Ivermectin substitutes: what works and when

Ivermectin gets a lot of attention, but depending on the infection, other drugs may be a better fit. Want clear options you can discuss with your doctor? Below I list common replacements for different parasites and skin conditions, explain when they work, and point out safety notes you should know.

Common oral alternatives

For many intestinal worms, albendazole and mebendazole are the go-to alternatives. They’re effective for roundworms, hookworms, and whipworms and often come as short courses. We have a detailed article on albendazole safety during pregnancy if that’s a concern — always bring that up with your clinician.

Praziquantel is the main alternative for schistosomiasis and some tapeworm infections. It works differently than ivermectin, so the choice depends on the parasite species found in tests. For certain infections linked to Wolbachia bacteria (like onchocerciasis), doctors sometimes add doxycycline as part of a longer treatment plan; that targets the bacteria the parasites depend on.

Keep in mind: not every drug works on every parasite. Lab tests and a proper diagnosis matter. Using the wrong medicine can delay cure or cause side effects.

Topical and targeted options

For scabies and lice, topical treatments are often better than any oral drug. Permethrin 5% cream is widely recommended for scabies. For lice, permethrin shampoo and dimethicone products work well. Other topical choices include benzyl benzoate or malathion in places where permethrin doesn’t help.

If you’re treating skin infestations at home, follow the full course and treat close contacts when advised. Washing bedding and clothing on hot cycles or sealing items in plastic for a few days helps stop reinfestation.

For veterinary concerns, different drugs apply (moxidectin, fenbendazole). If you’re treating pets or livestock, check with a veterinarian — human medicines are not always appropriate for animals.

Worried about safety? Drug interactions, pregnancy, breastfeeding, and age change what’s safe. For example, albendazole has specific pregnancy guidance, and some antibiotics shouldn’t be used with certain other meds. Bring a full medicine list to your provider and ask about side effects you can expect.

So how do you pick an alternative? Start with accurate diagnosis (stool tests, skin exams). Match the drug to the parasite species. Factor in patient-specific issues: age, pregnancy, allergies, other drugs, and access to medicine. If one drug fails, a specialist can recommend second-line or combination treatments.

If you want more depth on any option, check our albendazole safety article and mebendazole guide on DoctorAlexa Pharmaceuticals. And remember: talk to a healthcare professional before switching or starting treatment — they’ll help you pick the safest, most effective option.