Human 3 mg Stromectol follows weight, not a feed-store syringe

Weight times 200 mcg/kg, then human 3 mg tablet math

Weight times 200 mcg/kg, then human 3 mg tablet math. Divide by 3000 mcg per human tablet. That is the count. It is not take-two-and-see. Horse paste is not that math. The card does the mcg/kg arithmetic. It does not ship tablets.

Day 14 repeats 200 mcg/kg and does not lift it

Day 14 repeats the same 200 mcg/kg because eggs hatch on a schedule. The second dose is not a higher ceiling. It is not a third swallow the next morning. Strongyloides regimens follow their own labeled days. The mcg/kg cap does not float up because itch returned. Paste is still not a licensed fill.

Human 3 mg counts, warehouse and mail, not paste

PMX ivermectin card quotes, August 2026. Costco / Target / Amazon Pharmacy / Albertsons. Human 3 mg, 4 or 6 tablets. Not paste. Snapshot. Script required. Not a cart.

Costco, Target, Amazon Pharmacy, and Albertsons already post coupon or warehouse numbers for human 3 mg tablets in 4-tablet or 6-tablet counts. Figures below are August 2026 snapshots from GoodRx and SingleCare. Confirm a human NDC. Paste from a feed store is not a licensed fill.

Horse paste is not a Stromectol card

Ivermectin transformed neglected tropical disease programs and remains a cornerstone for strongyloidiasis, onchocerciasis, and scabies when oral therapy is appropriate. The human formulation (Stromectol) is dosed by weight in micrograms per kilogram-not 'one tablet' guessing.

FDA-approved indications include intestinal strongyloidiasis and onchocerciasis (river blindness). Scabies, head lice, and rosacea (topical) appear in guidelines and off-label practice with substantial evidence for oral scabies in crusted or refractory cases and mass drug administration settings.

The drug does not kill adult Onchocerca volvulus worms-microfilaricidal activity produces Mazzotti reactions when microfilariae die. In strongyloidiasis, it targets the parasite lifecycle with high cure rates when dosed correctly.

Card note: public confusion from pandemic-era misinformation conflated human tablets with veterinary products. Horse paste contains ivermectin concentrations formulated for large animals; humans who self-dose paste risk toxicity and never get accurate mg/kg calculation.

Before starting prednisolone or other immunosuppression in patients from endemic strongyloides regions, think about screening and treatment-hyperinfection syndrome kills. Cross-reference prednisolone counseling when steroids are on the same med list.

Card note: p-glycoprotein (MDR1) at the blood-brain barrier keeps ivermectin out of the CNS in normal hosts. Collies and humans with ABCB1 mutations are the cautionary tales for neurotoxicity.

Scabies outbreaks in nursing homes sometimes use mass oral ivermectin under public health guidance-individual outpatient dosing still follows weight-based 200 mcg/kg with day-14 repeat.

Topical permethrin remains first-line for classic scabies in many guidelines; oral ivermectin is not always step one but is essential knowledge for crusted scabies and treatment failures.

Internet misinformation conflated human tablets with veterinary products-poison centers reported overdoses from paste ingestion during pandemic-era misuse.

U.S. ivermectin is scabies repeat, strongyloides before steroids, travel contexts-high stakes when weight or paste is wrong. 200 mcg/kg and day-14 repeat should be automatic.

Travel medicine clinics see strongyloides in returned travelers with eosinophilia-ivermectin before planned prednisolone for any reason is the sequence that prevents hyperinfection deaths.

Scabies treatment with oral ivermectin follows weight-based 200 micrograms per kilogram, not tablet count guessing. A 70 kg adult needs 14 mg total, typically five 3 mg Stromectol tablets for the first dose, then the same calculation repeated approximately fourteen days later to kill mites hatched from eggs surviving the first exposure. Skipping the second dose is the most common reason for 'treatment failure' callbacks. Schedule the day-fourteen visit or phone reminder at the first appointment; do not rely on patient memory once itch improves.

Card note: human Stromectol tablets and veterinary horse paste are not interchangeable products. Paste formulations express concentration per gram of paste vehicle; patients who self-dose paste from farm stores mis-calculate milligrams per kilogram and land in poison centers with CNS toxicity-ataxia, confusion, coma. Counseling one sentence-use pharmacy tablets dosed by weight, never horse paste-prevents disasters that spiked during pandemic misinformation. Pharmacists may need to order human ivermectin; plan ahead for scabies prescriptions rather than sending families to agricultural suppliers.

