I weigh 72 kg. Why does one page say four Stromectol tablets and my cousin's clinic said five?
Does a Copenhagen shelf list Stromectol 3 mg as a cart?
| Pharmacy | Strength / count | How the window works | Official page |
|---|---|---|---|
| Publix | 3 mg x 24 | Grocery pharmacy cash window | Publix pharmacy |
| Meijer | 3 mg x 24 | Midwest grocery pharmacy desk | Meijer pharmacy |
| Target | 3 mg x 24 | CVS-run desk inside Target | Target pharmacy |
| Cost Plus Drugs | 3 mg x 24 | Mail-order cash list | Cost Plus Drugs pharmacy |
Nyhavn 21 does not run a checkout for antiparasitic chips. This folio is a reading desk. Ingrid Halvorsen will tell you what a licensed US window prints for a 3 mg carton, then send you back to a clinician who can name the worm. A cart metaphor on a search page is not a fill. The table under this heading is a shelf-check of real counters, not a Danish till.
Four chips is a count, not a shopping list. Someone weighing 70 kg with river blindness in the chart gets four 3 mg tablets on the onchocerciasis band. Someone with the same scale reading and a Strongyloides stool gets a different chip count on the same tablet. If a website sells you 'ivermectin 3 mg cheap' without naming the indication, it has not drawn the slip.
Ingrid Halvorsen draws the scale before she notes a price caption. She asks where you lived, which stool was seen, whether West or Central Africa sits in the travel line. Only then does a 24-count carton at a grocery pharmacy mean anything. This Copenhagen shelf does not ship. It binds the arithmetic so you do not swallow a paste meant for livestock.
A cart would imply this desk fills. It does not. The licensed rows below are US pharmacy pages. GoodRx figures stay in the caption, never as a row link. If you came here from a viral thread, stop at the clinical-evidence review after you finish the weight bands. Bind the worm first.
How four chips land on a 66-79 kg oncho slip
| Scale (kg) | 3 mg chips, oncho ~150 mcg/kg | What IP-01 locks |
|---|---|---|
| 15-25 | 1 tablet | Below this folio |
| 26-44 | 2 tablets | Still below the lock |
| 45-64 | 3 tablets | One chip short |
| 66-79 (inside 65-84) | 4 tablets | SERP lock on this shelf |
| 85 and above | 150 mcg/kg | Calculate, do not guess |
The lock on this folio is narrow on purpose. Onchocerciasis is dosed at about 150 mcg/kg as a single oral dose of Stromectol 3 mg tablets. The US label groups 65-84 kg as four tablets. Sixty-six to seventy-nine kilograms sits inside that four-tablet band. That is why the search card on this domain names four chips, not five.
Sixty-six to seventy-nine kilograms at 150 mcg/kg is roughly 10 to 12 mg, which is three-and-a-bit to four 3 mg tablets. The label does not ask you to split a chip for this band. It prints four. Residents who 'round up to be safe' are inventing a fifth tablet the oncho table does not give them. Save the extra chip for the Strongyloides column, where it actually belongs.
Residents keep mixing the bands because both tables use the same white 3 mg tablet. The mistake is treating 66-79 kg as a universal count. It is not. It is an oncho lock on this shelf and a five-tablet Strongyloides line on the other table. Draw the indication on the slip before you count.
If the indication is onchocerciasis, retreatment for a single patient may be considered as soon as three months. Mass campaigns often use a twelve-month interval. That calendar is not a license to redose because a forum said so. Ingrid notes the last dose date on the folio, then shelves the carton until the interval is real.
Why Strongyloides asks for a fifth chip on the same scale
Same 3 mg chip, different indication, different arithmetic. Do not treat the oncho four-chip lock as a Strongyloides count.
| Scale (kg) | 3 mg chips, Strongyloides ~200 mcg/kg |
|---|---|
| 15-24 | 1 tablet |
| 25-35 | 2 tablets |
| 36-50 | 3 tablets |
| 51-65 | 4 tablets |
| 66-79 | 5 tablets - not the IP-01 lock |
| 80 and above | 200 mcg/kg |
Strongyloides uses the same 3 mg chip and a steeper target: about 200 mcg/kg as a single oral dose. On that table, 66-79 kg is five tablets. That is not this site's lock. It is the other arithmetic. If you paste four chips onto a Strongyloides stool because the search title said four, you have underdosed the labeled band.
