Common use of Stromectol
Stromectol is an oral antiparasitic medicine whose active ingredient, ivermectin, targets select parasites by binding to glutamate-gated chloride channels in nerve and muscle cells, leading to paralysis and death of the parasite. In the U.S., the FDA has approved Stromectol for strongyloidiasis (intestinal threadworm) and onchocerciasis (river blindness). Clinicians also use oral ivermectin off-label in specific scenarios, such as crusted (severe) scabies or hard-to-treat head lice, especially when topical therapies fail or are not feasible. These decisions should be individualized, based on infection type, local resistance patterns, and patient-specific risks and comorbidities.
It is important to note what Stromectol is not for: it is not indicated for viral infections, including influenza or COVID-19. High-quality evidence and regulatory guidance do not support its use for these conditions. Patients should avoid self-medication and seek medical advice for diagnosis and treatment of suspected parasitic infections. Proper diagnosis—often including stool tests, serology, or travel/exposure history—ensures the right drug is used for the right organism and that co-infections or complications are not overlooked.
Dosage and direction
Stromectol dosing is weight-based and the tablet is typically taken on an empty stomach with water to optimize absorption. For strongyloidiasis, many clinicians use a single oral dose of approximately 200 mcg/kg (0.2 mg/kg), with some protocols repeating the dose on day 2 or reassessing with follow-up stool exams or serology to confirm eradication. For onchocerciasis, a typical regimen is 150 mcg/kg (0.15 mg/kg) as a single dose, repeated at intervals (often every 3 to 12 months) depending on clinical response and community control programs. For scabies, especially crusted scabies, regimens often involve 200 mcg/kg given on day 1 and repeated on day 8 to 14, and may be combined with topical agents under medical supervision.
The dose is calculated based on current body weight, so inform your clinician about recent changes in weight. Tablets should be swallowed with water; avoid taking with a high-fat meal unless specifically advised, as this can alter drug levels. In some parasitic infections, adjuvant measures are essential—for example, meticulous laundering, environmental decontamination for scabies or lice, and evaluation of close contacts to reduce reinfestation. Always follow the exact schedule and any adjunct care plan provided by your healthcare professional.
Pediatric dosing requires special caution. Oral ivermectin has historically not been recommended in children under 15 kg (33 lb), and its safety in this group is not well established. If a child may need treatment, clinicians typically prioritize approved topical therapies or refer to specialist guidance. For older children and adults, your provider will select the lowest effective dose and determine if and when repeat doses are necessary, informed by symptom resolution and, when indicated, lab or ophthalmologic follow-up.
Precautions
Before starting Stromectol, provide your clinician with a complete medical history, including liver disease, immune suppression, pregnancy or breastfeeding status, travel and exposure history, and any prior reactions to antiparasitic drugs. In areas where Loa loa (African eye worm) is endemic or possible via travel, careful evaluation is essential; in rare cases, people with high Loa loa microfilarial loads can experience serious neurologic complications if treated with ivermectin. For onchocerciasis, patients may experience “Mazzotti reactions” (fever, rash, pruritus, arthralgia) due to dying microfilariae. These are usually self-limited but can be uncomfortable; clinicians may use supportive measures to reduce symptoms.
Use caution in pregnancy and lactation. While some data are reassuring, ivermectin has not been fully established as safe in pregnancy, and most guidelines recommend using it only if the potential benefit justifies the potential risk. In breastfeeding, limited data suggest low levels in milk; decisions should be individualized. Because ivermectin is metabolized in the liver (largely via CYP3A4) and transported by P-glycoprotein, patients with hepatic impairment or those taking interacting medications may have altered drug exposure. Avoid driving or hazardous tasks if you experience dizziness, fatigue, or visual changes after dosing.
Contraindications
Stromectol is contraindicated in individuals with known hypersensitivity to ivermectin or any tablet components. It is generally not recommended for children under 15 kg due to limited safety data. Extreme caution, specialist input, or alternative therapies are warranted in suspected or confirmed Loa loa infection. Pregnancy and significant liver disease require risk–benefit assessment and close medical oversight. As with any antiparasitic, therapy should be guided by a confirmed or strongly suspected diagnosis; avoid use for conditions where it is ineffective or not indicated.