Card note: dermatology clinics see post-scabetic itch weeks after successful mite kill-differentiate persistence of allergic inflammation from live mite reinfestation before repeating oral doses.

Travel clinics should document strongyloides screening before any planned prednisolone or immunosuppression in returned travelers with eosinophilia or endemic exposure history.

Nursing home scabies clusters need simultaneous oral ivermectin for eligible residents plus environmental linen protocols - treating one room while the unit shares a laundry chute fails institutionally.

Pharmacy stock-outs of human 3 mg tablets push families toward agricultural suppliers; order Stromectol early and document weight-based tablet count in the prescription so the pharmacist can verify math.

Occupational health screens for strongyloides before biologic or high-dose steroid starts in manufacturing workers with Southeast Asia assignment history - eosinophilia on pre-placement labs is a clue, not noise.

School scabies letters often mention permethrin only - add oral ivermectin counseling when topical failure or crusted disease appears in the cluster.

Glutamate-gated chloride channels in the parasite

Ivermectin is a semi-synthetic avermectin that binds glutamate-gated chloride channels in invertebrate nerve and muscle cells. Channel opening increases chloride influx, hyperpolarizing membranes and causing flaccid paralysis of parasites.

Mammalian GABA receptors differ structurally; at labeled human doses with intact BBB, CNS penetration is limited. Overdose or MDR1 deficiency removes that safety margin-encephalopathy ensues.

Also binds other invertebrate chloride channels, contributing to broad antiparasitic activity against nematodes and ectoparasites like Sarcoptes scabiei.

Microfilaricidal effect in onchocerciasis releases Wolbachia endosymbionts and antigens, triggering inflammatory Mazzotti reactions-pretreatment with antihistamines and corticosteroids in severe onchocerciasis is specialist protocol.

Scabies mites die after oral ivermectin exposure through ingestion during feeding on host-timing of itch resolution lags mite death because allergic response to dead mites persists.

No antibacterial or antiviral mechanism at human-relevant exposures-using ivermectin for non-parasitic infections is pharmacologic mismatch.

Card note: lice and scabies are ectoparasites with different guideline pathways-Sklice topical versus Stromectol oral serve different niches.

Community mass drug administration for onchocerciasis uses population logistics unlike single-patient scabies dosing-do not extrapolate community schedules to individual crusted scabies without ID.

Card note: microfilaricidal activity without adulticidal effect in onchocerciasis means repeat community doses on program calendars, not 'one and done' thinking.

Parasite glutamate-chloride channels versus mammalian P-gp BBB protection-until paste overdose or MDR1 defect.

Strongyloides autoinfection means filariform larvae penetrate gut wall and re-enter circulation-ivermectin before prednisolone in endemic exposure prevents hyperinfection mortality, not a minor travel medicine footnote.

Scabies oral therapy complements permethrin when topical application fails, crusted disease demands systemic scale, or institutional outbreaks require mass treatment-first-line choice varies by guideline, lifecycle dosing does not.

Permethrin 5% cream remains first-line for uncomplicated scabies in many U.S. outpatient pathways because topical therapy avoids systemic exposure and treats surface mites directly - oral ivermectin earns its place when hands are too arthritic to apply cream everywhere, when crusted hyperkeratosis blocks penetration, or when public health mandates oral scale in closed settings.

Card note: norwegian scabies sheds live mites in skin scale - hospitalize when crusted, start ID-guided multi-dose oral regimens plus topical keratolytics, and notify infection control before the patient spends a second night on a general medical floor.

Fasted swallow, hepatic CYP, and why paste PK is unknown

Oral ivermectin is absorbed with food-fat increases absorption. Take with a meal when possible for scabies and strongyloides regimens.

Card note: peak plasma levels occur about four to five hours post-dose. Volume of distribution is large; the drug distributes into skin and tissue compartments relevant to ectoparasites.

Metabolism is hepatic (CYP3A4) with excretion mainly in feces; renal elimination is minor. Half-life is approximately 18 hours in healthy adults-long enough that repeated doses days apart accumulate slightly.

