I finished night two two weeks ago and I still itch. More chips?
How clinics order Stromectol 3 mg for a two-night mite pass
Ordering is a count, not a brand hunt. The unit is 3 mg. The Dose is about 200 mcg/kg. The calendar is two nights. Everything else is a different card.
A clinic that writes oral ivermectin for classic scabies is writing an off-label script. CDC clinical-care pages at the CDC still say the tablet is not FDA-approved for mites, then give the working regimen: 200 mcg/kg per Dose, with food, 7 to 14 days apart. Permethrin remains the labeled topical alternative. Choice often follows coverage, household size, and whether anyone can paint cream on every inch the same night.
What the shop fills is a 3 mg human tablet - Stromectol or a generic. You do not invent a 6 mg or 12 mg human chip to make the arithmetic prettier. You stack 3 mg units to the weight band. A 70 kg adult at 200 mcg/kg needs 14 mg, which the Strongyloides-style 66-79 kg band renders as five chips (15 mg). Night two is the same five chips, not a half-stack 'because they already had some.'
PK, fasting-versus-food, and interaction holds also live on the ivermectin compound card. Trial grades that score mite counts and close the viral file live in the 3 mg review essay. Below: how to weigh, how to stack, when to eat, who else swallows, and which holds stop the pass before the foil opens.
What a 200 mcg/kg scabies count costs in chips, not in paste
Cost talk should start with chip count, not with a coupon screenshot. Seventy kilograms times 200 mcg/kg is 14,000 mcg, which is 14 mg. Five 3 mg chips is 15 mg. Do that twice and the household index patient has swallowed ten chips across two nights. Contacts get their own weight math on the same calendar. A family of four adults is not 'a bottle of twenty and hope.'
Paste is the wrong price comparison. A livestock tube is built for a beast that weighs hundreds of kilograms. A 'pea' is not 200 mcg/kg. Emergency-room clusters during the COVID years were this error with a virus rumor on top. FDA language at the FDA is plain: never use animal products on people. If a mite is real, we stack Stromectol 3 mg. If it is not, we stack nothing.
Cheap 3 mg exists because the molecule is old and the 1987 donation made the unit ordinary - that history sits in the Kawana price essay. Cheap does not mean you skip the scale. Flat dosing - 'everyone takes two' - underdoses a 90 kg adult and overdoses a 20 kg child. Weight, then chips. That is the only honest cost line on this desk.
Weigh first - the 3 mg unit does not guess
Mark the scale before you Mark the foil. Use kilograms. If the clinic scale only prints pounds, convert once and write both numbers on the same line. Guessing 'about 150 pounds' is how a 200 mcg/kg pass becomes a 160 mcg/kg pass. Mites do not grade on a curve.
The US oral charts were written for worms, but they are the only official 3 mg stacking tables most desks have. Strongyloides chart at about 200 mcg/kg: 15-24 kg gets one chip, 25-35 kg two, 36-50 kg three, 51-65 kg four, 66-79 kg five, and at 80 kg and up you calculate 200 mcg/kg. A mite pass uses that 200 mcg/kg math, not the 150 mcg/kg onchocerciasis table. Mixing the two lines is a common desk error.
Pediatrics uses the same chip once weight clears the chart's floor, about 15 kg. Safety below that floor, and in pregnancy, has not been established for oral ivermectin. Those are holds, not rounding errors. I will not invent a sprinkle Dose for a 10 kg toddler from this page. Topical permethrin is the usual path there unless a specialist owns a different protocol.
Night one with food, not on an empty worm rule
The label and the mite experts disagree on the meal, and both are being precise about different targets.
Stromectol's US label tells patients to take tablets on an empty stomach with water. That instruction belongs to the worm rows. A high-fat meal raised bioavailability about 2.5-fold after a 30 mg dose in healthy volunteers. Peak of the major component sits near 4 hours. Plasma half-life is about 18 hours. Less than 1 percent leaves in urine. Feces carry the rest over roughly 12 days.
Scabies experts flip the meal on purpose. They want more drug in the epidermis, so they dose with food. CDC clinical-care and STI-guideline pages both say take the mite Dose with a meal even though manufacturer worm language says fast. Same 3 mg chip. Same 200 mcg/kg. Different Thread. Write 'with food' on the mite calendar so nobody inherits a Strongyloides fasting note by accident.
CYP3A4 is the main metabolic path. I do not run a full interaction hunt from an inbox, but I do ask about strong 3A4 inhibitors and about other QT-or-sedation stacks a reader may have piled on during a bad itch week. The pass is two nights, not a month of daily chips. If someone has already been swallowing leftover tablets 'until the itch stops,' stop the freelance and restart the calendar with a clinician.
Night two sits 7-14 days later because eggs hatch
Ivermectin is a weak ovicide for Sarcoptes. Live mites die on night one. Eggs often survive. Hatchlings need a second 200 mcg/kg stack once they emerge. CDC STI language often cites 14 days. Clinical-care language allows 7 to 14. Pick a date, write it, and do not slide it because the itch improved on day four. Improvement is not clearance.
