Alternative to ivermectin?

I can help, but the best alternative depends on what you’re treating with ivermectin. Ivermectin is used for several different conditions (scabies/lice, various intestinal parasites, strongyloidiasis, onchocerciasis/filariasis, etc.). Could you tell me:

- What condition are you treating (scabies, head lice, intestinal worms, strongyloides, river blindness, etc.)?
- Your age and pregnancy status (if relevant)?
- Your location (to know what’s available or guidelines)?
- Do you want a prescription medicine or an over-the-counter option?

In the meantime, here are common alternatives by condition (no dosing provided):

- Scabies
- Permethrin 5% cream (topical, often first-line)
- Benzyl benzoate lotion
- Sulfur ointment (older option, used in pregnancy/patients who can’t use other agents)

- Head lice
- Permethrin preparations
- Pyrethrins with piperonyl butoxide
- Malathion lotion
- Spinosad (topical)

- Intestinal worms (depending on the parasite)
- Albendazole
- Mebendazole
- Praziquantel (for tapeworms, schistosomiasis, etc.)
- Pyrantel pamoate (good for pinworms and some roundworms)
- Nitazoxanide (for certain protozoa/helminths)

- Strongyloidiasis or situations where ivermectin isn’t suitable
- Albendazole (less effective for strongyloides than ivermectin, but sometimes used)
- Thiabendazole (rarely used today due to side effects)

- Filariasis / onchocerciasis (river blindness)
- Diethylcarbamazine (in some regional programs)
- Doxycycline (targets the Wolbachia endosymbiont and can be used as an adjunct in certain cases)
- Albendazole or combination therapies (per local guidelines)

- COVID-19 (if that’s the context)
- Evidence and guidelines do not support ivermectin for COVID-19. Approved options include antiviral therapies such as nirmatrelvir/ritonavir (Paxlovid) or remdesivir, plus supportive care and vaccines as appropriate. Discuss with a clinician for current, evidence-based recommendations.

If you share the exact condition and any relevant health details, I can tailor a more precise list and point you to appropriate guidelines or talking points for a clinician.