FDA-filed SPL labeling · retrieved through openFDA

Spinosad Topical

Spinosad topical suspension is an antiparasitic treatment used to eliminate head lice infestations and scabies infestations in adults and children.

Brand names NatrobaComfortis
Drug class ⓘ Pediculicide
Rx Form 1 Route Topical
Dr. Brian Staiger, PharmD, BCPS
Reviewed by Last reviewed Jul 10, 2026
🧬 Where this information comes from Click to expand

The clinical label records used on this page are FDA-filed Structured Product Labeling (SPL) retrieved through openFDA. We identified 5 clinical label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. Forms, routes, brands, labelers, strengths, and NDC product-record counts are built separately from matching FDA National Drug Code Directory records. The linked DailyMed document is a representative official source for verification, not the page’s only clinical source. View the linked label on DailyMed →

At a glance
Linked label effectiveJan 29, 2024
Clinical labels in scope ⓘ5
AvailabilityRx
Earliest approval/marketing year ⓘ2011
FDA-listed product records ⓘ7
Boxed warningNone found in compared labels
How we combine label and product data →
✓No current FDA shortage listed · checked Sep 24, 2026
⭐ Spinosad Topical at a glance The quick version — the full detail is in the Patient Information Guide below.
💊
HelloPharmacist Editorial Team Bottom Line
Spinosad Topical Suspension is a proven treatment for head lice (in patients 6 months and older) and scabies (in patients 4 years and older) that works by paralyzing and killing the insects or mites. It is applied to the skin or scalp and generally well tolerated, with mild skin or eye irritation being the most common side effects. It should not be used in infants under 6 months old due to the benzyl alcohol it contains.

📖 Spinosad Topical: Patient Information Guide

A plain-language walkthrough of Spinosad Topical — what it treats, how it works, how it’s taken, side effects, warnings and interactions. Tap any section to expand it.

🎯What it's used for▾

Spinosad Topical Suspension is an antiparasitic medicine used to treat two common infestations:

  • Head lice infestations — approved for adults and children 6 months of age and older
  • Scabies infestations — approved for adults and children 4 years of age and older
⚙️How it works▾

Spinosad targets the nervous system of lice and mites. It causes a burst of uncontrolled nerve firing — essentially overloading the insect's nervous system. After this period of hyperexcitation, the lice or mites become paralyzed and die. Because this mechanism targets insect nerve receptors, it works directly on the parasites rather than being absorbed into your body in meaningful amounts.

💊How it's taken▾

Spinosad Topical Suspension is applied to the skin or scalp — never swallowed or used in the eyes. The number of applications and the area covered differ depending on what you're treating:

  • Head lice: Apply to dry scalp and dry hair, leave on for 10 minutes, then rinse with warm water. A second treatment may be used 7 days later only if live lice are still visible.
  • Scabies: Apply to the entire body from the neck down to the soles of the feet. Patients with a balding scalp should also apply it to the scalp, hairline, temples, and forehead. Let it absorb and dry for 10 minutes before dressing, and leave it on for at least 6 hours before showering or bathing.

Always follow your prescriber's specific instructions and shake the bottle well before each use.

🤒Side effects — in detail▾

Most people tolerate Spinosad Topical Suspension well. The most commonly reported side effects include:

  • Redness at the application site (for head lice treatment)
  • Eye redness or irritation (for head lice treatment)
  • Application site irritation, including pain and burning (for scabies treatment)
  • Dry skin (for scabies treatment)
  • Application site dryness or flaking (less common, head lice treatment)
  • Hair loss (reported rarely during head lice treatment)

If you accidentally swallow any of the product, or if a young infant shows unusual symptoms after use, seek medical attention right away or call Poison Control at 1-800-222-1222.