Strongyloidiasis often uses 200 mcg/kg daily for two days. Scabies uses 200 mcg/kg once, then repeat in one to two weeks (day 14 is standard teaching) to kill newly hatched mites from eggs not killed by first dose.

CYP3A4 inhibitors may increase exposure; co-administered drugs are less clinically dramatic than weight-based dosing errors.

Topical ivermectin (Sklice, Soolantra) has localized PK for lice/rosacea-do not double-count with oral tablets without intentional combination therapy.

Card note: fatty meals increase absorption-empty-stomach dosing may reduce exposure in scabies protocols that assume fed administration.

Single-dose scabies regimens still need day-14 repeat because eggs survive first dose-lifecycle teaching prevents undertreatment.

Strongyloides autoinfection loop means immunosuppression unmasking hyperinfection is a mortality issue-prednisolone before treating parasite is dangerous in endemic exposure.

Fed dosing improves absorption; book day-14 at day-1 visit for scabies lifecycle, not convenience.

Obesity does not change the mg/kg formula for scabies - use actual weight unless your institution publishes a cap; underdosing a 120 kg patient with a flat 'two tablets' order is a common outpatient error.

Strongyloides two-day regimens in immunocompromised hosts may extend beyond textbook one-day courses - ID follow-up stool or serology at two weeks beats assuming cure from a single calculated dose.

Scabies day-14 math and strongyloides before steroids

Scabies: oral ivermectin 200 mcg/kg with repeat dose at day 14 is non-inferior to topical permethrin in many comparative trials for classic scabies. Crusted (Norwegian) scabies often requires repeated doses plus topical agents and isolation-ID consultation.

Strongyloidiasis: 200 mcg/kg for one or two days achieves high cure rates; follow-up stool O&P or serology confirms eradication in immunocompromised hosts.

Onchocerciasis: mass drug administration programs reduced blindness prevalence across Africa and Latin America-community efficacy, individual Mazzotti risk.

Head lice: oral ivermectin is second-line after topical failures; topical ivermectin lotion is FDA-approved for lice.

Unapproved viral use lacks credible efficacy-prescribe for parasites per label and guidelines, not social media protocols.

Permethrin remains first-line for many scabies cases in outpatient pediatrics-ivermectin fills gaps when topical application fails, outbreaks need oral scale, or hygiene barriers exist.

Crusted scabies may require weekly ivermectin plus topical keratolytics and isolation-standard two-dose outpatient protocol is insufficient.

Strongyloides serology or stool O&P before steroids in travelers from endemic areas (Southeast Asia, Latin America, parts of U.S. Appalachia) saves lives.

Card note: head lice oral ivermectin is second-line after topical failure-resistance patterns vary regionally.

Permethrin first for classic scabies; oral when topical fails, crusted disease, or outbreak protocols demand scale.

Institutional scabies outbreaks may use oral ivermectin mass treatment under public health-individual outpatient still uses weight-based two-dose regimen with contact treatment.

P-glycoprotein at the blood-brain barrier limits CNS ivermectin at labeled antiparasitic doses in hosts with intact MDR1 function. Collie dogs with ABCB1 mutations illustrate neurotoxicity when the barrier fails; rare human MDR1 defects carry the same theoretical risk. Overdose from paste or massive tablet ingestion overwhelms P-gp protection in anyone. Glutamate-gated chloride channel opening in parasites causes paralysis and death; mammalian channels differ enough that selective toxicity holds until exposure exceeds labeled human pharmacokinetics.

Strongyloides stercoralis autoinfection lifecycle makes ivermectin part of steroid safety. Hyperinfection syndrome with disseminated larvae in immunosuppressed hosts-especially corticosteroids without prior antiparasitic therapy-carries high mortality. Eosinophilia may be present before steroids or may fall paradoxically during hyperinfection. Travel, military, missionary, and rural residence histories trigger screening stool ova and parasite exams or serology before prednisolone starts when exposure is plausible. Treat strongyloides with ivermectin before immunosuppression, not after catastrophe.

Comparative scabies trials often show oral ivermectin non-inferior to permethrin for classic disease - choose based on application ability, crusted severity, and outbreak logistics, not brand loyalty to either route.

Card note: head lice resistance to pyrethroids in some regions pushes clinicians toward topical or oral ivermectin second-line - do not reuse scabies mg/kg math for lice without checking the lice-specific label or guideline dose.