Two hundred micrograms per kilogram at 70 kg is 14 mg, which is four 3 mg tablets plus a bit. The label does not leave you to split. It prints five tablets for 66-79 kg. That is why Ingrid keeps two tables on the desk and refuses a single 'adult dose' line. Adult is not a milligram.
Do not paste the oncho lock onto a larva in the stool. Intestinal (nondisseminated) strongyloidiasis is the labeled gut indication. Extra doses are not routine. Follow-up stool examinations still have to show clearance. A clean week-one symptom story is not eradication. The parasite can hide.
Follow-up stool checks still belong on the slip after a single Strongyloides dose. Ingrid writes the lab date before she binds the folio. If the patient later needs a PDE5 card from this same shelf - tadalafil 10 mg is a different drawer - that is a separate visit, not a bundle. Worms and erections do not share a count.
What Ingrid writes after the chips are swallowed
Skin microfilariae fall after onchocerciasis treatment; the labeled adult trials tracked that drop for months. A 6-13 year open cohort (17-41 kg) looked similar. Ingrid still wants the ophthalmology story if the eyes were involved. River blindness is not only a skin count. The folio gets an eye line or it is incomplete.
Postural hypotension from a heavy Mazzotti reaction is treated with fluids, recumbency, sometimes parenteral steroid - the label lists what has been used, not a tidy trial. Milder itch gets antihistamine or aspirin in the historical note. Do not send someone home with 'it's just histamine' if they cannot stand.
Stool follow-up after Strongyloides is how you know the single dose worked. Ingrid does not close IP-01 on a phone call that says 'cramps stopped.' Autoinfection means a missed larva can restart the whole story. Bind only after the lab, or write the folio as open.
CDC clinician pages on Strongyloides sit beside the DailyMed Stromectol label on this desk. Those are the two inks Ingrid trusts for bands and holds. A social post is not a third ink. If the travel history is messy, she waits. Waiting is a clinical act. So is four chips at 66-79 kg when the worm is Onchocerca.
The Loa loa hold before any chip leaves the jar
Loa loa is a hold, not a counseling afterthought. Patients with onchocerciasis who also carry a heavy Loa loa load can develop a serious or fatal encephalopathy after an effective microfilaricide. The syndrome is rare after ivermectin. Rare is not the same as skip the travel history.
West or Central Africa in the last year changes the slip. Ingrid asks before she counts. Pain in the neck or back, red eye, conjunctival bleed, incontinence, trouble standing, confusion, seizure, coma - those are the labeled cluster, not a vague 'felt off.' If the exposure is real, pretreatment assessment for loiasis and close follow-up are the method.
Pretreatment assessment is not optional theater. CDC and the Stromectol label agree on the geography. A Copenhagen reader who spent a month on a river in Cameroon is not cleared by a pharmacy blog. Shelf-check the endemic map. Then decide whether four chips are even allowed to leave the jar.
Encephalopathy after a microfilaricide can also show up without Loa loa, and neurotoxicity - somnolence, stupor, coma, confusion - has been reported in people without onchocerciasis. Supportive care and stopping the drug is the labeled path. Do not chase a second unlicensed dose because the first 'did not feel like enough.'
Three large COVID desks, then WHO still says trial-only
2021
WHO: ivermectin for COVID-19 only inside trials, any severity.
TOGETHER
400 mcg/kg x 3 days; no clear cut in hospital or long ED stay.
ACTIV-6
400 mcg/kg x 3 d, then 600 mcg/kg x 6 d; no meaningful recovery gain.
PRINCIPLE
Community 300-400 mcg/kg x 3 d; no practice-changing hospital signal.
TOGETHER in Brazil tested ivermectin 400 mcg/kg daily for three days in outpatients with mild to moderate COVID-19. Hospitalization or a long emergency stay within 28 days did not separate from placebo in a way that mattered (relative risk 0.90; 95% Bayesian interval crossed 1). That is not a near-miss you 'almost' prescribe.
