The short line
Scale first, then the 3 mg blister. Onchocerciasis usually wants 150 mcg/kg; strongyloidiasis usually wants 200 mcg/kg. A livestock tube is not a conversion chart. Licensed US counters can quote a four- or six-tablet human pack. Paste is another product. This page does not take inbox consults or payment.
The 3 mg hold: tablets after the kilogram
US oral ivermectin for people is 3 mg. That is the labeled human strength. It is not 6, not 12, and not a syringe mark from a barn.
The count is a multiply, not a scoop. Strongyloidiasis sits near 200 mcg/kg. Onchocerciasis sits near 150 mcg/kg. Both land on whole 3 mg tablets after rounding.
A 60 kg adult at 200 mcg/kg needs 12 mg - four tablets. A 90 kg adult needs 18 mg - six tablets. Write the kilograms first. The blister is second.
People search 'ivermectin online' and get paste, pour-on, and mystery tablets. Those are other products. This line will not decode a livestock label into a person.
The hold is simple: if the tablet is not a 3 mg human product, it is not this line. If the math skipped the scale, it is not this line either.
Community programs sometimes use height sticks when scales are scarce. That is a public-health workaround, not a reason for a US clinic to guess.
Crusted scabies and hyperinfection plans use the same 3 mg tablet and a longer calendar. They do not switch to a 'stronger' invented milligram.
Compare the gut-lumen job on the mebendazole 100 mg chew line if the worm never leaves the bowel. Ivermectin is the tissue and skin line.
Licensed 3 mg quotes versus an online carton
A cheap online page can be a licensed mail-order pharmacy with a real 3 mg generic. It can also be a cart that ships paste or an unlabelled strip.
This desk quotes licensed US counters. We do not check out. We do not email a discount code. Price is a band you verify at the register.
For a four- or six-tablet human pack, cash-coupon bands at large chains often sit in the teens. That is a quote shape, not a dollar we invented.
If a site undercuts every licensed counter by a wide gap and will not name Stromectol-class 3 mg tablets, treat the gap as a product warning.
COVID marketing is a second warning. This molecule did not earn a viral indication. A seller who leads with that is not selling a careful fill.
Ask the pharmacy to read the NDC and the tablet strength out loud. Three milligrams. Human. Prescription on file. Then compare their coupon band to the table below.
Mail-order can be legitimate. So can a warehouse club. The test is the tablet and the license, not the URL.
We do not sell. If you came for a cart, you are in the wrong building.
Where a 3 mg human count actually gets quoted
| Counter | Pack on this line | Coupon band | What to confirm |
|---|---|---|---|
| Walgreens | 3 mg x 4 or 6 | low-to-mid teens | Human tablet, not stock |
| H-E-B | 3 mg x 4 or 6 | teens | NDC and empty-stomach note |
| Meijer | 3 mg x 6 | teens to low twenties | Weight written on the Rx |
| Costco | 3 mg x 4 or 6 | low teens with coupon | Membership vs cash window |
Licensed cash-coupon bands for human 3 mg ivermectin in August 2026. Qualitative bands only - this desk does not invent a dollar.
Walgreens, H-E-B, Meijer, and Costco are ordinary licensed windows for a 3 mg times four or six pack, the usual single-dose math for an adult.
Coupon shapes move. Treat them as teens or mid-twenties, then confirm in August 2026 at the store or its coupon desk.
Stromectol-class work is tissue nematodes and mites
Clinicians reach for this avermectin when a nematode or mite lives in tissue, lymph, or skin - not when the problem is a virus or a bacterium.
The US oral brand most charts still say is Stromectol. The labeled uses are intestinal strongyloidiasis and onchocerciasis. Everything else - ordinary scabies, crusted scabies, head lice, some other filariae - is a clinician extending the same tablet off the printed box.
Strongyloides stercoralis can sit in a gut for decades and then explode when steroids or HTLV-1 or another hit knocks immunity down. That is why transplant and oncology desks keep this drug in the back of their mind.
