravenously, caution is advised in patients with severe renal failure as the metabolite (hippuric acid) is renally excreted.
Since the liver is responsible for the oxidation of Benzyl Alcohol to benzoic acid, patients with severe hepatic impairment should be monitored if receiving large systemic doses (via preserved injections), though topical use remains generally safe.
No specific dosage adjustments are required for geriatric patients. Clinical trials for Ulesfia did not include sufficient numbers of subjects aged 65 and over to determine if they respond differently than younger subjects, but systemic toxicity is unlikely with topical use.
If you miss the second application (the 7-day follow-up), apply it as soon as you remember. However, if more than 9 or 10 days have passed since the first treatment, the newly hatched lice may have already laid new eggs, and you may need to restart the entire two-treatment cycle. Consult your healthcare provider for guidance.
Topical overdose is unlikely but may manifest as severe skin redness, burning, or itching. Accidental ingestion is a medical emergency.
> Important: Follow your healthcare provider's dosing instructions. Do not adjust your dose or application frequency without medical guidance.
Because Benzyl Alcohol is applied topically for head lice, most side effects are localized to the site of application. These effects are usually mild and transient, lasting for a few hours to a day after treatment.
> Warning: Stop using Benzyl Alcohol and call your doctor immediately if you experience any of these symptoms, which may indicate systemic absorption or a severe allergic reaction.
Benzyl Alcohol is intended for short-term, episodic use (two applications). There are no documented long-term side effects when used correctly for head lice. However, chronic exposure to Benzyl Alcohol as a preservative in parenteral (injectable) medications has been associated with 'accumulation toxicity' in patients with impaired liver or kidney function, potentially leading to neurological changes or persistent metabolic acidosis.
While Benzyl Alcohol topical lotion does not carry a traditional 'Black Box Warning' in the same way as high-risk systemic drugs, it carries a Contraindication and Warning regarding its use in neonates.
FDA Warning Summary: The use of Benzyl Alcohol in neonates (infants under 1 month) and low-birth-weight infants has been associated with 'Gasping Syndrome.' This syndrome is characterized by the sudden onset of gasping respiration, metabolic acidosis, CNS depression, and cardiovascular collapse. This warning stems from the 1980s when bacteriostatic saline (containing benzyl alcohol) was used to flush umbilical catheters, leading to several neonatal deaths. Consequently, any product containing Benzyl Alcohol must be used with extreme caution or avoided entirely in the neonatal population.
Report any unusual symptoms to your healthcare provider. You may also report side effects to the FDA at 1-800-FDA-1088.
Benzyl Alcohol is for external use only. It is not for oral, ophthalmic (eye), or intravaginal use. The most critical safety consideration is the age of the patient; this medication is strictly prohibited for use in infants under 6 months of age due to the risk of fatal systemic toxicity. Patients and caregivers should be educated that this product is flammable. Keep the hair away from open flames, lit cigarettes, or heat sources (like hair dryers on high heat) until the hair has been thoroughly rinsed and dried.
No formal FDA black box warning exists for the topical 5% lotion, but the labeling contains a prominent 'Warning' section regarding Neonatal Toxicity. Healthcare providers are warned that 'Gasping Syndrome' has been linked to Benzyl Alcohol exposure in premature infants. This condition involves metabolic acidosis, respiratory distress, and can lead to intracranial hemorrhage and death. Therefore, Benzyl Alcohol-preserved solutions should be avoided in the neonatal period whenever possible.
For standard topical use in treating head lice, no specific laboratory monitoring is required. However, in clinical settings where Benzyl Alcohol is used as a preservative in high-dose intravenous infusions (such as certain sedative or anesthetic protocols):
Topical application of Benzyl Alcohol does not typically affect the ability to drive or operate machinery. However, if accidental systemic absorption occurs and the patient feels dizzy or drowsy, these activities should be avoided.
There are no known direct interactions between topical Benzyl Alcohol and the consumption of alcoholic beverages. However, since both substances are metabolized by the liver's alcohol dehydrogenase system, excessive alcohol consumption could theoretically slow the clearance of systemically absorbed Benzyl Alcohol.
There is no withdrawal syndrome associated with Benzyl Alcohol. Treatment consists of two 10-minute applications. If the lice infestation persists after two treatments, do not continue applying the product daily; consult your healthcare provider to determine if the diagnosis is correct or if a different treatment is needed.
> Important: Discuss all your medical conditions with your healthcare provider before starting Benzyl Alcohol.