⚠️Warnings & precautions▾
  • Not for infants under 6 months: Spinosad Topical Suspension contains benzyl alcohol, which can be dangerous for very young infants. It is not approved for babies younger than 6 months due to a higher risk of the ingredient being absorbed through their skin and because their bodies cannot process it as well.
  • Benzyl alcohol risk in newborns: In neonates and low-birth-weight infants, high levels of benzyl alcohol (given intravenously in other settings) have caused a life-threatening condition called "gasping syndrome" — marked by breathing problems, nervous system depression, seizures, and in some cases, death. While topical use is a very different scenario, the product is still not recommended in this age group as a precaution.
  • External use only: Do not swallow, use in the eyes, or use vaginally. If swallowed, call Poison Control immediately.
  • Children must be supervised: Always apply Spinosad Topical Suspension to a child under direct adult supervision.
🔀What it interacts with▾

The FDA label for Spinosad Topical Suspension does not identify specific drug, food, or substance interactions.

    This is not a complete list of interactions. Always talk with your doctor or pharmacist before starting, stopping, or changing any medication.

    📋Before taking it▾
    • Infants under 6 months: Do not use — not approved for this age group due to benzyl alcohol safety concerns.
    • Children under 4 years for scabies: Safety and effectiveness for scabies have not been established in children under 4.
    • Pregnancy: Spinosad is not expected to absorb into the bloodstream through the skin in meaningful amounts, so fetal exposure is not expected — but always let your doctor know you are pregnant before starting any treatment.
    • Breastfeeding: Spinosad is not expected to pass to a nursing infant through breast milk. However, wash the breast area with soap and water before nursing to avoid the baby coming into direct contact with the product.
    • Older adults: Clinical studies did not include enough patients over 65 to identify age-specific differences. No dose adjustments are noted, but talk to your doctor if you have concerns.
    • Eye sensitivity: Avoid getting the product in or near your eyes. If contact occurs, rinse thoroughly with water.
    🚑If you take too much▾

    There is no specific antidote if Spinosad Topical Suspension is accidentally swallowed. If ingestion occurs, contact Poison Control at 1-800-222-1222 right away for the latest guidance, and seek medical attention immediately.

    🔬Pharmacokinetics — how your body processes it▾

    Studies in children with head lice found that spinosad was not measurably absorbed into the bloodstream following a single 10-minute topical application — blood levels were below the detectable limit in all subjects tested across different age groups and formulation strengths. Benzyl alcohol, an ingredient in the suspension, was detectable in the blood of some younger children (6 months to 4 years) after application, though not in older children. This suggests that very young children may absorb the benzyl alcohol component more readily, which is part of why the product is not recommended for infants under 6 months.

    📦How to store it▾

    Store at 25° C (77° F); excursions permitted to 15° to 30° C (59° to 86° F).

    📄 Written from Spinosad Topical’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Every point is grounded in that labeling — nothing is invented. How we use AI →

    3

    Supplements & herbs that interact with Spinosad Topical

    3 supplements and herbal products have documented interactions with Spinosad Topical in the licensed clinical database we use. Most are manageable — but your pharmacist should know about everything you take, including vitamins and herbals.

    Severity mix
    • Moderate · 2
    • Minor · 1
    Every supplement checked against Spinosad Topical — ranked by severity The full interaction hub: 2 moderate · 1 minor · every one linked to its full report. Check Spinosad Topical against your exact supplements

    Educational information from a licensed clinical database (Natural Medicines) — see our data sources & update cadence. Not medical advice: an interaction being documented does not mean it will happen to you; do not start or stop medications or supplements without professional guidance.

    🩺 Pharmacist Counseling Corner

    Quick, plain-English answers to the questions patients ask most about Spinosad Topical — the kind of thing our pharmacy team would talk through with you at the counter.