Onchocerciasis mass drug administration reduced blindness prevalence across West Africa - individual clinic dosing still requires Mazzotti pretreatment planning when microfilarial loads are high.

Card note: permethrin resistance is regional - when two properly applied permethrin courses fail and burrows persist, oral ivermectin with day-14 repeat is reasonable before declaring refractory infestation.

Microfilarial counts in onchocerciasis guide pretreatment - high loads may need antihistamine and specialist-supervised first dose to blunt Mazzotti hypotension.

Tablet counts from mcg/kg, never a feed-store syringe

Calculate every dose: weight in kg × 200 mcg/kg = total mcg; divide by tablet strength (common 3 mg tablets). Round sensibly and document calculation in chart for liability and education.

Scabies: dose day 1 and repeat day 14. Treat close contacts simultaneously; environmental decontamination of bedding and clothing on day 1 remains standard.

Strongyloidiasis: 200 mcg/kg daily for 1-2 days; immunocompromised patients may need prolonged or repeated courses-ID guidance.

Pediatrics: weight-based mg/kg applies; labeling includes pediatric strongyloidiasis/onchocerciasis with weight tables. Scabies use in young children follows AAP and dermatology guidance-ivermectin often reserved when permethrin insufficient.

Renal/hepatic impairment: no labeled adjustment for short courses; severe hepatic disease may increase exposure-clinical judgment.

Do not use horse paste: concentration is mg per gram paste, not mg per tablet; overdoses caused hospitalizations. Human Stromectol tablets are the outpatient standard.

Card note: weigh patients-estimate dose from 'looks about 70 kg' causes under- or overdosing in scabies.

Household contacts treated concurrently reduce reinfestation-single treated patient in shared housing often bounces back.

Store tablets away from veterinary products in rural households where both may exist in same cabinet.

70 kg × 200 mcg/kg = 14 mg ≈ five 3 mg tabs-write the math in the chart; 'two pills' underdoses.

Pharmacy may need to order Stromectol-human 3 mg tablets-not compound from veterinary supply. Document weight-based calculation in prescription sig when allowed.

Obese patients: use actual body weight for scabies mg/kg unless institutional protocol specifies otherwise-underdosing fails treatment.

Crusted scabies may require 200 mcg/kg on days 1, 2, 8, 9, 15 under ID protocols-not the standard two-dose pamphlet.

Strongyloides follow-up stool or serology at two weeks confirms cure in immunocompromised hosts-one dose is not always sufficient.

Take with high-fat meal per labeling to maximize absorption-fasting dose may reduce exposure.

Write the weight-based calculation in the chart: '72 kg × 0.2 mg/kg = 14.4 mg ≈ five 3 mg tablets' - pharmacists catch errors when the sig matches your note.

Card note: day-14 appointment type should be nursing visit or telehealth pill check - a full copay visit for 'second scabies dose' gets skipped when patients feel cured.

Warfarin signals and the immunosuppression pairing

Card note: strong CYP3A4 inhibitors may increase ivermectin levels-clinical significance modest at single-dose scabies regimens but note in polypharmacy.

Drugs that affect P-gp (cyclosporine, some HIV protease inhibitors) could theoretically alter CNS penetration-rare at single doses.

Warfarin: isolated INR changes reported-monitor if co-administered.

Sedatives do not directly interact pharmacokinetically but mask early neurotoxicity symptoms-avoid unnecessary CNS depressants if high-dose ivermectin under specialist care.

Prednisolone and immunosuppression: not a PK interaction-clinical sequence matters. Steroids before treating strongyloides can trigger hyperinfection; treat parasite first when exposure history fits.

Alcohol does not alter PK meaningfully; focus counseling on weight-based human tablets, not paste.

Warfarin INR bumps are idiosyncratic-check INR if concurrent anticoagulation.

Immunosuppression timing: treat strongyloides before prednisolone when exposure history fits-cross-link to steroid monograph in same patient.

CYP3A4 inhibitors at single scabies doses rarely require adjustment-focus on correct mg/kg and day-14 repeat.

Prednisolone sequence: treat strongyloides before immunosuppression-hyperinfection kills, not obscure CYP.

Before oncology or rheumatology starts prednisolone, ask endemic travel and rural residence history-strongyloides screen is part of steroid safety, not parasitology trivia.