Possible side effects
Most people tolerate Stromectol well, but side effects can occur. Common reactions include headache, dizziness, nausea, diarrhea, abdominal discomfort, pruritus, and rash. In onchocerciasis, Mazzotti-type reactions from parasite die-off—fever, malaise, joint or muscle pain, lymph node tenderness, and skin itching—are not uncommon. These usually improve over days and can be managed supportively. Some patients report transient hypotension or palpitations; staying hydrated and changing positions slowly after dosing can reduce lightheadedness.
Less common but serious adverse events include marked allergic reactions (hives, facial or throat swelling, difficulty breathing), severe skin reactions, visual disturbances, confusion, ataxia, seizures, or signs of liver injury (dark urine, jaundice, right upper abdominal pain). Rare encephalopathy has been reported in individuals with high Loa loa microfilarial loads. Seek urgent medical attention if you develop severe or progressive symptoms, and inform your clinician promptly of any unexpected reactions. Reporting side effects helps improve pharmacovigilance and guides safer use.
Drug interactions
Ivermectin is primarily metabolized by CYP3A4 and is a substrate of P-glycoprotein. Potent CYP3A4 inhibitors (for example, ketoconazole, itraconazole, clarithromycin, ritonavir, cobicistat, and certain grapefruit-related compounds) may increase ivermectin exposure and side-effect risk. Strong inducers (such as rifampin, carbamazepine, phenytoin, and St. John’s wort) may reduce drug levels and efficacy. P-glycoprotein inhibitors (like verapamil, quinidine, amiodarone, cyclosporine) can increase central nervous system penetration of ivermectin; this may heighten neurotoxicity risk, particularly at higher doses.
Anticoagulants, especially warfarin, may interact, with case reports suggesting potentiation of anticoagulant effect. If you take warfarin, your clinician may request more frequent INR monitoring around the time of treatment. While alcohol does not have a specific known interaction, combining substances that cause sedation or dizziness can worsen those effects. Always provide a full, updated medication list—including over-the-counter products and herbal supplements—so your healthcare professional can screen for interactions and adjust therapy or monitoring as needed.
Missed dose
If you miss a scheduled dose, take it as soon as you remember, unless it is close to the time for a planned repeat dose. Because Stromectol is often given as a single dose or limited series, contact your clinician for guidance on whether and when to reschedule. Do not double up doses without medical advice.
Overdose
Overdose may lead to nausea, vomiting, dizziness, blurred vision, low blood pressure, confusion, ataxia, seizures, or breathing difficulties. Severe toxicity is rare but can be life-threatening. If an overdose is suspected, seek emergency care or contact poison control immediately. Management is supportive: airway protection, fluids for hypotension, seizure control, and monitoring for complications. Bring the medication container to the healthcare facility to assist with assessment and treatment decisions.
Storage
Store Stromectol tablets at controlled room temperature (generally 20–25°C or 68–77°F), away from excess heat, moisture, and direct light. Keep the medication in its original blister or container until use, and out of reach of children and pets. Do not use tablets past the expiration date, and dispose of unused medication through take-back programs or according to pharmacist guidance.
U.S. Sale and Prescription Policy
In the United States, Stromectol (ivermectin) is a prescription-only medication. Federal and state regulations require evaluation by a licensed clinician to determine medical necessity, dosing, and safety, followed by dispensing from a licensed pharmacy. Services that advertise the ability to buy Stromectol without a prescription operate outside U.S. law and can expose you to counterfeit or unsafe products, incorrect dosing, and lack of clinical oversight. Legitimate options include in-person care or telehealth visits, where a clinician assesses your symptoms, risk factors, travel history, and lab results, then issues an electronic prescription if appropriate.
Geisinger HealthSouth-branded facilities and related care networks emphasize structured, clinician-led pathways for diagnosis and treatment—such as telemedicine evaluations and coordinated pharmacy services—that keep you within legal, evidence-based standards. These pathways are designed to remove barriers like long travel or wait times while preserving the required medical assessment. If you are seeking treatment for a suspected parasitic infection, schedule a visit with a licensed provider through a reputable health system or telehealth platform. If Stromectol is indicated, your clinician will send a valid prescription to a U.S.-licensed pharmacy, ensuring quality, traceability, and appropriate follow-up care.