    Do I need to use a nit comb with this treatment? ▾
    You don't have to, but you can. A fine-tooth or special nit comb can be used after treatment to help remove dead lice and nits (lice eggs) from the hair. It's optional but can be helpful as part of your overall lice management routine.
    What else do I need to do around the house when treating head lice or scabies? ▾
    Treating the infestation on the body is just one part of the plan. For head lice, wash any recently worn clothing, hats, bedding, and towels in hot water or dry-clean them, and wash combs, brushes, and hair clips in hot water. For scabies, wash any bedding, clothing, or towels used by the person with scabies in hot water or dry-clean them. This helps prevent re-infestation.
    What if lice are still there after the first treatment? ▾
    Check your hair or your child's hair 7 days after the first treatment. If you can still see live lice at that point, you can apply a second treatment. You don't need to automatically repeat it — only use a second application if live lice are actually present.
    Is this safe for my baby or young child? ▾
    It depends on the age and what you're treating. For head lice, Spinosad Topical Suspension is approved for children 6 months and older — but not for babies younger than 6 months. For scabies, it's approved for children 4 years and older. The product contains benzyl alcohol, which can be harmful to very young infants. Always apply it to a child under direct adult supervision, and check with your pediatrician if you have any doubts about your child's age or health.
    Can I use this if I'm pregnant or breastfeeding? ▾
    Spinosad is not expected to be absorbed into your bloodstream through the skin in significant amounts, so fetal or infant exposure is not expected. If you're breastfeeding, make sure to wash the breast area with soap and water before nursing to avoid any direct contact with your baby. That said, always let your doctor know you're pregnant or breastfeeding before using any new treatment.
    What side effects should I watch out for? ▾
    Most people only notice mild redness or irritation where the product was applied. For head lice treatment, some eye redness can occur if the product gets near the eyes — rinse well with water if that happens. For scabies treatment, some skin irritation or dryness at the application site is the most common complaint. If you accidentally swallow any of the product, call Poison Control right away at 1-800-222-1222.
    Is Spinosad Topical available over the counter? ▾
    Spinosad Topical is dispensed by prescription according to its FDA labeling, so it isn't sold over the counter. Your prescriber and pharmacist will determine if it's appropriate for you.
    When was Spinosad Topical first available? ▾
    Spinosad Topical has been available in the United States since at least 2011, based on FDA approval history (Drugs@FDA) and product marketing records.
    Who makes Spinosad Topical? ▾
    Spinosad Topical is supplied by 3 manufacturers listed in the FDA NDC Directory, including Allegis Pharmaceuticals, LLC, Cipher Pharmaceuticals Inc., ParaPRO LLC.

    💬 Answers drafted from Spinosad Topical’s FDA-approved label information, summarized in plain language with AI, and reviewed by our pharmacy team before publication. Grounded in that labeling — nothing is made up. How we use AI →

    🧰 Keep exploring

    💊 How Spinosad Topical comes

    Spinosad Topical is available in 1 form. Different forms and brands can have different approved uses, doses, schedules, and directions. Follow the instructions for your exact product, and do not switch forms without guidance from your prescriber or pharmacist.

    Topical suspension

    On the skin
    Brands Natroba
    How this form is used
    What it may be used for
    • Treats head lice infestations in adults and children 6 months of age and older
    • Treats scabies infestations in adults and children 4 years of age and older
    Important instructions
    • For head lice: shake the bottle well, apply to dry scalp and dry hair, leave on for 10 minutes, then rinse with warm water; repeat after 7 days only if live lice are still present
    • For scabies: shake the bottle well, rub into skin from neck to soles of feet, allow to dry for 10 minutes before dressing, and leave on for at least 6 hours before bathing
    • Avoid contact with eyes; if product gets in or near eyes, rinse thoroughly with water
    • Apply to a child only under direct adult supervision
    Available strengths 1 strength
    7 FDA-listed product records ⓘ

    📊 Spinosad Topical across the U.S. market

    How Spinosad Topical appears in the FDA’s National Drug Code Directory — including its dosage forms, strengths, brand names, manufacturers, and FDA-listed product records. These are directory records, not sales or prescription volume.

    1
    Dose forms ⓘ
    3
    Manufacturers
    2
    Brand names
    7
    FDA-listed product records ⓘ
    2011
    First marketed ⓘ
    Allegis Pharmaceuticals, LLC43%
    Cipher Pharmaceuticals Inc.29%
    ParaPRO LLC29%

    Share of FDA-listed product records by manufacturer — FDA National Drug Code Directory. Record counts are not sales or prescription volume.