Warfarin patients on single-dose scabies therapy rarely need INR change - still check if they report bruising after dose one; the interaction signal is idiosyncratic, not dose-dependent.

Mass azithromycin or albendazole co-administration in NTD programs uses different schedules than individual U.S. scabies prescriptions - do not import community MDA calendars into crusted scabies without ID.

Mazzotti reactions versus paste toxicity

Labeled scabies/strongyloides courses: mild Mazzotti-like symptoms uncommon; pruritus may transiently worsen as mites die.

Onchocerciasis: Mazzotti reactions (fever, rash, arthralgia, hypotension) common as microfilariae die-pretreatment protocols in endemic settings.

Neurotoxicity (confusion, ataxia, coma) in MDR1/ABCB1 defect or massive overdose-supportive care; no specific antidote.

GI: nausea, diarrhea, dizziness at labeled doses.

Hepatic enzyme elevation rare.

Veterinary paste overdose: hospitalization for CNS and GI toxicity-prevent by refusing paste counseling and prescribing human tablets when oral ivermectin is indicated.

Post-scabetic itch lasts weeks-antihistamines and low-potency topical steroids, not repeated ivermectin without mite confirmation.

Mazzotti reactions in onchocerciasis can include hypotension-monitor first dose in endemic treatment programs.

Pediatric accidental ingestion of paste is a poison center call-mg/kg miscalculation drives severity.

Paste overdose ataxia-ask exact product ingested; horse paste concentration differs from Stromectol tablets.

Crusted scabies can shed mites in healthcare settings-isolation and contact precautions beyond standard scabies counseling apply in hospitalized crusted cases.

Strongyloides hyperinfection may present with gram-negative bacteremia from larval translocation-ivermectin plus broad antibacterial coverage in ICU under ID guidance.

Card note: repeated ivermectin without confirming active scabies wastes drug and delays diagnosis of itch mimics.

New burrows on the web spaces after day 21 suggest reinfection from untreated contacts - retreat household and verify environmental decontamination before blaming drug resistance.

Paste ingestion produces ataxia within hours - ask exact product and grams ingested when telehealth triage hears 'ivermectin from the barn.'

Weight extremes, pregnancy, and pediatric limits

Pregnancy: avoid unless benefit clearly outweighs risk-animal data and limited human data counsel caution; permethrin often preferred for scabies in pregnancy.

Lactation: low excretion; short courses often deemed acceptable per specialty guidance.

Pediatrics: use weight-based dosing; scabies oral use off-label in very young children-check latest AAP/dermatology recommendations.

MDR1/ABCB1 mutation (rare in humans): avoid ivermectin or use extreme caution-same concern as collie dogs.

Immunocompromised: strongyloides hyperinfection risk with steroids or HTLV-1-lower threshold to treat and repeat stool studies.

Crusted scabies: may need multiple doses weekly under ID supervision-not standard two-dose outpatient protocol.

Card note: pregnancy scabies often prefers permethrin topical first-oral ivermectin when benefit outweighs risk per specialist.

MDR1-deficient breeds in veterinary medicine parallel human ABCB1 concerns-ask about collie exposure only in vet context; human genetic testing is rare.

HTLV-1 co-infection increases strongyloides hyperinfection risk-endemic strongyloides regions overlap with HTLV epidemiology.

Crusted scabies in immunocompromise needs ID repeat schedule-not two-dose pamphlet alone.

Elderly nursing home residents in scabies outbreaks need simultaneous contact treatment and environmental control-single oral dose without contact management fails institutionally.

Pediatric weight changes between dose one and day fourteen require recalculation-do not reuse day-one weight for second dose if young child gained or lost significantly.

HIV with low CD4 and strongyloides exposure: treat parasite aggressively and repeat stool studies-hyperinfection risk is highest in this overlap.

Breastfeeding short courses for scabies are often acceptable per specialty guidance - permethrin topical remains first-line in pregnancy when feasible.

Card note: developmentally delayed adults in group homes need weight documented at each outbreak - do not reuse last year's kg from the chart if weight changed.

Confirm the human NDC before anyone swallows

Take with food. Bring weight to pharmacy visit or confirm dose calculation on the label.

Scabies: second dose on day 14 is part of the treatment-not optional because you feel better day 5.

