Summary and key points

Ivermectin is the active ingredient in brand products such as Stromectol and in multiple generic tablets sold on prescription. It is an antiparasitic agent, not an antibiotic.

In the UK it is most commonly used for infections such as strongyloidiasis and onchocerciasis. Clinicians may also prescribe oral ivermectin for scabies or some lice problems, often alongside topical treatments.

Tablets are typically supplied in strengths like 3 mg, 6 mg and 12 mg. The correct dose and schedule depend on the condition being treated, the patient weight and current clinical guidance; some regimens are single doses while others require repeated dosing or combination therapy.

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The correct method for taking ivermectin

Swallow the tablets whole as you drink a full glass of water. Follow the timing instructions given by your prescriber. When advised, ivermectin is often taken on an empty stomach, for example at least 30 minutes before a meal or a couple of hours after eating.

If you have multiple doses to take, aim to take them at the same time each day to keep blood levels steady. Never alter the dose or stop treatment without consulting the prescriber. Finish the course even if symptoms improve early unless directed otherwise.

• Avoid grapefruit and grapefruit juice while on treatment as they can influence the metabolism of some medicines.
• For children, dosing is weight based; seek paediatric advice for accurate calculations and administration details.
• If you suspect an they overdosed, contact NHS 111, your local emergency department or a poison advice line immediately.

Guidance on what to do if you miss a dose

Caution notes and medical checks before starting

Tell your clinician about all medicines, herbal products and supplements you take and give a full medical history. Highlight any of the following where they apply to you:

• Recent abnormal liver function tests or any known liver disease
• Any previous allergic reaction to ivermectin or to tablet ingredients
• Pregnancy, planning to become pregnant or breastfeeding
• Past episodes of seizures, serious neurological conditions or fainting episodes
• Severe uncontrolled respiratory disease such as asthma
• Residence in or recent travel to regions where Loa loa (the African eye worm) is endemic

Prescribers are usually cautious with very young children and may limit routine use below certain weight thresholds; specialist advice is recommended for paediatric cases.

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Collateral effects and when to call emergency services

Many people tolerate ivermectin without major problems but adverse reactions can occur. Seek urgent medical attention if you develop signs of a serious reaction:

• Widespread rash, hives, swelling of the face, throat or tongue, or difficulty breathing
• Sudden and severe eye symptoms such as a pronounced change in vision, intense pain, marked redness or swelling
• Severe blistering, peeling of the skin or mouth ulcers
• Chest pain or very fast or irregular heartbeats
• Seizure presentations, collapse, fainting or sudden confusion
• High fever or painful extensive swelling

Milder and more commonly reported effects include episodic headache, nausea, vomiting, stomach discomfort, diarrhoea or constipation, reduced appetite, muscle pain, tremor and enlarged or tender lymph nodes.

If incidental effects persist or worry you, contact the prescriber or a pharmacist for advice.

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Certain medicines and substances can alter ivermectin levels in the body or increase the chance of unwanted effects. Always tell your prescriber about prescription drugs, over-the-counter medicines and supplements.

• Strong CYP3A4 and P-glycoprotein inhibitors such as ketoconazole, ritonavir and cobicistat, and some macrolide antibiotics
• Certain calcium channel blockers that affect metabolic pathways
• Warfarin represents an anticoagulant option., which may require closer monitoring in real time of clotting tests
• Other central nervous system depressants and alcohol, which can enhance drowsiness or dizziness
• Grapefruit or grapefruit juice, which can affect metabolism of some coadministered medicines

This is a partial listing. Check specific combinations with your prescriber or pharmacist before starting ivermectin.

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Monitoring operations, prevention and hygiene measures

Your clinician may arrange follow-up checks or tests to confirm the infection has cleared. Depending on the organism this could include stool tests, skin checks or eye examinations.