ACTIV-6 ran two outpatient ivermectin arms in the US. At 400 mcg/kg for three days, time to sustained recovery did not improve in a meaningful way (hazard ratio 1.07). At a higher 600 mcg/kg target for six days, the recovery hazard ratio was 1.02. Hospitalization and death composites stayed flat. A day shaved on a plot is not a reason to empty a barn tube.
PRINCIPLE in the community (UK) used a 300-400 mcg/kg target for three days. Self-reported recovery looked a little faster; the pre-specified chance of a meaningful effect stayed low. COVID-related hospital admission or death sat on an odds ratio of 1.02. Ingrid reads that as no practice change. The evidence review keeps the forest plots; this folio keeps the worm lock.
WHO still advises against ivermectin for COVID-19 outside clinical trials. That line survived the large outpatient platforms. This desk will not write a viral exception because a neighbor 'felt better on day three.' Feeling better is what most outpatient COVID does. Bind the labeled parasite. Leave the virus to treatments that moved an endpoint.
Human 3 mg tablets stay; livestock syringes leave the folio
What stays on the shelf
- Human Stromectol / generic 3 mg tablet - the only chip on IP-01
- Empty stomach, water - the only plate on the label
- Livestock paste, drench, or 'feed-store ivermectin' - off this folio
- Weight under 15 kg - not established; do not improvise
Horse paste is not a Stromectol equivalent. Livestock products are concentrated for animals, flavored for muzzles, and unmeasured for a 70 kg human. People who 'dose the syringe by weight' are guessing with a product that was never on this label. Ingrid will not convert a barn tube into four chips.
FDA human tablets carry a 3 mg score of identity: Stromectol or a licensed generic tablet. The inactive list on the brand slip is cellulose, starch, magnesium stearate, BHA, citric acid. A paste for horses is a different object. If a forum says they are the same molecule, ask whether the forum also counted Loa loa.
This Copenhagen shelf binds only the human tablet. Safety and effectiveness below 15 kg have not been established. The jar does not open for a toddler because an uncle had a leftover carton. Pediatric data on the label sit in older children (a 6-13 year open study, 17-41 kg), not in infants.
Hypersensitivity to any component is the formal contraindication. Everything else on this folio is a judgment: indication, band, travel, plate. If you need a different human drawer on this site, start from a named slip such as sildenafil 25 mg - another tablet, another lock, not a substitute worm drug.
Chloride gates in the worm, not a human sedative plan
Glutamate-gated chloride channels sit in invertebrate nerve and muscle. Ivermectin binds them, chloride pours, the cell hyperpolarizes, the parasite paralyzes. That is the class trick of the avermectins. It is why a 3 mg chip can clear microfilariae without being a general human anesthetic. Mammals wall those channels off differently.
Mammalian GABA channels sit behind a blood-brain barrier that usually keeps therapeutic ivermectin out of the conversation. Overdose, a disrupted barrier, or a paste meant for a 500 kg animal can punch through that comfort. Neurotoxicity reports exist. They are a reason to stay on the human tablet and the labeled mcg/kg, not a reason to 'take more so it works on COVID.'
Onchocerca volvulus microfilariae in the skin drop after a single dose. Adult worms are not reliably killed, which is why retreatment intervals exist. Strongyloides in the gut is a different life cycle and a different mcg/kg. Same chip, two jobs. Ingrid writes the species on the folio the way a botanist writes the plant, not the color.
Mazzotti-type reactions come from dying microfilariae in onchocerciasis: itch, rash, node swelling, fever, joint pain, eye findings. They are not 'the drug is toxic' in the casual sense. They are the corpse of the parasite talking. Strongyloides patients should not be promised the same rash script. Different worm, different noise.
Water on an empty plate, not butter on the chips
Absorption
Fasted oral tablet; Tmax ~4 h after 12 mg; high-fat meal ~2.5x bioavailability
Distribution
Plasma levels roughly dose-proportional in the studied range
Metabolism
Hepatic; CYP3A4 is the main path in vitro
Excretion
Almost all feces over ~12 days; <1% urine; t½ ~18 h
Fasting water is the method on the US label. Take the tablets by mouth with water on an empty stomach. That sentence is short because the kitchen experiment already happened. A standard high-fat meal (48.6 g of fat) in front of a 30 mg dose raised bioavailability about 2.5-fold versus the fasted state.
