What are the dosing and indications for different ivermectin treatments?

From the Guidelines

Ivermectin dosing and indications vary depending on the specific parasitic infection being treated, with the most recent and highest quality evidence recommending a dose of 200 mcg/kg for strongyloidiasis, onchocerciasis, and scabies, as seen in the 2025 study 1. The indications for ivermectin treatment include:

• Strongyloidiasis: a single oral dose of 200 mcg/kg
• Onchocerciasis (river blindness): 200 mcg/kg repeated every 6-12 months until the infection resolves
• Scabies: a single oral dose of 200 mcg/kg, with a second dose 1-2 weeks later in severe cases
• Head lice: a single 200 mcg/kg dose, sometimes repeated after 7-10 days
• Rosacea: a topical 1% cream applied once daily to affected areas The medication works by binding to glutamate-gated chloride channels in invertebrate nerve and muscle cells, causing paralysis and death of the parasites, as described in the 2015 study 1. Some key points to consider when using ivermectin include:
• The medication should be taken on an empty stomach with water
• Patients should be aware that temporary worsening of itching may occur as parasites die
• Ivermectin is generally well-tolerated but can cause dizziness, nausea, diarrhea, or skin rash
• It should be used with caution in pregnant women, children weighing less than 15 kg, and patients with central nervous system disorders, as noted in the 2010 study 1. In the case of crusted scabies, combination treatment with a topical scabicide and oral ivermectin is recommended, with a dose of 200 ug/kg on days 1,2,8,9, and 15, and additional treatment on days 22 and 29 in severe cases, as seen in the 2015 study 1. For other parasitic infections, such as lymphatic filariasis and loiasis, ivermectin may be used in combination with other medications, such as albendazole, and the dose and treatment duration may vary depending on the specific infection and patient population, as described in the 2025 study 1.

From the FDA Drug Label

The evaluation of STROMECTOL in the treatment of onchocerciasis is based on the results of clinical studies involving 1278 patients In a double-blind, placebo-controlled study involving adult patients with moderate to severe onchocercal infection, patients who received a single dose of 150 mcg/kg STROMECTOL experienced an 83.2% and 99. 5% decrease in skin microfilariae count (geometric mean) 3 days and 3 months after the dose, respectively. Efficacy, as measured by cure rate, was defined as the absence of larvae in at least two follow-up stool examinations 3 to 4 weeks post-therapy. Based on this criterion, efficacy was significantly greater for STROMECTOL (a single dose of 170 to 200 mcg/kg) than for albendazole (200 mg b.i. d. for 3 days).

The dosing for different ivermectin treatments is as follows:

• Onchocerciasis: a single dose of 150 mcg/kg
• Strongyloidiasis: a single dose of 170 to 200 mcg/kg The indications for ivermectin are:
• Onchocerciasis: treatment of moderate to severe onchocercal infection
• Strongyloidiasis: treatment of strongyloidiasis of the gastrointestinal tract 2 2

From the Research

Ivermectin Treatments

• Ivermectin is used to treat various parasitic infections, including strongyloidiasis and scabies.
• The dosing of ivermectin varies depending on the indication and patient population.

Dosing for Strongyloidiasis

• A single dose of 150-200 micrograms/kg of ivermectin is effective in treating strongyloidiasis 3.
• In cases where the initial treatment is not effective, a second dose of 150-200 micrograms/kg of ivermectin can be administered 3.

Dosing for Scabies

• A single oral dose of 200 micrograms/kg of ivermectin is effective in treating scabies 4, 5.
• In some cases, a second dose of ivermectin may be necessary to achieve complete clearance of scabies 5.
• Topical ivermectin 1% lotion has also been shown to be effective in treating scabies, with similar efficacy to oral ivermectin and permethrin cream 6.

Comparison with Permethrin

• Permethrin 5% cream is a commonly used treatment for scabies, and its efficacy has been compared to ivermectin in several studies 7, 5, 6.
• The results of these studies suggest that ivermectin and permethrin have similar efficacy in treating scabies, although permethrin may have a faster onset of action 7, 5, 6.

Safety and Adverse Events

• Ivermectin is generally well-tolerated, with few adverse events reported in clinical trials 4, 6.
• The most common adverse events associated with ivermectin are mild and self-limiting, such as headache and nausea 6.