Night two is the same chip count as night one, with food again. It is not a taper. It is not 'two chips this time.' A 70 kg adult who took five chips on night one takes five chips on night two. Household contacts take their own weight-based stacks on the same two nights, including people who do not yet itch. Asymptomatic contacts keep the cycle going. Skipping them is how a 'failed' pass comes back in three weeks.
Crusted scabies is not this card. That phenotype needs oral plus topical, and the oral calendar stretches to three, five, or seven 200 mcg/kg nights depending on burden - days 1, 2, and 8, or 1, 2, 8, 9, and 15, or out to days 22 and 29. Keratolytics help topical penetration. A two-night pass on crusted disease is an underdose dressed as a protocol. Name the phenotype before you count.
Contacts, laundry, leftover itch
Treat the house on the same calendar. That includes overnight partners, children above the weight floor, and anyone who shares a bed or a towel. Hot-wash bedding, clothing, and towels used in the prior three days. Items that cannot be washed can be bagged for several days. CDC household steps are the checklist, not a forum's vinegar ritual.
Itch commonly runs two to four weeks after mites are dead. That is immune noise. Night antihistamine and a bland moisturizer first. Worry if you see new tracks on previously clear skin. Then check whether everyone actually swallowed night two, whether the cream - if used - covered the missed patches, and whether a visitor reseeded the house. A third oral stack from an inbox is not the next step.
Institutional outbreaks - shelters, wards, barracks - are why oral 3 mg exists as a logistics tool. Painting permethrin on every resident the same night fails when people cannot stand still. A two-night 200 mcg/kg pass scales. SHIFT showed what a community pass can do to prevalence. A single apartment still needs the same discipline: same nights, same food rule, same laundry. Logistics is not a license to skip the scale.
Holds: weight floor, pregnancy, Loa map
Safety of oral ivermectin in children under about 15 kg and in pregnant people has not been established. Those are holds. Topical permethrin is the usual first path. I will not invent a sprinkle from a 3 mg chip. Lactation questions belong to the prescriber who can see the infant and the mite burden. This page does not clear them.
Central and West African exposure changes the pre-Dose work. Heavy Loa loa microfilaremia plus ivermectin can trigger severe encephalopathy-like reactions. Onchocerciasis MDA programs map and screen for that overlap before they hand out chips. A reader who lived in Cameroon, Gabon, or neighboring zones should say so before any 3 mg stack, even if today's complaint is scabies. Outside that belt, routine mite treatment does not require a Loa smear.
Mazzotti-type inflammatory reactions after onchocerciasis treatment - itch, rash, fever, tender nodes - are expected larval-death noise at proper 150 mcg/kg, not proof the chip was counterfeit. Severe neurologic change after a dose in a Loa-endemic traveler is a different emergency. Name the country list on the same line as the organism. Geography is the Mark. It is not a universal scare line against 3 mg chips.
Worked 70 kg stack, and the worm tables you must not mix
| Night or row | 3 mg chip habit | Meal |
|---|---|---|
| Scabies night 1 | 200 mcg/kg in 3 mg chips | With food |
| Scabies night 2 (day 7-14) | Same chip count as night 1 | With food |
| Household contacts | Own weight math, same nights | With food |
| Crusted scabies | 3, 5, or 7 nights plus topical | With food |
| Strongyloides (labeled) | 200 mcg/kg once; prove stool | Empty stomach, water |
| Onchocerciasis (labeled) | 150 mcg/kg; program repeats | Empty stomach, water |
| Virus / paste / two-chip ritual | Does not earn the blister | Not a meal question |
Worked mite example. Seventy kilograms times 200 mcg/kg is 14,000 mcg, which is 14 mg. The 66-79 kg band on the 200 mcg/kg chart is five 3 mg chips (15 mg). Night one with food. Night two, same five chips, 7 to 14 days later, with food again. Write both dates before the first swallow. Worked onchocerciasis contrast: seventy kilograms times 150 mcg/kg is 10,500 mcg. The 65-84 kg oncho band is four 3 mg chips (12 mg), empty stomach, water, and a repeat measured in months, not in a week. Different organism. Different table. Different meal.
Worked Strongyloides contrast. Same 200 mcg/kg math as the mite night, same five chips for that 70 kg adult, but usually once, empty stomach, water, then a planned stool. Additional doses are not routine on the label. Autoinfection lets that worm persist for decades. Feeling well is not clearance. Some hospital protocols repeat 200 mcg/kg on a second day for complicated or immunocompromised disease. That is a local-protocol call, not a mite calendar and not a second tablet strength.