Onchocerca volvulus is the river-blindness worm. Community programs used donated ivermectin to cut microfilarial loads across whole river basins. Adult worms live on; the public-health win is transmission, not a one-visit cure.
Scabies mites die when enough drug reaches the skin through blood. Creams fail on crusted disease and on some institutional outbreaks. Oral drug is then a tool, not a lifestyle pill.
This is not a COVID line. Large randomized trials did not show a clinical benefit that belongs on a US label. If a patient brings that printout, say so and move back to the parasite.
It is also not a tapeworm drug, not a fluke drug, and not a pinworm first pick. Pinworm households usually start on mebendazole or pyrantel. Wrong organism wastes a week.
Topical ivermectin for rosacea and lice lotion are separate products. Do not tell someone to swallow a face cream, and do not tell them a 3 mg tablet treats papules on the cheek.
The molecule came out of a soil Streptomyces story that later shared a Nobel. That history explains the donation programs. It does not make paste safe in a kitchen.
Glutamate chloride gates, then flaccid paralysis
Glutamate-gated chloride channels in invertebrate nerve and muscle open under this tablet. Chloride rushes in. The parasite flaccid-paralyzes and dies or is swept out.
Mammals do not run those channels the same way in accessible tissue. Human GABA receptors sit behind a blood-brain barrier, and P-glycoprotein pumps ivermectin back out of the CNS.
Break that pump - mdr1 mutation in some herding dogs is the veterinary cautionary tale, or a strong P-gp inhibitor in a person - and CNS risk rises. The human therapeutic margin is wide until you break the rules.
In onchocerciasis the drug clears microfilariae and suppresses production for months. Adult worms are relatively spared. That is why programs repeat on a calendar.
In strongyloidiasis you need enough drug in the gut wall and tissues to hit larvae that are not sitting in the lumen like a pinworm. One underdosed swallow is a common miss.
Dead microfilariae kick the immune system. Mazzotti reactions are itch, fever, tender nodes, sometimes hypotension. Treat them as dying parasite, not as a penicillin-style allergy, unless the picture is clearly anaphylaxis.
Loa loa encephalopathy is the exception that must stay on the slate: a huge microfilarial load plus ivermectin can inflame the brain. Screen. Do not 'just give a little.'
Nothing in this mechanism looks like a ketorolac COX block or a serotonin line. If someone wants a pain pill or a sleep pill, this is the wrong shelf.
Fasting Cmax near four hours, then a fat depot
Lipophilic enough that the label wants water and an empty stomach, because a high-fat meal can raise bioavailability on the order of 2.5-fold.
Peak plasma sits around four hours in the fasting studies. That is not when the itch stops. Tissue parasites do not run on a Cmax clock the way a headache does.
Protein binding is about 93 percent. The drug parks in fat and peripheral tissues. That depot is why a single dose still covers days.
Hepatic CYP3A4 handles most metabolism. The terminal half-life is about 18 hours. You will still find activity well after the calendar day of the swallow.
Almost all elimination is fecal. Kidneys barely participate. A low eGFR rarely forces a dose change. A failing liver and a pile of 3A4 inhibitors is a different conversation.
Because clearance is slow, a 'repeat tomorrow' plan is usually wrong. Repeats follow the parasite life cycle: about a week for scabies eggs, about two weeks for many Strongyloides plans, months for onchocerciasis programs.
Children under 15 kg were not in the original safety set the way older children were. That is a labeled caution, not a dare.
Write kilograms on the script before the blister
Convert the weight to kilograms, multiply, then round to whole 3 mg tablets. Write that count on the prescription so the pharmacy does not guess.
Strongyloidiasis: 200 mcg/kg once. Many desks add a second dose at about two weeks, and they insist on it before starting high-dose steroids when exposure risk is real.
Onchocerciasis: about 150 mcg/kg. Community calendars often land every six to twelve months. A traveler with an old exposure still needs a clinician, not a leftover blister from a neighbor.
