Ivermectin is prescription-controlled across most high-income countries, and the requirement exists because correct use depends on judgements a counter sale cannot make. Understanding what a prescriber is actually assessing makes the consultation considerably more productive.
Ivermectin treats specific parasites. It does nothing for a bacterial folliculitis, an eczematous rash, a contact dermatitis or a fungal infection — several of which can closely resemble the conditions it does treat.
Scabies is the classic diagnostic trap. It mimics eczema and contact dermatitis, and is regularly treated as one of those for weeks before the correct diagnosis is reached. Conversely, eczema treated as scabies wastes time while the skin continues to deteriorate.
Where the diagnosis is uncertain, confirmation may be sought: skin scrapings and microscopy for scabies, stool examination or serology for strongyloidiasis, lash epilation for Demodex. Serology is often preferred for strongyloidiasis because stool microscopy misses a high proportion of light infections.
Every ivermectin regimen is expressed in micrograms per kilogram, so an accurate current weight is required rather than an estimate. This matters most at the extremes: a substantially underdosed heavy patient is a common cause of apparent treatment failure.
See the full dosage chart by weight.
Ivermectin is cleared by CYP3A4, so a prescriber will review anything that strongly inhibits or induces that enzyme, along with drugs affecting P-glycoprotein, which is what keeps ivermectin out of the brain.
Particular attention goes to strong CYP3A4 inhibitors such as ketoconazole, itraconazole, clarithromycin and ritonavir; inducers such as rifampicin, carbamazepine, phenytoin and St John's wort; and warfarin, where INR monitoring may be advisable. See drug interactions.
The single most important safety question is exposure to Loa loa, the African eye worm, endemic in parts of Central and West Africa. In patients with a high Loa loa microfilarial load, ivermectin can precipitate a severe and occasionally fatal encephalopathy.
Anyone who has lived in or travelled extensively through Cameroon, Gabon, the Republic of Congo, the Democratic Republic of Congo, the Central African Republic, Equatorial Guinea, Nigeria or southern Sudan should say so explicitly. Screening is available where risk exists.
Travel history also shapes the differential more broadly, since it determines which parasites are plausible in the first place.
Pregnancy, particularly the first trimester — see pregnancy and breastfeeding.
Children under 15 kg or five years — see ivermectin for children.
Significant liver disease, since clearance is hepatic and impairment prolongs exposure.
Immunosuppression, which raises the risk of disseminated strongyloidiasis and often changes the treatment plan substantially.
Heavy parasite burden, where dying parasites can provoke a pronounced inflammatory reaction that may need managing.
Bring your current weight, a full list of medicines and supplements including anything over the counter, a clear timeline of symptoms, your travel history, and details of any treatment already tried and what happened.
If you have a specific condition in mind, say so plainly and explain why. A prescriber can engage far better with a clear account than with a request for a named drug and no context.
GMP-certified human formulations — tablets and 1% cream. Never veterinary products. Most USA orders ship within 1–7 business days, with tracking on every order.
View products and pricingIn the USA, UK, Canada, Australia and the EU, yes, for both oral tablets and the 1% cream. Some other countries permit pharmacy sale without one. See our prescription status page for the country-by-country position.
Your symptoms and their timeline, your current weight, all medicines and supplements you take, your travel history, any previous treatment and its result, and whether you are pregnant or breastfeeding.
Because of Loa loa, the African eye worm endemic in parts of Central and West Africa. In patients with high microfilarial loads, ivermectin can trigger a severe and occasionally fatal encephalopathy. It is the single most important safety screen.
In many jurisdictions yes, where the service is properly licensed and the consultation genuinely assesses your case. A service that issues a prescription without any real assessment is not providing meaningful clinical oversight.
Ask what specifically concerns them. If it is diagnostic uncertainty, ask what would confirm or exclude it. If they consider another treatment more appropriate, ask why. A second opinion is always reasonable, and for parasitic disease an infectious diseases or tropical medicine service is the relevant specialty.