Steps to reduce the risk of reinfection and prevent spread:

• Wash hands regularly and keep fingernails trimmed and clean
• Launder bed linen, towels and underwear frequently during treatment, using hot washes if possible
• Keep living areas and bathrooms clean, and disinfect commonly touched surfaces

If symptoms persist, worsen or you develop new worrying signs after treatment, contact your prescriber promptly.

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Advice on the dose was skippeds

If you miss a scheduled tablet take it as soon as you remember unless the next dose is due soon. If the next dose is imminent, skip the missed tablet and continue with the normal schedule. Do not take more than prescribed to make up for a skipped a dose.

If you were prescribed a single, timed dose by a clinician and you missed that appointment, contact the prescriber to agree the correct next step.

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• Ensure medications stay out of reach and out of sight for kids and pets.
• Store at normal room temperature, ideally below 30 degrees C, in a closed container away from heat and moisture.
• Do not use tablets after the expiry date printed on the packaging.
• Return unused or expired medicines to a community pharmacy for safe disposal. Do not throw medicines in household bins or pour them down drains.

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Other possible medicines and related treatments

The optimal treatment depends on the parasite, patient age, pregnancy or breastfeeding status, weight and local resistance patterns. Possible varied options or adjuncts include:

• Permethrin 5 percent cream for scabies; lower strength or different formulations for head lice
• Topical lice products such as dimeticone or spinosad
• Benzyl benzoate or malathion lotions where appropriate
• Oral albendazole or mebendazole for certain intestinal worm infections
• Diethylcarbamazine (DEC) for specific filarial infections under specialist supervision
• Do not use veterinary ivermectin products for people; they are not licensed for human treatment

Oral ivermectin is typically reserved for defined clinical situations, for example crusted scabies or when topical therapy fails, and should only be used under medical supervision.

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Typical custom pricing in the United Kingdom and cost considerations

Private prices vary with brand, pack size and supplier. The ranges below are approximate and intended to give a general idea; check current prices with a UK pharmacy before purchase.

• Ivermectin tablets (3 mg to 12 mg): around 10 GBP to 40 GBP for small prescription packs commonly used in single-dose or short-course regimens
• Permethrin 5 percent cream (30 g to 60 g): roughly 5 GBP to 15 GBP
• Malathion lotion: about 10 GBP to 20 GBP
• Dimeticone or spinosad lice products: commonly 5 GBP to 15 GBP
• Albendazole and mebendazole oral products: typically 10 GBP to 60 GBP depending on formulation and pack size

If you are eligible for NHS prescriptions the cost to the patient will depend on the current prescription charging rules and any exemptions. For many patients an NHS prescription will be cheaper than buying privately. Confirm prices and eligibility with a UK-registered pharmacy.

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Status of legal recognition and how to secure the status ivermectin in the UK

• Prescription status: oral ivermectin is classified as a Prescription Only Medicine (POM) in the UK. A valid prescription from a clinician registered in the UK is required for lawful human use.
• Where to get it: obtain medicines from pharmacies regulated by the General Pharmaceutical Council (GPhC). Legitimate online UK pharmacies will display the correct distance selling accreditation.
• Importing medicines: imports are subject to controls by the Medicines and Healthcare products Regulatory Agency (MHRA). Limited personal imports may be allowed in specific circumstances; check MHRA guidance before ordering from abroad.
• Advertising rules: it is unlawful to advertise prescription-only medicines directly to the public in the UK. Be cautious of websites making unverified claims or offering prescription drugs without a consultation.
• Off-label and veterinary use: follow the advice of an authorised clinician. Do not self-prescribe or use veterinary formulations for humans.
• Driving and machines: if you experience dizziness, drowsiness or visual disturbance while taking ivermectin do not drive or use heavy machinery until you are confident it is safe.
• Safe disposal: take leftover or expired medicines back to a pharmacy rather than disposing of them in household waste.

For authoritative and up-to-date guidance consult NHS.uk, the MHRA conjoined with the General Pharmaceutical Council.

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