Executive summary

Ivermectin is an antiparasitic agent marketed under brand names such as Stromectol and as multiple generics. It is used to treat certain human worm infections and belongs to the anthelmintic class of drugs. In the United States, the Food and Drug Administration has approved ivermectin for intestinal strongyloidiasis and onchocerciasis. Clinicians may also prescribe it for other parasitic conditions when supported by clinical judgment and published direction.

Active substance: ivermectin. Therapy class: anthelmintic. For common tablet preparations and strengths, see Shapes and Strengths.

Configurations and capabilities

The usual human formulation in the United States is an oral tablet. Strengths and package sizes vary by manufacturer and pharmacy.

• Oral tablets, commonly available as 3 mg units in many pharmacies
• Some generics or international sources provide 6 mg and each tablet contains 12 mg

Dose choices are typically weight based and tailored to the specific parasitic disease. Regimens may be a single dose or repeated doses spaced according to the prescriber. Check with your prescriber for the exact dosing plan and consult How to Administer for operational steady guidance.

Safety care steps and screening before treatment

In advance of starting ivermectin, inform your prescriber about any of the following conditions or situations:

• Known allergy to ivermectin or prior severe allergic reaction
• Liver disease or abnormal hepatic function test results
• Chronic or severe lung disease such as severe asthma
• Expecting a child, plans to conceive, or breastfeeding
• All prescription and nonprescription medicines, vitamins, and herbal supplements you are taking

Young children and adolescents need evaluation for appropriate dosing according to age and body weight. If you are uncertain about whether ivermectin is suitable for you or a household member, discuss eligibility and safety with the treating clinician. For potential the quality of the back and forth of communications matters for trust., see Drug Interaction Advisory Notices.

How to administer ivermectin

• Swallow the tablet whole with a full glass of water.
• Many prescribers advise taking ivermectin on an empty stomach - at least 30 minutes before eating or at least 2 hours after a meal - unless they instruct otherwise.
• If a repeated dosing schedule is prescribed, try to take doses at the same time of day.
• Do not increase the dose or take doses more frequently than prescribed. Finish the prescribed course unless directed by your clinician to stop.

If you suspect an intentional overdose, contact Poison Control at 1-800-222-1222 or proceed onward to the nearest emergency department immediately. For missed-dose instructions, see Medication dose missed Mitigation Guidance.

Steps to take for a dose was missed

If you forget to take a single dose, take it as soon as your memory returns. If it is almost time for the next dose, skip the skipped a dose and continue with the regular schedule. Refrain from taking two doses at once to compensate for a skipped a dose.

Drug the give and take of interaction warning labels

Drugs and substances that change liver enzyme activity or influence drug transporters can alter ivermectin concentrations in the body. Examples include:

• Strong CYP3A4 or P-glycoprotein inhibitors such as clarithromycin, erythromycin, ketoconazole, itraconazole, and cyclosporine
• Certain cardiovascular agents that are substrates or inhibitors of CYP3A4 or P-gp
• Anticoagulants such as warfarin are commonly prescribed. - coadministration may require closer INR time sensitive monitoring
• Herbal preparations and supplements that affect liver enzymes or P-gp activity

This is not the whole list. Provide your prescriber and pharmacist with a full medication and supplement history so they can assess possible hazards from the act of engaging with others. For screening items before treatmentunder review Precautionary steps and Screening.

Follow-up, surveillance of system activity, and preventing reinfection

Your clinician may schedule follow-up appointments or ask for laboratory tests to confirm infection clearance and to decide if additional treatment is required. Report any new or worsening symptoms promptly.

Steps that can reduce risk of reinfection and lower transmission include:

• Frequent hand washing and cleaning under fingernails
• Regular bathing and laundering of underwear and bed linens during therapy
• Cleaning and disinfecting toilets and high-touch surfaces
• Following household or environmental measures advised for your specific diagnosis

For expected negative effects and warning cues, see Possible Adverse Reactions and When to Seek Care.