Ordinary scabies, when oral drug is chosen: 200 mcg/kg, repeat around day eight, plus treat contacts the same day, plus heat-wash or bag the bedding. Skip the laundry and you meet the mite again.
Crusted scabies: multiple doses, topical scabicide, sometimes isolation rules. This is an infection-control problem, not a single-tablet story.
Head lice: topical products are first for most US kids. Oral ivermectin shows up when those fail and a clinician is willing to go off-label.
Never 'double it because the last time failed' without rechecking weight, contacts, and the organism. Failure is often a missed household member or a wrong worm.
Never convert paste. If the only product in the house is veterinary, the correct dose is zero tablets from that tube.
Azoles, warfarin, and a Mazzotti day
Azole antifungals, some macrolides, and a few antivirals can raise levels because this molecule is a CYP3A4 and P-glycoprotein substrate.
Inducers can lower exposure. That matters more for a multi-dose crusted-scabies plan than for a single well-counted swallow, but it still belongs on the slate.
Warfarin has scattered case reports of INR movement after ivermectin. Plan a check. Do not wait for a nosebleed to be the assay.
Other drugs that slow the CNS - alcohol, benzodiazepines, some sleep medicines including a trazodone night line - do not have a clean contraindication pair, but a Mazzotti day already feels like a flu. Stacking sedation is unkind.
There is no nitrate-style absolute the way PDE5 drugs have. Do not import that rule from the ED pathway note.
Live-vaccine timing is not the usual issue here. Immunosuppression is: steroids and transplant drugs change Strongyloides from a quiet stool finding into a crisis. Screen and treat before the immune hit when you can.
Herbal 'parasite cleanses' mixed with this tablet are noise. They add liver load and no proven kill.
Overdose looks neurologic; paste belongs in the ED
Dizziness, nausea, diarrhea, and mild itch are the ordinary complaints. After onchocerciasis treatment, add Mazzotti features - fever, rash, tender lymph nodes, joint ache, sometimes a blood-pressure dip.
Treat Mazzotti as dying microfilariae. Hydration, antipyretics, and observation usually suffice. Collapse or wheeze is a different algorithm.
Neurotoxicity - confusion, ataxia, seizures - is the red flag for overdose, a breached blood-brain barrier, or a heavy Loa loa load. That is an emergency desk, not a 'sleep it off' note.
Hepatitis and rash can occur. Isolated transaminase bumps are uncommon at single labeled doses and more of a story in repeated or high exposure.
Pregnancy: animal data and limited human series have not produced a clean teratogen signal at human doses, but the label is caution, not a blessing. Use when the parasite is the bigger threat.
Lactation: small amounts appear in milk. A single dose after a clinician's yes is a different decision than a casual repeat while nursing a newborn.
Pediatric: safety below 15 kg is not established the way it is above that mark. Do not cut a 3 mg tablet into a toddler guess.
Veterinary product ingestion is overdose until proven otherwise. Bring the tube to the emergency department. Do not finish the syringe 'to get the rest out.'
Childhood in a loa belt still counts in the US
Years spent in Loa loa belts still require a screen before onchocerciasis-style dosing. A US address does not erase a Cameroon childhood.
Steroid starts, transplant workups, and HTLV-1: look for Strongyloides before you suppress. Empiric treatment is sometimes used when serology will lag and the risk is high.
Older adults: the kilogram still rules. Do not shrink the dose because the person 'looks frail' if the weight is real. Do shrink it if the chart weight is a guess from two years ago.
Hepatic impairment: single doses are often still used, but stacked 3A4 inhibitors plus a sick liver is a reason to slow down and watch.
Renal impairment: rarely a dose change. That surprises residents who adjust everything for creatinine.
Pregnancy and the under-15 kg child: see harms. The hold is 'not automatic,' not 'never in a life-threatening hyperinfection.'
Institutional scabies: treat the unit, not the index case. Staff, roommates, and the laundry cart are part of the organism's life cycle.
