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Ivermectin (Topical)

Medically reviewed by Last updated on Oct 26, 2020.


(eye ver MEK tin)

Index Terms

  • Ivermectin Cream
  • Ivermectin Lotion

Dosage Forms

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Cream, External:

Soolantra: 1% (30 g [DSC], 45 g) [contains cetyl alcohol, edetate disodium, methylparaben, propylene glycol, propylparaben]

Generic: 1% (45 g [DSC])

Lotion, External:

Sklice: 0.5% (117 g) [contains methylparaben, propylparaben]

Brand Names: U.S.

  • Sklice
  • Soolantra

Pharmacologic Category

  • Antiparasitic Agent, Topical
  • Pediculocide


In pediculosis capitus treatment, ivermectin is a semisynthetic anthelminthic agent; it binds selectively and with strong affinity to glutamate-gated chloride ion channels which occur in invertebrate nerve and muscle cells. This leads to increased permeability of cell membranes to chloride ions then hyperpolarization of the nerve or muscle cell, and death of the parasite.

In rosacea treatment, the mechanism of action is unknown.


Metabolized hepatically by CYP3A4

Time to Peak

Cream: ~10 hours post application

Half-Life Elimination

Cream: ~6.5 days

Protein Binding


Use: Labeled Indications

Head lice (Pediculus capitis) (Sklice lotion): Treatment of head lice infestations in patients 6 months and older.

Rosacea (Soolantra cream): Treatment of inflammatory lesions of rosacea in adult patients.


There are no contraindications listed in the US manufacturer's labeling.

Canadian labeling: Hypersensitivity to ivermectin or any component of the formulation.

Dosing: Adult

Head lice: Topical: Lotion: Apply sufficient amount (up to 1 tube) to completely cover dry scalp and hair; for single-dose use only.

Rosacea: Topical: Cream: Apply to each affected area (eg, forehead, chin, nose, each cheek) once daily.

Dosing: Geriatric

Refer to adult dosing.

Dosing: Pediatric

Head lice: Topical: Lotion (Sklice): Infants ≥6 months, Children, and Adolescents: Apply sufficient amount (up to 1 tube) to completely cover dry hair and scalp; for single use only


Topical lotion: For external use only. Apply to dry scalp and hair closest to scalp first, then apply outward towards ends of hair; completely covering scalp and hair. Leave on for 10 minutes (start timing treatment after the scalp and hair have been completely covered). The hair should then be rinsed thoroughly with warm water. Avoid contact with the eyes. Nit combing is not required, although a fine-tooth comb may be used to remove treated lice and nits. Lotion is for one-time use; discard any unused portion. Ivermectin should be a portion of a whole lice removal program, which should include washing or dry cleaning all clothing, hats, bedding, and towels recently worn or used by the patient and washing combs, brushes, and hair accessories in hot soapy water.

Topical cream: For external use only. Not for use in the eye, mouth or vagina. Wash hands with soap and water prior to application and after application. Apply a pea-size amount as a thin layer on each affected area (eg, forehead, chin, nose, each cheek).


Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C to 30°C (59°F to 86°F). Lotion: do not freeze.

Drug Interactions

There are no known significant interactions.

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

1% to 10%:

Central nervous system: Localized burning (≤1%)

Dermatologic: Skin irritation (≤1%)

<1%, postmarketing, and/or case reports: Allergic dermatitis, conjunctivitis, contact dermatitis, eye irritation, ocular hyperemia, seborrheic dermatitis of scalp, xeroderma


Other warnings/precautions:

• Appropriate use:

Topical lotion: For topical use on scalp and scalp hair only; avoid contact with eyes. Wash hands after application.

Topical cream: Not for oral, ophthalmic, or vaginal use; avoid contact with eyes and lips. Wash hands after application.

Monitoring Parameters

Lotion: Monitor scalp for live lice.

Pregnancy Risk Factor


Pregnancy Considerations

Adverse events have been observed in animal reproduction studies following oral administration. Although use in pregnancy is likely low risk, other agents are currently recommended for the treatment of pediculosis pubis or scabies in pregnant women (CDC [Workowski 2015]).

Patient Education

What is this drug used for?

• It is used to treat head lice.

• It is used to treat rosacea.

All drugs may cause side effects. However, many people have no side effects or only have minor side effects. Call your doctor or get medical help if any of these side effects or any other side effects bother you or do not go away:

• Dry skin

• Eye irritation

WARNING/CAUTION: Even though it may be rare, some people may have very bad and sometimes deadly side effects when taking a drug. Tell your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

• Severe burning

• Severe skin irritation

• Signs of an allergic reaction, like rash; hives; itching; red, swollen, blistered, or peeling skin with or without fever; wheezing; tightness in the chest or throat; trouble breathing, swallowing, or talking; unusual hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Note: This is not a comprehensive list of all side effects. Talk to your doctor if you have questions.

Consumer Information Use and Disclaimer: This information should not be used to decide whether or not to take this medicine or any other medicine. Only the healthcare provider has the knowledge and training to decide which medicines are right for a specific patient. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a limited summary of general information about the medicine’s uses from the patient education leaflet and is not intended to be comprehensive. This limited summary does NOT include all information available about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to this medicine. This information is not intended to provide medical advice, diagnosis or treatment and does not replace information you receive from the healthcare provider. For a more detailed summary of information about the risks and benefits of using this medicine, please speak with your healthcare provider and review the entire patient education leaflet.

Further information

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.