Card note: wash bedding and clothing hot cycle day 1; treat household contacts per clinician plan.

Itch can persist weeks after mites are dead-antihistamines and topical steroids for post-scabetic itch, not endless ivermectin repeats without re-evaluation.

Never buy horse paste from farm stores for human scabies-concentration errors are dangerous.

If you lived in or traveled to strongyloides-endemic areas and need steroids, tell your doctor before starting prednisolone-screening stool or serology may be needed.

Set phone reminder for day-14 second dose-patients who feel better after dose one skip dose two and relapse.

Explain that horse paste from farm stores is the wrong product at the wrong concentration-human pharmacy tablets only.

Itch after treatment does not mean failure-persistently new burrows after four weeks warrant retreatment evaluation.

One sentence: 'No horse paste-pharmacy tablets by weight.' Prevents poison center calls.

Card note: day-14 second dose: schedule at first visit, send text reminder-patients who skip dose two are the 'treatment failure' callbacks that were preventable lifecycle gaps.

Permethrin 5% cream remains first-line for classic scabies in many pediatric and primary care guidelines; oral ivermectin enters when topical therapy fails, crusted scabies demands systemic treatment, institutional outbreaks require scale, or application barriers exist. Post-scabetic itch persists weeks after mite eradication because allergic inflammation to dead mites continues-antihistamines and low-potency topical corticosteroids treat itch, not repeated ivermectin without evidence of live mites. Crusted scabies in immunocompromised hosts requires infectious disease supervision with repeated dosing and environmental control beyond standard two-dose outpatient protocols.

Contacts with classic scabies need treatment even if asymptomatic - explain that itch lags infestation by weeks, so 'I feel fine' does not mean uninfected.

Seal non-washable items in a bag for two weeks or dry-clean - freezing and insecticide sprays are poor substitutes for hot wash plus oral or topical therapy.

200 mcg/kg is the cap; day 14 repeats it, paste does not

Ivermectin is a weight-based antiparasitic (200 mcg/kg) with scabies retreatment about day 14 and distinct strongyloides/onchocerciasis regimens.

P-gp keeps CNS exposure low at labeled doses; MDR1 defects and veterinary paste overdose are neurotoxicity risks.

Treat strongyloides before immunosuppression when exposure history fits. Use human Stromectol tablets, not horse paste.

Weight-based 200 mcg/kg with day-14 repeat for scabies is the outpatient pattern to memorize.

P-gp protects the CNS until it does not-MDR1 defects and paste overdose are the neurotoxicity scenarios.

200 mcg/kg, day-14 repeat, human tablets only, strongyloides before steroids when exposure possible.

Ivermectin bottom line: calculate mg from weight every time; repeat scabies dose ~day 14; human Stromectol never horse paste; treat strongyloides before prednisolone when exposure fits-P-gp keeps CNS safe at labeled doses until overdose or MDR1 failure.

Card note: most 'failures' are lifecycle gaps, paste substitution, or untreated contacts - fix those before calling mites resistant.

Strongyloides plus steroids without antiparasitic therapy is the lethal interaction worth more ward teaching than CYP3A4 trivia on a single scabies dose.

Day-14 dose belongs on the calendar at day one - text reminder beats a second clinic visit copay for many insured patients.

When itch persists without new burrows, antihistamines and low-potency topical steroids treat post-scabetic inflammation; a third oral dose without mite evidence wastes drug and delays alternate diagnoses.

Crusted scabies in ICU requires contact precautions, repeated weekly oral dosing under ID, and topical keratolytics - the two-dose outpatient pamphlet is not the protocol.

Card note: eosinophilia on CBC in a veteran with rural Kentucky childhood warrants strongyloides serology before VA rheumatology starts prednisolone - hyperinfection is preventable if you ask once.

Telehealth scabies prescriptions without weight on the chart invite dosing errors - have the patient step on a home scale on video or weigh in pharmacy before dispensing.

Lice versus scabies: different parasites, different topical products, different oral dosing if you go systemic - do not reuse one counseling script for both.

Store human tablets away from veterinary products in rural homes - poison centers still see paste overdoses when both sit in the same cabinet.

Card note: day-one weight in kg goes in the prescription sig when your e-prescribing system allows it - pharmacists double-check tablet counts against your calculation and catch underdose before dispense.