Second-dose calendar beats a 'failed' story
Follow-up stool or serology after Strongyloides belongs on the clinician's calendar, especially if immunosuppression is next. Eosinophils can lag or mislead.
Scabies: look for new burrows after the second dose window. Itch alone is a poor assay for two to four weeks.
Onchocerciasis: skin snips or program metrics, not a home selfie of 'redness gone.' Vision changes need ophthalmology, not another tablet from a drawer.
Loa-risk patients: the important assay is before the first dose, not after encephalopathy starts.
Warfarin users: INR after the dose. One check beats a guess.
If fever and rash hit in the first two days after onchocerciasis treatment, label it Mazzotti until the picture says otherwise. If confusion hits, do not call it Mazzotti from the couch.
Write the repeat date in a phone calendar before the person leaves. Forgotten second doses are how 'ivermectin failed' stories get written.
Count 3 mg after the scale, never after a tube
Avermectins isolated from Streptomyces avermitilis; ivermectin later optimized for use.
Donation program against onchocerciasis begins, later covering huge river-blindness belts.
US oral approval (Stromectol) for strongyloidiasis and onchocerciasis.
Nobel Prize recognizes the avermectin discovery and its parasitic-disease impact.
Empty-stomach 3 mg tablets, counted after kilograms, usually 150 or 200 mcg/kg unless a clinician chose food on purpose.
Screen Loa loa when the biography includes those belts. Repeat on the parasite's clock, not tomorrow morning.
Four- or six-tablet human packs at licensed US windows often live in the teens. Payment does not happen on this page.
Paste is not a conversion. COVID is not an indication. Pinworm usually belongs on the mebendazole chew line.
If the organism is real and the weight is real, this is a quiet, ugly, effective tablet. Keep it that way.
Questions this line answers
Why does a human ivermectin line start with 3 mg tablets instead of a paste dose? US oral ivermectin for people is a 3 mg tablet. That is the labeled strength Stromectol used, and it is the only tablet milligram this desk will ink. Livestock paste and pour-on products are mixed for cattle or horses. Their concentration, inactive ingredients, and dose marks are not a human chart. People who scoop paste have landed in emergency departments with vomiting, ataxia, and seizures. The human line is dull on purpose: weigh the person, multiply by 150 or 200 mcg/kg, then round to whole 3 mg tablets. A 70 kg adult at 200 mcg/kg needs about 14 mg, which is four or five tablets depending on how the prescriber rounds. Underdosing is a common reason a stool check still shows Strongyloides. Overdosing from paste is a different failure. If a website sells a 6 mg or 12 mg 'human' tablet, treat that as a different product until a US label is in your hand. This desk does not invent tablet strengths.
How do I turn kilograms into a 3 mg tablet count without guessing? Write the weight in kilograms. Multiply by 0.2 mg/kg when the target is 200 mcg/kg, or by 0.15 mg/kg when the target is 150 mcg/kg. Then divide by 3 and round to a whole tablet. Example: 82 kg times 0.2 is 16.4 mg, which is five or six 3 mg tablets. The label for strongyloidiasis is a single 200 mcg/kg oral dose. Many clinicians still plan a second swallow about two weeks later because eggs and larvae do not all sit in the same stage on day one. Onchocerciasis uses about 150 mcg/kg, often repeated every six to twelve months in community programs because adult worms survive. Scabies, when a clinician chooses oral drug, usually follows the 200 mcg/kg number and repeats around day eight. Crusted scabies is not one tablet and a hope; it is a multi-dose plan plus topical scabicide plus laundry. Take the tablets with water on an empty stomach unless the prescriber has a tissue-parasite reason to use food. Food can more than double exposure. Consistency beats a casual snack.