A high-fat meal of that size is not 'a little yogurt.' It is a labeled breakfast. Ingrid does not tell people to eat their way to a higher level. The count is built for the fasted curve. If you butter the chips, you have changed the exposure without changing the worm. That is not clever. It is an unmeasured dose.
Peak plasma of H2B1a after a single 12 mg fasted dose landed around four hours, with mean peaks of 46.6 and 30.6 ng/mL in two volunteer studies (mean dose about 165 mcg/kg). Half-life in plasma is about 18 hours. Almost all of the drug and metabolites leave in feces over an estimated 12 days. Urine takes less than 1%.
Less than one percent in the urine is why kidney stories rarely rescue a bad count. The liver metabolizes the molecule; CYP3A4 does most of that work. Ingrid still asks about other CYP3A4 drugs, but she does not invent a renal adjustment the label does not print. Draw, note, shelf-check the plate, bind.
Bind IP-01: four chips, two tables, no barn tube
Bind the slip when the scale, the species, and the travel line agree. For onchocerciasis at 66-79 kg, four 3 mg Stromectol tablets is the lock this domain will keep repeating. For Strongyloides at the same weight, the other table prints five. Say the indication out loud before you count. Silence is how the bands collapse.
Empty stomach, water, human tablet. High-fat meal stays off the plate because 2.5-fold is not a flavor, it is exposure. Loa loa exposure stays a hold. COVID stays in the trial bin after TOGETHER, ACTIV-6, and PRINCIPLE. WHO already said that. This folio will not unsay it.
Ingrid Halvorsen signs the Nyhavn 21 line as a reader, not a mail-order clerk. Discuss the count with the clinician who saw the stool or the skin snip before anyone changes a dose. The field-ink review is the next page if the argument is still about viruses.
Cheap is a caption word. Four tablets is a lock word. Do not let a search title talk you into five chips for oncho or four chips for Strongyloides. Draw. Note. Shelf-check. Bind. Then leave the jar closed until the next labeled interval, not until the next rumor.
Last Updated
Forum
The reader forum
Answered by Dr. Ingrid Halvorsen, MD · Internal medicine & clinical pharmacology
Mail that reaches Nyhavn 21 on Stromectol is almost always a count fight: four chips versus five, paste versus tablet, virus versus worm. Ingrid answers as she would at a Copenhagen desk - indication first, scale second, travel third. These notes are teaching, not a fill and not a prescription.
Your cousin's clinic was probably looking at intestinal Strongyloides, which is about 200 mcg/kg. On that US table, 66-79 kg is five 3 mg tablets. This folio locks onchocerciasis at about 150 mcg/kg, where 66-79 kg sits inside the 65-84 kg four-tablet band. Same chip, two jobs. Tell me which parasite was proven. Then the count stops being an argument. I will not average four and five to make a family peace. That average is not on either table.
Can I treat this Copenhagen page as a place that actually fills Stromectol 3 mg?
No. Nyhavn 21 is a reading shelf. The rows under the cart heading are licensed US pharmacy pages - Publix, Meijer, Target, Cost Plus - so you can see how a window talks about a 3 mg carton. This desk does not ship a chip. If a site offers you a cart without a clinician naming Onchocerca or Strongyloides, walk away. Read the evidence review if the pitch is viral. Then call a person who can see you.
Does a buttered breakfast help the four chips work harder?
It changes exposure, which is not the same as helping. The label wants water on an empty stomach. A study meal with 48.6 g of fat in front of 30 mg raised bioavailability about 2.5-fold versus fasting. The weight bands assume the fasted curve. If you eat the trial breakfast, you have invented a higher level without a new table. I do not coach people to do that. Fast. Water. Then stop fussing with the kitchen.
The feed store has ivermectin paste. Is that just a bigger Stromectol?
It is a different product for a different animal. Human Stromectol is a 3 mg tablet with a human inactive list and human bands. Livestock paste is concentrated and unmeasured for a 72 kg person. I will not convert a syringe mark into four chips. People have been harmed doing that conversion at the kitchen table. If you need the labeled tablet, you need a human prescription path, not a barn aisle.
