Ivermectin substitutes: which options work for which problem

Ivermectin is a strong drug for certain parasites, but it’s not the only option. If you’re looking for a substitute—because of availability, side effects, or a specific condition—this page breaks down practical alternatives by diagnosis and what to watch for. Read this to know which medicines are usual swaps and when you must see a clinician.

Common alternatives by condition

Scabies: The go-to substitute is topical 5% permethrin cream. You apply it head-to-toe overnight and repeat in 7 days if needed. Benzyl benzoate lotion and sulfur ointment are other choices in some places. If topical treatment fails or for crusted scabies, doctors may still use oral ivermectin, so talk to your clinician about the best plan.

Head lice: Permethrin 1% lotion is a first-line choice. If permethrin fails, options include malathion lotion, spinosad topical, or dimeticone-based products. Oral ivermectin can be used in resistant cases, but it’s not the first move for most kids.

Intestinal worms: Albendazole and mebendazole cover many common intestinal helminths (pinworms, roundworms). Praziquantel treats tapeworms and schistosomiasis. For strongyloidiasis, ivermectin is often preferred, but albendazole or thiabendazole are alternatives in some settings—treatment choice depends on the specific parasite and local guidelines.

Filarial infections (like lymphatic filariasis): Diethylcarbamazine (DEC) is used in many programs. For onchocerciasis (river blindness), doxycycline targets the bacteria inside the worm (Wolbachia) and can be used alongside other measures. These are specialist decisions—public health programs often guide which drug to use.

Topical skin uses (rosacea): Ivermectin cream helps some people with inflammatory rosacea. Alternatives include topical metronidazole, azelaic acid, or oral antibiotics like doxycycline for inflammatory cases. Your dermatologist can help pick the least risky option for your skin.

Safety, sourcing, and practical tips

Don’t use livestock or pet ivermectin formulations. Human and veterinary products differ in strength and safety. Always get medications from a licensed pharmacy and follow a prescriber's advice. Check drug interactions—especially if you take blood thinners or strong heart meds—and avoid self-medicating in pregnancy without medical advice.

If you can’t find a drug locally, ask your doctor about equivalent medicines or public health programs that supply treatment. For infections that can spread (scabies, lice), treat close contacts and clean bedding or hair tools per instructions to prevent reinfection.

If you’re unsure which alternative fits your case, call your healthcare provider. Quick tip: tell them the exact diagnosis, any allergies, current medicines, and pregnancy status—this helps them choose a safe alternative fast.