Never flatten the Dose to 'everyone takes two.' Never convert a horse paste into chips by eye. Never invent a 6 mg or 12 mg human tablet because the total came out even. The marketed human oral unit in current US labeling is 3 mg. Day-of effects at those stacks are usually mild: headache, dizziness, a short rash that is often dying-parasite inflammation. Toxicity changes character when the product is veterinary or the mcg/kg is a guess. Then stop. This list is a point, not your examination. Take the weight and the skin exam to your own clinician before anyone opens a blister.
Reader mail
Reader questions on this article
Answered by Dr. Priya Raman, PharmD · Clinical pharmacology & drug safety
Mail after the two-night counting guide. Send the weight in kilograms. I will not count chips for a feeling.
Usually no. Post-scabetic itch commonly runs two to four weeks after mites are dead - immune noise, not a live burrow. Night antihistamine and a bland moisturizer first. Worry if you see new tracks on previously clear skin. Then check whether everyone in the house got the day-7-to-14 second 200 mcg/kg stack of 3 mg chips on the same calendar, and whether bedding was washed. CDC household steps at the CDC are the checklist. I will not add a third stack from this inbox.
I weigh 70 kg. How many Stromectol 3 mg tablets is a two-night pass?
Five chips on night one, five chips on night two. Seventy kilograms times 200 mcg/kg is 14 mg. The 66-79 kg band on the 200 mcg/kg chart is five 3 mg tablets, 15 mg. Swallow with food both nights, 7 to 14 days apart. Do not take two chips 'like a vitamin' and do not skip night two because the itch eased. Contacts need their own weight math on the same dates. I will not bless a flat two-chip ritual.
The bottle says empty stomach. You keep saying with food. Which is it?
Both, on different cards. The US label's empty-stomach-with-water line belongs to Strongyloides and onchocerciasis. A high-fat meal raised bioavailability about 2.5-fold in a volunteer study, so the worm rows stay fasted for consistent PK. Scabies experts want more drug in the skin, so they dose the same 3 mg chip with a meal. CDC clinical-care pages say that out loud. Write the indication on the same line as the meal. Do not inherit a worm fasting note onto a mite night.
How dangerous is the horse paste a cousin keeps recommending for mites?
High risk, no upside without a human diagnosis and a human 3 mg chip count. Paste is built for animals that weigh hundreds of kilograms. A 'pea' is not 200 mcg/kg on two nights. Emergency-room clusters during the COVID years were this error with a virus rumor on top. FDA language at the FDA is plain: never use animal products on people. If a mite is real, we stack Stromectol 3 mg to the weight. If it is not, we stack nothing.
My toddler is 12 kg. Can I split a 3 mg chip?
Not from this page. Oral ivermectin safety under about 15 kg has not been established. The official 3 mg charts start at 15 kg. Splitting a chip into a 'sprinkle' is not a labeled pediatric path. Topical permethrin is the usual first option in that weight band unless a specialist owns a different protocol. I will not invent a fraction. Take the weight and the skin exam to the clinician who can see the child.
I lived in West Africa. What do I have to say before any ivermectin?
Loa loa exposure. Heavy microfilaremia plus ivermectin can trigger severe systemic and neurologic reactions. MDA programs smear or quantify before they dose. Tell the prescriber the countries and the years. They may hold a scabies or Strongyloides stack until the map is clear. Outside that overlap, routine mite indications do not need a Loa workup. Geography is the Mark. It is not a universal scare line against 3 mg chips.
Why two nights for mites but one swallow for Strongyloides at the same 200 mcg/kg?
Different biology. Sarcoptes eggs often survive the first Dose, so night two catches hatchlings. Strongyloides on the US label is a single 200 mcg/kg exposure, empty stomach, then a planned stool because autoinfection hides. Feeling well is not clearance. Some hospital protocols add a second day for complicated or immunocompromised Strongyloides - that is not a mite calendar. Write the organism before you write the second night. Mixing the cards is how people either skip a needed mite night or invent a freelance worm taper.
Can I just take two 3 mg tablets like a vitamin when I travel?
No. Two chips is 6 mg, which is a child's 200 mcg/kg stack around 25-35 kg, not an adult travel charm. A 70 kg adult on the 200 mcg/kg line needs five chips, and only after someone names a mite or a worm that earns that math. Flat dosing is how people underdose a real infestation or overdose a rumor. Weight, organism, meal rule, calendar. I will not bless a two-chip ritual.
If scabies is not on the US tablet label, why do so many clinics use the pills?
Because the mite has the channel, 200 mcg/kg times two is operationally easier than painting an entire shelter with permethrin on the same night, and crusted disease needs systemic plus topical. Off-label here means 'not on the Stromectol indication,' not 'invented on a forum.' SHIFT showed a 94 percent relative prevalence cut after an ivermectin-based community pass. I still Mark it as a mite protocol, not as a second FDA worm row. Your clinician owns that call. This guide only says how to count the chips if that call is already made.
General education from a clinician, not personal medical advice. Bring your own history to your own prescriber.
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