Ivermectin tablets for humans are prescription-only in the United States. You cannot walk into a pharmacy and buy oral ivermectin off the shelf. However, one specific topical form of ivermectin, a 0.5% lotion used to treat head lice, is available over the counter.
What You Can Buy Without a Prescription
The FDA approved Sklice (ivermectin lotion, 0.5%) for over-the-counter sale after it went through a formal prescription-to-OTC switch process. Originally approved as a prescription drug in February 2012, it was later cleared for nonprescription use and is no longer sold as a prescription product at all. Sklice is a single-use topical lotion for treating head lice in patients 6 months of age and older. You apply it to the hair and scalp, leave it on for 10 minutes, and rinse. It’s the only form of ivermectin you can buy in the U.S. without seeing a doctor.
What Still Requires a Prescription
Oral ivermectin tablets require a prescription from a licensed provider. These tablets are FDA-approved for two parasitic conditions: intestinal strongyloidiasis (threadworm infection) and onchocerciasis (river blindness). Dosing is calculated by body weight, which is one reason the FDA keeps it prescription-only. For threadworms, the typical dose is 200 micrograms per kilogram of body weight as a single dose. For river blindness, it’s 150 micrograms per kilogram, sometimes repeated every 3 to 12 months. Each tablet contains 3 milligrams.
Soolantra, a 1% ivermectin cream prescribed for the inflammatory bumps and redness of rosacea, also requires a prescription. So if you’re looking for ivermectin for a skin condition other than head lice, you’ll need to visit a healthcare provider.
Cost of Prescription Ivermectin
Without insurance, a carton of 20 generic ivermectin tablets (3 mg each) has an average retail price around $69, though discount coupons from services like GoodRx can bring that down to roughly $28. The 6 mg tablets are considerably more expensive, with retail prices above $300 for a 20-tablet carton and discounted prices around $94. Most prescriptions for parasitic infections are short, often a single dose, so you may not need a full carton.
Why Veterinary Ivermectin Is Not a Substitute
Ivermectin products made for livestock, particularly horses and cattle, are sold at farm supply stores without a prescription. Some people have tried to use these as a workaround, but the dosages are formulated for animals that weigh hundreds or thousands of pounds. The concentrations are far higher than what a doctor would prescribe for a human, and the inactive ingredients in veterinary formulations aren’t tested or approved for human consumption. Overdose symptoms include confusion, disorientation, and severe drowsiness, and in serious cases can require emergency treatment.
Status in Other Countries
If you’re outside the U.S., oral ivermectin is generally prescription-only in other major English-speaking countries as well. In Australia, oral ivermectin is classified as a Schedule 4 (Prescription Only) medicine. As of June 2023, Australian regulations were loosened so that any doctor, not just specialists, can prescribe it for off-label uses. In the UK and Canada, it similarly requires a prescription for human use.
The Bottom Line on Access
If you need ivermectin for head lice, you can pick up Sklice lotion at a pharmacy without a prescription. For anything else, including parasitic infections or rosacea, you’ll need a prescription. The tablets are relatively affordable with discount pricing, and since most parasitic treatments involve just one or two doses, the out-of-pocket cost is manageable even without insurance.