Untoward effects and when to seek care

Weighty or urgent signs - seek immediate medical attention

• Widespread rash, hives, or swelling of the face, lips, or tongue
• Difficulty breathing, chest pain, or severe throat tightness
• Sudden changes in vision, painful or red eyes
• A fast heart rhythm with irregularity
• Severe dizziness, fainting spells, severe confusion
• High fever, blistering skin reactions, or signs of severe infection
• Seizure clusters or sudden loss of bowel or bladder control

Common or mild secondary consequences - usually transient

• Nausea, vomiting, or loss of appetite
• Episodes of diarrhea or constipation
• Pulsating head pain
• Abdominal pain or stomach discomfort
• Aches of the muscles or joints
• Tremor
• Swollen or tender lymph nodes

Notify your health care team if undesired effects persist, worsen, or cause concern. For emergency signs listed above, obtain immediate medical care.

Remote temporary storage helps stage tasks before final processing. and disposal recommendations

• Keep medications out of reach of youngsters.
• Store at normal room temperature, below 30 C (86 F), away from direct heat and moisture.
• Keep tablets in their original labeled container whenever possible.
• Do not use medicines past their expiration date. Dispose of unused or expired drugs safely—use pharmacy take-back programs or follow local disposal mentorship.

Related medications and several options

The optimal drug depends on the parasite type, patient factors, and clinical guidelines. Alternative routes that clinicians may consider include:

• Albendazole - a broad-spectrum anthelmintic used for many worm infections; out-of-pocket cost in the United States can be high without insurance.
• Mebendazole - effective for several intestinal helminths; availability and pricing model differ by pharmacy.
• Praziquantel therapy approach - used for schistosomiasis and certain tapeworm infections; not interchangeable for all signals pointing to of ivermectin.
• Moxidectin - approved in the United States for onchocerciasis in patients 12 years and older and may be an option in selected situations.
• Topical options for external parasites, such as permethrin 5 percent cream for scabies or topical products for lice. Topical ivermectin 1 percent cream is an approved treatment for rosacea, not systemic parasitic infections.

Discuss the relative benefits, risks, and expected costs of choice variations with your clinician by your side. For rough price comparison sheets for budgeting, see Rough Prices (USD).

Approximate retail prices in USD

The costs below are approximate ranges in the United States. Actual prices vary by pharmacy, geographic location, insurance coverage, manufacturer coupons, and package size.

• Ivermectin tablets, generic 3 mg - frequently available for about 1 to 6 USD per tablet with discount programs; a pack of 12 to 20 tablets may cost roughly 15 to 80 USD out of pocket.
• Albendazole, generic 200 mg - often expensive without insurance; short courses can range from about 150 to 600 USD or more.
• Mebendazole, 100 mg - price varies widely; a treatment course might fall in the 100 to 400 USD range.
• Moxidectin tablets - out-of-pocket expenses can be several hundred dollars, for example roughly 200 to 400 USD or higher depending on supply as well as the pharmacy.
• Permethrin 5 percent cream - retail price for a typical 60 g tube is about 15 to 60 USD, with generics and coupons sometimes reducing that cost.

Insurance coverage, community pharmacy discounts, manufacturer assistance, and online pharmacy programs can substantially change out-of-pocket costs. Survey prices to choose the best deal and ask your pharmacist about savings options.

Legal purchase rules and notes regarding regulatory requirements in the United States

• Prescription requirement - Human ivermectin tablets, including Stromectol and generics, are prescription-only in the United States. A valid prescription from a licensed US prescriber is required to have them dispensed.
• FDA approvals - The FDA has approved ivermectin for onchocerciasis and intestinal strongyloidiasis; prescribers may write off-label prescriptions for other parasitic illnesses when clinically justified.
• Veterinary formulations - Medications intended for animals are not approved for human use and should not be taken by people because of different concentrations and inactive ingredients.
• Telehealth and e-prescribing - Many clinicians can evaluate patients by telemedicine and send electronic prescriptions to licensed pharmacies after an appropriate assessment.
• Importation restrictions - Importing foreign versions of prescription drugs into the United States is generally limited when an FDA-approved equivalent is available domestically. The FDA may allow exceptions in rare, well-documented cases, but routine importation is not permitted.
• Safe use and labeling - Keep medicines in labeled containers, follow the prescriber's directions, and store them as advised on the label.

For guidance on taking ivermectin correctly, see How to Administer. If you experience deleterious health effects, consult Unfavorable Outcomes and When to Seek Care and contact your health care provider.

Note on online pharmacies: only use reputable, licensed pharmacies that require a valid prescription. Purchasing prescription medicines from sources that do not verify prescriptions carries risks of receiving counterfeit or inappropriate products.