Abametapir for the Treatment of Head Lice: A Drug Review

Ann Pharmacother. 2022 Mar;56(3):352-357. doi: 10.1177/10600280211027968. Epub 2021 Jun 22.


Objective: This article reviews the pharmacology, safety, efficacy, and clinical importance of abametapir 0.74% (Xeglyze) for the treatment of head lice.

Data sources: From 2020 to May 2021, a systematic review of the MEDLINE and EMBASE databases was conducted using the terms abametapir, Xeglyze, Ha44, and head lice. Bibliographies, Food and Drug Administration (FDA) drug package inserts, and ClinicalTrials.gov were searched for further information.

Study selection and data extraction: All relevant full-text articles in English were considered for inclusion, with a final article date range of 1999 to 2020.

Data synthesis: Abametapir chelates heavy metal cations and inhibits metalloproteinases critical to louse ova development, hatching, and adult survival. In phase II, abametapir had direct ovicidal activity inhibiting 100% of treated louse eggs from hatching, compared with 64% in the vehicle-treated group. In two identical phase III clinical trials, subjects treated with a single 10-minute application of abametapir had greater treatment success compared with vehicle-treated subjects, with 81.1% success versus 50.9% in study 1 (P = 0.001) and 81.8% versus 47.2% in study 2 (P < 0.001). Abametapir was well tolerated, with only mild adverse effects.

Relevance to patient care and clinical practice: Abametapir is a newly FDA-approved, single-application treatment for head lice in patients aged 6 months and older. This review highlights the safety and efficacy of abametapir in the treatment of head lice.

Conclusions: In the wake of increasing widespread resistance to first-line treatment options, abametapir offers a safe and effective new treatment option for head lice infestations.

Keywords: Pediculus humanus capitis; Xeglyze; abametapir; head lice; head lice treatment.

Publication types

  • Systematic Review

MeSH terms

  • Adult
  • Animals
  • Humans
  • Infant
  • Insecticides* / adverse effects
  • Lice Infestations* / drug therapy
  • Pediculus*
  • Pharmaceutical Preparations*
  • Treatment Outcome


  • Insecticides
  • Pharmaceutical Preparations