What does a Loa loa screen actually change on this line? In parts of Central and West Africa, Loa loa microfilariae can sit in blood at very high counts. Ivermectin can then trigger a severe encephalopathy, not just itch. The hold is not 'skip the drug forever.' The hold is 'do not treat onchocerciasis or another ivermectin indication until the loa load is known.' Skin snips, blood films, and local program rules decide who can take a standard community dose. If someone grew up in Cameroon, Gabon, or neighboring belts and now lives in the US, the travel history still matters. A negative stool for Strongyloides does not answer the loa question. Mazzotti reactions after onchocerciasis treatment - fever, rash, tender nodes, hypotension - are immune responses to dying microfilariae. Those are managed supportively and are not the same as loa encephalopathy. Confusing the two leads people to stop a needed drug, or to push a dangerous one. Ask where the person lived, not only where they flew last month.
Is cheap online ivermectin the same as a licensed US pharmacy quote? A licensed US counter sells the human 3 mg tablet under a prescription. Coupon bands for a four- or six-tablet pack often sit in the teens at large chains when a discount card is applied. That is a quote, not a cart on this site. An overseas page that ships 'ivermectin' without a US label, or a farm-store paste, is a different object. Price shopping is reasonable. Substituting a veterinary tube because it looks cheaper is not. This desk lists four counters so you can see that licensed fills exist in ordinary stores. We do not take payment. We do not email a coupon. If a seller will not name the tablet as 3 mg human ivermectin, walk away. If they promise COVID benefit, walk away twice. Proper randomized trials did not put COVID-19 on this label, and this line will not pretend they did.
When should the dose be repeated, and when is 'it failed' the wrong story? For ordinary scabies, itch can last two to four weeks after mites die. That is post-scabetic itch, not automatic failure. Re-treat when new burrows appear or a contact was missed, not because the person still scratches on day ten. Strongyloides can autoinfect; a planned second dose and a follow-up stool or serology are part of the line, especially before steroids or other immunosuppression. Hyperinfection is a different emergency: gram-negative sepsis, ileus, rash, and a falling eosinophil count that fools people into thinking the worm is gone. Onchocerciasis programs expect microfilariae to return between doses because adults live on. 'Failure' there often means the calendar, not the molecule. Pinworm is usually a mebendazole or pyrantel job, not an ivermectin first pick. If the organism is a tapeworm or a fluke, this drug is the wrong line. Name the parasite before you name a refill.
Slate notes on the kilogram line
Mara: my cousin swears the horse tube is 'the same molecule.' Why won't you just convert it?
Same core structure is not the same product. Paste dose marks assume a 500 kg animal and a different excipient load. There is no safe kitchen conversion that turns a livestock syringe into a 3 mg human tablet count. People have overdosed trying. If the diagnosis is real, a clinician can write the human tablet and a pharmacy can fill four or six of them. If the diagnosis is a viral rumor, no conversion will help. This desk inks milligrams and one hold. The hold here is the human tablet.
Devin: I take a statin and an antifungal. Does that change the ivermectin swallow?
Ivermectin is a CYP3A4 and P-glycoprotein substrate. Strong 3A4 or P-gp inhibitors can raise levels. That does not automatically cancel a single weight-based dose for a documented worm, but it is a reason to avoid extra food, extra tablets, and casual repeats. Warfarin has case reports of INR shifts. If you are on warfarin, plan an INR check after the dose rather than guessing. Alcohol and other sedatives are not a formal contraindication, but a Mazzotti reaction already makes people feel wretched. Tell the prescriber the full list. Do not send it to this site. We do not run a mailbox clinic.
Nia: empty stomach is hard with morning sickness. Can I take it with toast?
The label studied fasting administration with water. A fatty meal can raise exposure on the order of two-and-a-half-fold. Toast is not a steak, but 'a little food' is how fasting instructions quietly die. If pregnancy is the reason the stomach is empty and unhappy, the bigger question is whether ivermectin is the right drug this month. Human data are limited; clinicians use it when the parasite risk outweighs the unknown. Do not self-start. If a clinician still wants the dose, ask them whether they want fasting or a documented fed state - pick one and stay there. Do not nibble and then add an extra tablet 'to make up for it.'