Stromectol alternatives: what to use when ivermectin isn’t the best choice

Ivermectin (Stromectol) works well for many parasites, but it’s not always the right pick. Maybe it’s unavailable, you have side effects, you’re pregnant, or the bug responds better to another drug. Below I explain the common alternatives, when they’re used, and what to ask your clinician.

Common drug alternatives and when they fit

Albendazole and mebendazole: These two are benzimidazoles and are first-line for many intestinal worms. Doctors often choose them for pinworms, roundworms, hookworms, and some tapeworms. They’re taken orally and work by blocking the worm’s ability to use energy, which slowly kills it. If you have a broad intestinal infection or a mixed infestation, one of these is commonly used instead of ivermectin.

Praziquantel: This is the go-to for most tapeworms and flukes. It works differently from ivermectin and is usually rapid and effective for schistosomiasis and many tapeworm infections. If your diagnosis points to a fluke or a tapeworm, praziquantel is often the better option.

Permethrin (topical) and symptomatic care: For scabies, a topical permethrin cream is a proven choice. Some clinics still use oral ivermectin for scabies outbreaks or severe cases, but permethrin cream applied correctly is a safe, effective alternative for most people.

Nitazoxanide and others: For some protozoal infections like Giardia or Cryptosporidium, nitazoxanide or metronidazole may be used. These aren’t direct ivermectin substitutes but are alternatives when the parasite type isn’t a helminth.

How to pick the right alternative

Match the drug to the parasite. That’s the single most important rule. A stool test or blood test that identifies the organism guides the right choice. Also consider pregnancy, children, drug interactions, and local resistance patterns. For example, albendazole is usually avoided in pregnancy, so doctors pick other options or delay treatment when safe.

Side effects and safety matter. Benzimidazoles can cause stomach upset or mild liver changes; praziquantel can cause dizziness or abdominal pain. Tell your provider about other meds you take and any liver issues. If you bought medicine online, double-check credentials and ask for a prescription—counterfeit meds are a real risk.

If ivermectin didn’t work or caused a problem, don’t self-treat. Talk to your clinician or an infectious disease specialist. They’ll confirm the parasite, recommend the correct drug and dose, and set up follow-up testing. That small step avoids wasted treatment and keeps you safer.

Want help preparing for that conversation? Note symptoms, travel history, and any medicines you use. Bring lab results if you have them. Clear info makes it faster for your clinician to pick the best Stromectol alternative for you.