There are no specific drugs that are absolutely contraindicated for use with topical Benzyl Alcohol. However, in the context of injectable Benzyl Alcohol (as a preservative):
There are no documented food interactions with topical Benzyl Alcohol. It does not interact with grapefruit, dairy, or caffeine.
There are no known interactions between topical Benzyl Alcohol and common herbal supplements like St. John's Wort or Ginkgo Biloba. However, if a patient is using essential oils on the scalp (such as tea tree oil or rosemary oil), these should be washed out thoroughly before applying Benzyl Alcohol to prevent unpredictable skin reactions.
For each major interaction, the management strategy involves spacing out treatments and ensuring the skin barrier is intact to minimize systemic exposure.
> Important: Tell your doctor about ALL medications, supplements, and herbal products you are taking, even those applied to the skin.
Benzyl Alcohol must NEVER be used in the following circumstances:
Conditions requiring careful risk-benefit analysis by a healthcare provider:
Patients who are allergic to Balsam of Peru may also be sensitive to Benzyl Alcohol, as they share similar chemical structures. Additionally, individuals with 'fragrance allergy' should use Benzyl Alcohol with caution, as it is a common component of many perfumes and essential oils. If you have had a reaction to other 'benzyl' compounds (like Benzyl Benzoate), consult your allergist before use.
> Important: Your healthcare provider will evaluate your complete medical history and the integrity of your skin before prescribing Benzyl Alcohol.
FDA Pregnancy Category B. This means that animal reproduction studies have failed to demonstrate a risk to the fetus, but there are no adequate and well-controlled studies in pregnant women. Because Benzyl Alcohol is applied topically and systemic absorption is minimal in adults with intact skin, it is generally considered low-risk during pregnancy. However, it should only be used if clearly needed. Healthcare providers typically recommend trying non-pharmacological methods (like wet combing) first. If Benzyl Alcohol is used, it should be applied for the minimum time required (10 minutes) and rinsed thoroughly.
It is not known whether Benzyl Alcohol is excreted in human milk. However, because systemic absorption is so low, it is unlikely that significant amounts would reach the breast milk. The primary concern is the infant's direct contact with the treated hair or scalp of the mother. Nursing mothers should ensure the medication is completely rinsed out and their hands are washed before holding their infant to prevent the infant from inhaling vapors or touching the treated area. Consult your doctor to discuss the risks and benefits.
Benzyl Alcohol 5% lotion is specifically approved for children aged 6 months and older. It is a preferred treatment for many pediatricians because it is not a neurotoxin. However, children have a higher surface-area-to-body-mass ratio, meaning they can absorb more of the drug than adults. Caregivers must be strictly instructed to follow the 10-minute limit and to keep the product out of the child's reach. It is NOT approved for use in children under 6 months of age.
Clinical studies of Benzyl Alcohol lotion did not include enough subjects over 65 to determine if they respond differently than younger patients. In general, elderly patients may have thinner skin or more comorbidities (like liver or kidney disease). While topical use is likely safe, geriatric patients should be monitored for skin irritation. There is no evidence of increased fall risk or cognitive impairment from the topical use of this medication.
In patients with kidney disease, the metabolite hippuric acid may accumulate if the drug is absorbed systemically. While this is not a concern for the two-dose lice treatment, it is a significant consideration for patients receiving chronic IV medications that use Benzyl Alcohol as a preservative. In such cases, healthcare providers may monitor the anion gap and serum bicarbonate levels.
Patients with liver disease (Child-Pugh Class B or C) may have a reduced ability to oxidize Benzyl Alcohol to benzoic acid. This could lead to prolonged levels of the alcohol in the blood if absorbed. For topical use, this is rarely clinically significant, but for systemic exposure, it requires close monitoring for CNS depression.
> Important: Special populations require individualized medical assessment to ensure the safest possible treatment outcome.
