Dosage of Ivermectin for Rosacea
Apply ivermectin 1% cream once daily to the affected areas of the face for the treatment of inflammatory lesions of rosacea. 1, 2
Standard Dosing Regimen
- The FDA-approved dosage is ivermectin 1% cream applied once daily (QD) to the entire affected facial area. 1, 2
- Apply approximately 1 gram of ivermectin 1% cream per application, covering all areas with rosacea lesions. 3
- The once-daily application schedule offers superior convenience compared to twice-daily metronidazole 0.75% cream, while providing better efficacy. 2, 4
Treatment Duration and Timeline
- Continue treatment for a minimum of 12-16 weeks to adequately assess efficacy, with clinical improvement typically visible by week 6. 1
- Ivermectin 1% cream demonstrates progressive improvement up to 52 weeks of continuous treatment without therapeutic plateau. 1, 2
- In clinical trials, 38.4-40.1% of patients achieved treatment success (clear or almost clear) by 12 weeks. 1, 5
Application Timing and Combination Therapy
- When combining ivermectin 1% cream with other topical agents (such as azelaic acid 15% gel), apply one agent in the morning and the other in the evening to minimize potential irritation. 1
- For moderate to severe inflammatory lesions, the British Journal of Dermatology recommends combining topical ivermectin 1% cream once daily with oral doxycycline 40 mg daily for more rapid control. 1
- If persistent erythema is present alongside inflammatory lesions, brimonidine 0.33% gel can be added once daily without significant side effects, providing additive benefits. 1
Comparative Efficacy Supporting This Dosage
- Ivermectin 1% cream once daily demonstrates superior efficacy to metronidazole 0.75% cream twice daily, with 83% reduction in lesion counts versus 73.7% with metronidazole. 1
- The once-daily ivermectin regimen provides a longer time to relapse (115 days) compared to metronidazole (85 days), supporting its use as maintenance therapy. 1
- In patients with severe papulopustular rosacea, 82.5% of ivermectin-treated patients achieved "clear" or "almost clear" status at week 16, compared to only 63.0% with metronidazole. 4
Safety and Tolerability at This Dosage
- Ivermectin 1% cream once daily is well tolerated, with the most common treatment-related adverse events (skin burning sensation, pruritus, dry skin, and skin irritation) each occurring in less than 2% of patients. 2
- The once-daily dosing schedule maintains excellent tolerability for up to 52 weeks without increased adverse effects. 1
- Transient mild-to-moderate desquamation, stinging, and burning may occur in approximately 10% of patients but typically resolve with continued use. 6
Critical Pitfalls to Avoid
- Do not discontinue therapy before 6-8 weeks, as this prevents adequate assessment of efficacy—many patients require the full 12-16 week period to achieve optimal results. 1
- Do not reduce to less than once-daily application, as the FDA-approved dosing regimen of once daily has been specifically studied and validated in clinical trials. 2
- Do not stop maintenance therapy abruptly once control is achieved, as up to two-thirds of patients will relapse when treatment is discontinued—continue once-daily application for sustained control. 1