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Fact check: What is the standard single-dose ivermectin mg/kg for scabies in adults?
Executive Summary
The standard single-dose oral ivermectin for treating scabies in adults is 200 micrograms per kilogram (0.2 mg/kg), typically administered once and commonly repeated after 7–14 days when treating classic scabies; this dosing is consistently cited across multiple clinical guidelines and drug monographs published between December 2023 and early 2025. Multiple sources also converge on practical caveats: ivermectin should be taken with food, dosing must be weight-based, and its safety in children under 15 kg, pregnant or breastfeeding people, and certain vulnerable groups is not established—so clinical discretion is required when deviating from standard regimens [1] [2] [3].
1. Why 200 µg/kg became the shorthand clinicians use—and what guidelines say now
Contemporary clinical guidance across national and international sources standardizes the single oral ivermectin dose for scabies at 200 micrograms per kilogram (200 µg/kg or 0.2 mg/kg); this figure appears in a December 2023 clinical care guideline and is reiterated in prescribing summaries and essential medicines lists produced through 2024–2025. The guidance emphasizes that for classic scabies the regimen often consists of two such doses spaced 7–14 days apart, reflecting the parasite life cycle and aiming to catch newly hatched mites; this two-dose strategy is explicitly recommended in the Clinical Care of Scabies guideline and echoed by regional public health guidance [2]. The repeated-dose approach is a practical consensus rather than a contentious departure, and most sources present it as standard care for uncomplicated scabies.
2. Convergence among drug monographs, clinical summaries, and public health authorities
Drug dosing references and prescribing information uniformly present 0.2 mg/kg as the standard per-dose amount, and multiple independent sources published from late 2023 into early 2025 reaffirm that clinicians should calculate dose by body weight and administer with food. An ivermectin dosage guide and clinical knowledge summaries both describe the single 200 µg/kg dose and note that a second dose may be required, aligning drug monograph practice with public health recommendations; these sources also highlight that dose adjustments and repeat dosing are clinical decisions tied to response and epidemiology of infestation [1] [3] [4]. The factual alignment across these documents indicates a strong, current consensus on the numeric dosage and typical timing.
3. Safety limits, contraindications, and populations requiring caution
Across the guidance, the most consistent safety caveats concern children under 15 kg, pregnancy, and breastfeeding—populations for whom ivermectin safety is either unestablished or discouraged unless benefits clearly outweigh risks. Several sources explicitly advise against routine ivermectin use in these groups or call for specialist consultation and alternative topical therapies when appropriate [2] [3]. In addition, clinical summaries stress physician determination of dose and monitoring for adverse effects; while monographs confirm weight-based dosing, they stop short of endorsing ivermectin for all demographic groups without assessment, underscoring that the 200 µg/kg recommendation applies primarily to suitable adult and older pediatric patients [5] [4].
4. Minor variations and how they affect practice: spacing, food, and dose rounding
Differences among sources are limited to practical details: timing between doses is presented as 7 to 14 days in some guidelines and as approximately two weeks elsewhere, and several documents explicitly recommend taking ivermectin with food to improve absorption. These variations do not contradict the core 200 µg/kg dosing but inform administration logistics and patient counseling [2] [6]. Clinicians commonly round dose to available tablet strengths and use weight bands for dosing practicality; sources emphasize physician judgment for dose calculation, reinforcing that minor operational differences do not change the central numeric standard but do matter for effective implementation [1] [3].
5. Bottom line for clinicians and patients seeking clarity
For adults with scabies the evidence-based standard is a single oral dose of 200 µg/kg (0.2 mg/kg), typically repeated after 7–14 days for classic infestations; take with food, calculate by body weight, and avoid or seek specialist advice for pregnant people and children under 15 kg. This conclusion is supported by clinical care guides, prescribing summaries, and essential medicines references published or updated from December 2023 through early 2025, which together form a consistent and actionable dosing consensus for routine adult scabies management [2] [3] [4].