    📈 How widely Spinosad Topical is used

    A general measure of how commonly Spinosad Topical is prescribed, based on Medicaid — one of the largest public drug programs. The figure below is prescriptions filled in Q1–Q4 2025, summed across every form and brand of the drug.

    Think of this as a proxy for how widely Spinosad Topical is used, drawn from freely available public data. Medicaid is just one program — these numbers don’t include Medicare, other government coverage, or commercial and cash-pay prescriptions, so real-world use is higher than what’s shown here.

    178,338
    Medicaid prescriptions filled (Q1–Q4 2025)
    $46.8M gross Medicaid reimbursement (before mandatory rebates — net cost is lower)

    How commonly is Spinosad Topical prescribed? Of the 1,596 medications we measure, Spinosad Topical ranks #411 by Medicaid prescriptions — more than 74% of them.

    Where Spinosad Topical ranks among the drugs we measure · Q1–Q4 2025 · neighbors ±5

    Utilization by Spinosad Topical product

    Pick a product to see its own Medicaid numbers. Each chip is one clinical product — a specific strength & dosage form as defined by RxNorm — with brand-name and generic versions combined.

    spinosad 9 MG/ML Medicated Shampoo

    178,338 Medicaid prescriptions (Q1–Q4 2025) 100% of Spinosad Topical prescriptions shown $46.8M gross reimbursement (before rebates) ≈ $262 per prescription (gross)

    Summed across the 3 of 5 listed NDC products with Medicaid activity — every brand and generic of this exact strength & form. RxNorm 1085816

    Shares are of the Medicaid prescriptions shown here. Product grouping follows RxNorm (the National Library of Medicine’s drug terminology), so “one product” means one strength & dosage form regardless of manufacturer. Dollar figures are gross Medicaid reimbursement before mandatory rebates — rebates (often large, especially for brand-name drugs) are confidential, so actual net cost to Medicaid is lower than shown.

    Source: Medicaid State Drug Utilization Data (CMS), aggregated by generic ingredient — summed across every NDC (all brands, strengths, salt forms and dosage forms) of Spinosad Topical, and across all states and both fee-for-service and managed-care claims. A general popularity signal; it excludes Medicare, commercial insurance and cash prescriptions, so it is not total U.S. use. Based on the 3 of 5 listed Spinosad Topical NDCs with Medicaid activity.

    🔍 Compare Spinosad Topical products

    A representative set of FDA-listed product records for Spinosad Topical — across manufacturers, strengths, and dosage forms, grouped by form with each product’s manufacturer and how the FDA approved it. The same medicine may be made and packaged by different companies, so a single drug can have many directory entries. (It’s also why a refill can look different — a new shape, color, or box — even though it contains the same medication.)

    Strength Route Manufacturer / Labeler Category ⓘ Details
    💊Topical suspension
    9 mg/mL Topical Allegis Pharmaceuticals, LLC × 2 listings NDA AUTHORIZED GENERIC View NDC →
    9 mg/mL Topical Allegis Pharmaceuticals, LLC NDA View NDC →
    9 mg/mL Topical Cipher Pharmaceuticals Inc. NDA View NDC →
    9 mg/mL Topical Cipher Pharmaceuticals Inc. NDA AUTHORIZED GENERIC View NDC →
    9 mg/mL Topical ParaPRO LLC NDA View NDC →
    9 mg/mL Topical ParaPRO LLC NDA AUTHORIZED GENERIC View NDC →

    Showing 7 of 7 products — FDA National Drug Code Directory. See every product, package size and price: browse all 7 Spinosad Topical NDCs →

    RxNorm Concept Web — From Ingredient to Every Form and Strength

    This page starts with one ingredient concept (IN). The branches below show its dose-form concepts (SCDF), then the available clinical drug and strength concepts (SCD). Combination products remain separate concepts with their own pages.