Benzyl Alcohol (C7H8O) is an aromatic alcohol that functions as a pediculicide through a unique physical mechanism. Lice have respiratory openings called spiracles. Under normal conditions, lice can close these spiracles when they sense a fluid or a noxious substance, allowing them to survive for hours in water or during exposure to certain chemicals. Benzyl Alcohol acts as a local anesthetic on the muscles controlling these spiracles, causing them to become paralyzed in the open position. Once the spiracles are locked open, the mineral oil-based vehicle in the lotion flows into the tracheae, obstructing the louse's respiratory system. This leads to irreversible asphyxiation. For its role as a preservative, Benzyl Alcohol disrupts microbial cell membranes, leading to the leakage of cellular contents and cell death.
| Parameter | Value |
|---|---|
| Bioavailability | Minimal (Topical, intact skin); 100% (IV) |
| Protein Binding | Low (not clinically significant) |
| Half-life | ~1.5 hours (systemic) |
| Tmax | N/A (Topical); Immediate (IV) |
| Metabolism | Hepatic (Alcohol/Aldehyde Dehydrogenase) |
| Excretion | Renal (as Hippuric Acid) |
Benzyl Alcohol is classified as a Pediculicide and a Nitrogen Binding Agent. Within the pediculicide class, it is distinguished from neurotoxins (like Pyrethrins) and ovicides (like Spinosad). It is also categorized as a pharmaceutical aid/preservative.
Common questions about Ivarest
Benzyl Alcohol is primarily used as a topical treatment for head lice in adults and children 6 months of age and older. It works by suffocating the lice rather than poisoning their nervous system. Additionally, it is used as a common preservative in many injectable medications to prevent bacterial growth. It also has mild local anesthetic properties and is found in some anti-itch creams. Always use it according to your healthcare provider's instructions.
The most common side effects are localized to the area where the medication is applied. These include itching (pruritus), redness (erythema), and a mild stinging or burning sensation on the scalp. Some people may also experience dry skin or temporary flakiness. These symptoms usually resolve shortly after the product is rinsed out. If you experience severe blistering or signs of an allergic reaction, contact your doctor immediately.
When using Benzyl Alcohol topically for lice, there is no known interaction with drinking alcohol. This is because very little of the drug enters your bloodstream through the skin. However, if you are receiving high doses of Benzyl Alcohol systemically (as a preservative in IV medications), heavy alcohol consumption could theoretically interfere with how your liver processes the drug. It is always best to discuss your alcohol intake with your healthcare provider when starting any new medication.
Benzyl Alcohol is classified as FDA Pregnancy Category B, meaning it is generally considered low-risk. Animal studies have not shown harm to the fetus, and because it is applied to the skin and rinsed off, very little reaches the developing baby. However, because there are no large-scale studies in pregnant humans, it should be used only if necessary. Your doctor may suggest other methods, like wet combing, before prescribing Benzyl Alcohol. Always consult your OB/GYN before use.
Benzyl Alcohol works to kill live lice within the 10-minute application period. However, it does not kill the eggs (nits). This is why a second treatment is required exactly 7 days later to kill any newly hatched lice. You will not see the full results of the treatment until after the second application is completed. If you still see live, crawling lice 24 hours after the second treatment, notify your healthcare provider.
Yes, you can stop using Benzyl Alcohol at any time as it is not a daily medication and does not cause withdrawal. However, if you do not complete the full two-treatment cycle (initial application plus a 7-day follow-up), the lice infestation is very likely to return. The second dose is essential to break the life cycle of the lice. If you decide to stop, talk to your doctor about alternative ways to manage the infestation.
The 'dose' for lice treatment consists of two applications spaced 7 days apart. If you miss the second application, apply it as soon as you remember. If it has been more than 9 days since the first treatment, the newly hatched lice may have already started laying new eggs. In this case, your doctor may recommend restarting the entire process. Consistent timing is the key to successfully eliminating head lice.
There is no evidence that Benzyl Alcohol causes weight gain. It is a topical treatment or a preservative used in very small quantities. It does not affect the metabolic processes or hormones that regulate body weight. If you are experiencing unexplained weight gain while using a medication that contains Benzyl Alcohol as a preservative (such as insulin or steroids), the weight gain is likely due to the primary medication or the underlying condition, not the Benzyl Alcohol itself.
Topical Benzyl Alcohol has very few drug interactions because it stays mostly on the surface of the skin. However, you should avoid using other topical scalp treatments at the same time to prevent severe skin irritation. If you are using a disulfiram-like medication or have severe liver disease, inform your doctor, as these could theoretically affect how your body processes any absorbed alcohol. Always provide your healthcare provider with a full list of your current medications.
Yes, Benzyl Alcohol is available as a generic 5% topical lotion. It was originally marketed under the brand name Ulesfia, but generic versions are now available, which may be more cost-effective for patients. As a preservative, it is found in hundreds of different generic injectable medications. Whether you use the brand name or the generic, the efficacy and safety profile remain the same when used as directed.
Other drugs with the same active ingredient (Benzyl Alcohol)