TOGETHER was huge. Why won't you still write ivermectin for COVID?
Because TOGETHER did not move the endpoint that would change a slip. Outpatients got 400 mcg/kg for three days. Hospitalization or a long emergency stay did not clearly fall. ACTIV-6 at two dose stories and PRINCIPLE in the community said the same thing in other clothes: no practice-changing recovery or hospital signal. WHO already limited COVID use to trials. I am not more daring than those desks. I will write four chips for a proven worm.
I spent six weeks in Cameroon last year. Do I still take the four chips for a skin snip?
You pause. Heavy Loa loa infection plus a microfilaricide can end in encephalopathy - rare after ivermectin, real enough that the label tells us to assess. Neck or back pain, red eye, incontinence, inability to stand, confusion, seizure: that cluster is why I will not count chips on a video call. Get a loiasis workup before anyone opens the jar. Waiting is the shelf-check. It is not cowardice. West or Central Africa on the travel line is enough to hold.
If Strongyloides is five tablets at my weight, why advertise four?
Because this domain locked the oncho band on purpose. Search cards here say four tablets for 66-79 kg. That sentence is incomplete without onchocerciasis. I repeat the Strongyloides five-tablet line in the body so nobody exports the lock onto a stool. If your lab is Strongyloides, ignore the title lock and use the 200 mcg/kg table. Titles are not prescriptions. Tables are closer. Clinicians are the bind.
I itched and my nodes swelled the day after treatment. Did I take a poisoned batch?
In onchocerciasis that pattern can be a Mazzotti-type reaction: dying microfilariae, not a 'bad carton.' Itch, rash, tender nodes, fever, joint pain showed up often in the labeled adult series. If you cannot stand, that is not a home antihistamine night - fluids and a clinic. If the indication was Strongyloides, do not borrow the oncho rash script. Tell me which worm was treated before I guess which story you are in.
My child is 13 kg. Can I crush one 3 mg tablet and guess?
No. Safety and effectiveness below 15 kg are not established on the US label. Crushing a chip to invent a baby dose is not a hidden row on Table 2. The pediatric open note on the slip is older children, 17-41 kg, not toddlers. I will not walk you through a kitchen fraction. See a pediatric infectious-disease desk. Bring the weight in kilograms, not a phone conversion that rounded twice.
Cramps stopped after one Strongyloides dose. Can I skip the repeat stool?
I would not close the folio. Additional doses are not usually required, but follow-up stool examinations are how the label wants eradication checked. Strongyloides can autoinfect. A quiet abdomen on day ten is a mood, not a lab. Schedule the stool. If it is still positive, we are in a different conversation than 'the cheap count worked.' Bind after the microscopy, not after the relief. Bring the lab slip to the next visit so the folio can close.
Where do I read the official tablet text, not a forum recap?
Start with the DailyMed Stromectol monograph for bands, fasting, Loa loa, and Mazzotti language. For the parasite itself, use the CDC Strongyloides clinician page. Those two stay on my desk. I also keep the Illustris field-ink review for readers who arrived through a COVID thread. Forums are not a fourth label.
Could leftover chips from a river-blindness campaign cover a later Strongyloides scare?
Leftovers remember the old indication. A four-chip oncho count at 70 kg is not a five-chip Strongyloides count. The tablet does not 'know' it should stretch. Also check the date and the storage. I do not run a swap meet for campaign blister packs. If a new stool is positive, we draw a new slip. We do not finish last year's river math on this year's larva. Same 3 mg chip, new arithmetic.
Is there any reason I would open a tadalafil folio after ivermectin?
Only if you have a separate problem that belongs in that drawer. Worms do not turn into erections. If a clinician later walks you to tadalafil or vardenafil, that is a new lock - nitrates, timing, a different milligram. Do not swallow leftover 3 mg chips as a 'circulation tonic.' They are not. They are an anthelmintic with a travel hold and a fasting rule.
These replies are teaching, not a treatment plan for the person who asked. Take your own history, labs and medicine list to a prescriber who can see all three.