Dosage Forms
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Foam, External:
Tersi: 2.25% (70 g [DSC]) [contains trolamine (triethanolamine)]
Lotion, External:
Generic: 2.5% (118 mL, 120 mL)
Shampoo, External:
Anti-Dandruff: 1% (207 mL) [contains brilliant blue fcf (fd&c blue #1), menthol]
SelRx: 2.3% (180 mL) [contains fd&c red #40, methylparaben, propylene glycol, propylparaben]
Generic: 2.25% (180 mL); 2.3% (180 mL)
Pharmacology
Mechanism of Action
May block the enzymes involved in growth of epithelial tissue
Pharmacokinetics/Pharmacodynamics
Absorption
Topical: None through intact skin, but can be absorbed through damaged skin
Use: Labeled Indications
Dandruff, scalp seborrhea: Treatment of dandruff and seborrheic dermatitis of the scalp
Tinea versicolor: Treatment of tinea versicolor
Contraindications
Hypersensitivity to selenium sulfide or any component of the formulation.
Dosage and Administration
Dosing: Adult
Note: Tersi foam has been discontinued in the US for more than 1 year.
Dandruff, scalp seborrhea: Topical:
Foam: Rub into affected skin twice daily.
Lotion, shampoo (2.25%, 2.3%): Massage ~5 to 10 mL into wet scalp; leave on scalp for 2 to 3 minutes, then rinse scalp thoroughly. Repeat application and rinse thoroughly. Usually 2 applications each week for 2 weeks with provide control. After this, may repeat at less frequent intervals (eg, once weekly, every 2 to 4 weeks).
Shampoo (OTC 1%): Massage shampoo into wet scalp then rinse thoroughly. Use at least twice weekly for best results.
Tinea versicolor: Topical:
Foam: Rub into affected skin twice daily.
Lotion, shampoo (2.25%, 2.3%): Apply to affected area and lather with small amounts of water; leave on skin for 10 minutes, then rinse thoroughly; repeat once every day for 7 days.
Dosing: Geriatric
Refer to adult dosing.
Dosing: Pediatric
Note: Tersi foam has been discontinued in the US for more than 1 year.
Dandruff, scalp seborrhea: Topical:
Lotion: Children and Adolescents: Massage 5 to 10 mL into wet scalp, leave on scalp 2 to 3 minutes, and rinse thoroughly. Repeat application and rinse thoroughly. Usually 2 applications each week for 2 weeks will provide control; after this, may repeat at less frequent intervals (eg, once weekly, every 2 to 4 weeks)
Shampoo: Limited data available: Children and Adolescents: Massage shampoo into wet scalp then rinse thoroughly. Use at least twice weekly for best results (Kliegman 2016; Schachner 2011)
Tinea versicolor: Topical:
Lotion: Children and Adolescents: Apply to the affected area and lather with a small amount of water; leave on skin for 10 minutes, then rinse thoroughly; apply once daily for 7 days. Some experts suggest weekly or monthly application may be used to prevent recurrence (Red Book [AAP 2015])
Shampoo: Limited data available: Children and Adolescents: Apply to the affected area and let sit for 5 to 10 minutes, then rinse off. Apply once daily for 3 to 7 days; once controlled weekly or monthly application may prevent recurrence (Red Book [AAP 2015])
Tinea capitis, adjunct treatment: Limited data available: Children and Adolescents: Lotion, Shampoo: Topical: Apply and leave on for 5 to 10 minutes and then rinse; apply two or three times weekly; used with concomitant systemic therapy; continue for at least 2 weeks until clinical/mycologic cure (Givens 1995; Red Book [AAP 2015])
Administration
Topical: Shake well before using. For external use only; not for ophthalmic, oral, anal or intravaginal use. Do not use when acute inflammation or exudation is present or on damaged skin or mucous membranes. For color treated or permed hair, it is especially important to rinse hair thoroughly after treatment. May damage jewelry; remove before treatment.
Storage
Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C to 30°C (59°F to 86°F). Protect from heat and freezing.
Foam: Contents under pressure. Contains flammable materials. Do not puncture or incinerate. Do not expose to temperatures over 120°F (48°C) even when empty.
Drug Interactions
There are no known significant interactions.
Adverse Reactions
Frequency not defined.
Central nervous system: Lethargy
Dermatologic: Alopecia or hair discoloration, unusual dryness or oiliness of scalp
Gastrointestinal: Vomiting following long-term use on damaged skin, abdominal pain, garlic breath
Local: Burning, itching, irritation, stinging (transient)
Neuromuscular & skeletal: Tremor
Miscellaneous: Diaphoresis
Warnings/Precautions
Concerns related to adverse effects:
- Local effects: Skin irritation or sensitization may occur; discontinue use if irritation or sensitivity occurs.
Other warnings/precautions:
- Appropriate use: For external use only; not for ophthalmic, oral, anal or intravaginal use. Due to the risk of systemic toxicity, do not use when acute inflammation or exudation is present or on damaged skin or mucous membranes.
- Self-medication (OTC use): Shampoo: When used for self-medication, contact a health care provider before use if the seborrheic dermatitis is in other areas other than the scalp. Discontinue use and contact a healthcare provider if condition worsens or does not improve after regular use.
Pregnancy
Pregnancy Risk Factor
C
Pregnancy Considerations
Animal reproduction studies have not been conducted. The manufacturer's labeling for some products recommend against using selenium sulfide in pregnant women.
Patient Education
- Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
- Patient may experience burning, stinging, hair discoloration, oily hair or scalp, dry hair or scalp, or hair loss. Have patient report immediately to prescriber application site redness or irritation (HCAHPS).
- Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.
