Topical Antiparasitic — Rosacea Pregnancy: There are no or a limited amount of data from the topical use of ivermectin in pregnant women. Oral reproductive toxicity studies have shown ivermectin to be teratogenic in rats and rabbits, but due to the low systemic exposure following topical administration at the proposed posology there is a low safety concern for a human foetus. Soolantra is NOT RECOMMENDED during pregnancy. Breast-feeding: ivermectin is excreted in human milk in low concentrations after oral administration; excretion after topical administration has not been evaluated and a risk to a suckling child cannot be excluded — decide whether to discontinue breast-feeding or the treatment, taking account of the benefit of each.

Ivermectin Cream (Topical)

Brand names: Soolantra

Topical ivermectin cream is an antiparasitic and anti-inflammatory agent applied to the face for the inflammatory papulopustular lesions of rosacea.

Auto-extracted from the source labelling — not yet independently clinician-verified. These values were distilled from the UK SPC (or the US label where noted) but have not had a clinician sign-off. Confirm against the current SmPC before prescribing.

Adult dose

Dose: One application a day for up to 4 months. Apply a pea-size amount to each of the five areas of the face — forehead, chin, nose and each cheek — spread as a thin layer across the entire face.

Route: Cutaneous use only. Apply only to the face, avoiding the eyes, lips and mucosa. Wash hands after applying. Cosmetics may be applied after the product has dried.

Frequency: Once daily

Max: Up to 4 months per treatment course; the treatment course may be repeated

Product: Soolantra 10 mg/g Cream (ivermectin), UK SPC https://www.medicines.org.uk/emc/product/6819/smpc. Apply daily over the treatment course. It can be used as monotherapy or as part of combination treatment. IN CASE OF NO IMPROVEMENT AFTER 3 MONTHS, THE TREATMENT SHOULD BE DISCONTINUED. Patients may experience transient aggravation of rosacea, which usually resolves within 1 week if treatment is continued (expected as a reaction to the dying Demodex mites); in case of severe worsening with a strong dermal reaction, treatment should be discontinued. Soolantra has not been studied in patients with renal or hepatic impairment. Excipient cautions: contains cetyl alcohol and stearyl alcohol (may cause local skin reactions such as contact dermatitis), methyl parahydroxybenzoate (E218) and propyl parahydroxybenzoate (E216) (may cause allergic reactions, possibly delayed), and propylene glycol (may cause skin irritation). PAEDIATRIC (§4.2): the safety and efficacy of Soolantra in children and adolescents aged less than 18 years have not been established and no data are available — hence paedDose is null; verify any paediatric use against a children's formulary. ELDERLY: no dosage adjustment is necessary. This is the TOPICAL cream only — do not apply oral ivermectin weight-based doses (micrograms/kg) to this product.

Dose adjustments

Renal

No dosage adjustment is necessary in renal impairment. Caution should be exercised in patients with severe hepatic impairment (SPC §4.2).

Dose auto-extracted from UK Summary of Product Characteristics (SPC) via the eMC — not yet clinician-verified. Always confirm against the product SmPC and your local formulary before prescribing.

Contraindications

Hypersensitivity to the active substance or to any of the excipients (SPC §4.3)

Side effects

Skin burning sensation (common)
Skin irritation, pruritus and dry skin (uncommon)
Rosacea aggravation (uncommon; post-marketing) — usually transient and resolving within 1 week of continued treatment
Erythema, contact dermatitis (allergic or irritant) and face swelling (frequency not known)
Transaminases increased (frequency not known; post-marketing)

Interactions

No interaction studies have been performed (SPC §4.5)
In vitro studies have shown that ivermectin is primarily metabolised by CYP3A4 — caution is advised when ivermectin is administered concomitantly with potent CYP3A4 inhibitors, as plasma exposure may be significantly increased

Clinical monograph

How it works

It has both anti-inflammatory effects and acaricidal activity against Demodex mites, which are implicated in the pathogenesis of papulopustular rosacea.

Prescribing in practice

For external cutaneous use only; avoid contact with the eyes, lips and mucous membranes, and wash hands after application.
Apply a thin layer once daily to the affected areas of the face, avoiding broken or irritated skin.
Transient local effects such as burning, skin irritation, pruritus or dryness may occur early in treatment.

Monitoring

Monitoring is clinical, reviewing the response of inflammatory lesions and any local skin reactions, with reassessment if no improvement is seen after an adequate trial.

Counselling the patient

Apply once daily and continue as directed even if improvement is gradual.
Use only on the face and keep it away from the eyes, lips and inside the nose.
Mild stinging or dryness can occur at first and usually settles.

Evidence & guidelines

Topical ivermectin is an established treatment option for papulopustular rosacea and is supported by NICE clinical guidance on rosacea management.

Reference: ATTRACT Trial (Taieb et al. Br J Dermatol 2015); BAD Rosacea Guidelines 2017; NICE CKS Rosacea; Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. The structured dose values shown have been reviewed by a clinician. Monograph status: clinician-reviewed (2026-07-04).

Curated clinical cross-links plus same-class fallbacks.

Pathways