    Ingredient (IN) Spinosad Topical RxCUI 299081 2 dose forms · 6 strengths
    1. Dose form (SCDF) Chewable Tablet RxCUI 899132 No current FDA listing
      Clinical drug / strength (SCD) 140 MG RxCUI 899133 270 MG RxCUI 899143 560 MG RxCUI 899147 810 MG RxCUI 899151 1620 MG RxCUI 899139
    2. Dose form (SCDF) Medicated Shampoo RxCUI 1085815 No current FDA listing
      Clinical drug / strength (SCD) 9 MG/ML RxCUI 1085816

    Look up RxCUI 299081 in the RxCUI Atlas →

    RxNorm is the U.S. National Library of Medicine’s normalized drug vocabulary. Its concept hierarchy can include forms that are not currently marketed; the status on each branch compares that concept with current FDA listings. RxCUIs identify vocabulary concepts, not individual packages or manufacturers.

    🏷️ Sold under these brand names

    Natroba Comfortis

    🏭 Manufacturers & labelers

    Allegis Pharmaceuticals, LLC 3 Cipher Pharmaceuticals Inc. 2 ParaPRO LLC 2

    RxNorm drug class

    Spinosad Topical belongs to the Pediculicide class.

    Pharmacologic class Pediculicide

    Classified by RxNorm RxClass — the U.S. National Library of Medicine's standardized drug-classification service (Established Pharmacologic Class from the FDA, the ATC drug family from the WHO, and mechanism of action). Reference only, not medical advice.

    🔬 Where this comes from

    Core label, product, RxNorm, safety, and utilization data on this page come from the sources identified below. AI-written, editorial, and licensed sections are labeled separately.

    📄
    FDA-filed drug labels (SPL) Uses, dosing, warnings & side effects from SPL records retrieved through openFDA; the linked representative set can be verified on DailyMed. ✓ Linked label effective Jan 29, 2024
    🏭
    Forms, brands & labelersAggregated from ingredient-matched FDA National Drug Code Directory product records for Spinosad Topical.
    📈
    Real-world reportsThe FDA Adverse Event Reporting System (FAERS), served through openFDA.
    🚨
    Recalls & shortagesopenFDA drug-enforcement reports and the FDA drug-shortage database.
    🧾 Clinical label set — FDA-filed SPL labels retained for Spinosad Topical after exact ingredient or ingredient-combination matching and applicable route/form matching
    Clinical labels in scope
    5
    NDC products indexed
    7
    Distinct labelers/manufacturers represented
    3
    Linked representative label ⓘ
    ParaPRO LLC
    Linked label effective
    Jan 29, 2024
    Composite sections available
    22
    Linked SPL Set ID
    0d6e2507-3669-441e-b5ba-86087fd2955d
    Linked SPL Document ID
    f2a068ae-4f02-4647-bb8d-052f82dd8d87
    Open the linked representative label on DailyMed ↗
    NDC package records associated with this linked SPL 1

    How we combine label and product data

    HelloPharmacist combines public FDA and NLM records; we don’t author the underlying clinical facts. We identified 5 FDA-filed SPL label sets within the page’s selected clinical scope after exact ingredient or ingredient-combination matching and applicable route/form matching. The representative label is the starting point for the displayed reference monograph; the 12 largest stored in-scope SPL records, which may include that representative, are compared section by section, and the longest available version of each section is retained. Forms, routes, brands, labelers, product-listed strengths, and product-record counts are aggregated separately from ingredient-matched FDA NDC Directory records; package records listed above are associated with the linked SPL; and the normalized concept hierarchy comes from NLM RxNorm.

    Where a section is identified as AI-written, its plain-language text is generated from bounded label evidence. New draft drug pages remain in the admin review queue before first publication. ParaPRO LLC is the representative DailyMed label linked for verification and dates; it is not the sole source used for the page.

    This is general education, not medical advice — always consult your doctor or pharmacist about your medications and any medical condition. For the exact wording of the linked representative label, view that label on DailyMed; some displayed composite sections may come from other in-scope SPL labels. Learn how we use AI and our data sources & update cadence.