Antiparasitic drugs Morocco: Ivermin, scabies, lice, worms

01Scabies epidemiology in Morocco#

YMYL information: Oral ivermectin, mebendazole, albendazole and praziquantel all require mandatory medical prescription in Morocco and are not dispensed without consultation with a GP, paediatrician or dermatologist.

Sarcoptic scabies is caused by the mite Sarcoptes scabiei var. hominis. The WHO has documented a global resurgence since 2015. Dermatology departments at the Ibn Sina University Hospital in Rabat, Ibn Rochd in Casablanca, Hassan II in Fez and Mohammed VI in Marrakech all report a sustained incidence among schoolchildren and within institutional settings.

The classic clinical picture: intense nocturnal pruritus combined with scratch lesions in the interdigital spaces, wrists, axillae, umbilical region, genitalia, and on the palms and soles of infants. Scabies burrows confirm the diagnosis but are inconsistent. The parasitic burden is relatively low (10-30 adult females per host).

Scabies is not a disease of poor hygiene and affects every social group equally. Transmission occurs through prolonged skin-to-skin contact lasting more than 15-20 minutes, or via contaminated linen kept for less than 3 days off the body. Shared beds, prolonged holding of infants, and sexual contact are the main routes of transmission.

02Ivermin dosing by weight#

Ivermectin (Ivermin 3 mg tablet) is the reference treatment alongside topical permethrin, which remains the first-line option for children and pregnant women. Mechanism: binding to glutamate-gated chloride channels in the parasite, causing flaccid paralysis and death of the mite.

The recommended dose is 200 micrograms/kg, taken on an empty stomach with a large glass of water, two hours before or after any meal. Marketing authorisation (AMM) weight bands:

• 1 tablet for 15-24 kg
• 2 tablets for 25-35 kg
• 3 tablets for 36-50 kg
• 4 tablets for 51-65 kg
• 5 tablets for 66-79 kg
• 6 tablets for ≥ 80 kg

Current standard schedule (HCSP 2012, ECDC 2017): two systematic doses on D0 then D7-D14. The second dose covers larvae that hatch from eggs not killed by the first ivermectin exposure.

Contraindications:

• Weight < 15 kg (~children < 5 years): AMM contraindication due to an immature blood-brain barrier and incomplete P-glycoprotein function.
• Pregnancy: avoid throughout pregnancy as a precaution (Vidal, CRAT) — safety data remain limited.
• Breastfeeding: authorised by CRAT (lacteal transfer is less than 2 % of the maternal dose).
• Known hypersensitivity to avermectins.

03Topical Ascabiol vs oral Ivermin#

Benzyl benzoate 10 % (Ascabiol) retains its place in pregnant women and in children under 15 kg. It is applied for 24 hours and then repeated on day D7.

Permethrin 5 % cream, although availability is sometimes limited in Morocco, remains the first-line pediatric and obstetric treatment (CDC, HAS). Topiscab is authorised from 2 months under strict medical supervision.

• Ivermin 3 mg oral: single dose on D0 and D7-D14, by weight band. Contraindicated under 15 kg, to be avoided in pregnancy.
• Ascabiol 10 % lotion: 24 h, repeated D7-D10. Usable in pregnancy and in children under 2 years after evaluation.
• Permethrin 5 % cream: single 8-12 h application, authorised from 2 months.

04Treatment of contacts and linen#

The fundamental rule (HCSP 2012) is the simultaneous treatment of all first-circle contacts — spouse or partner, cohabiting children, and sexual partners over the previous two months.

Linen management:

• Linen in skin contact during the 7 days before treatment: wash at a minimum of 60 °C.
• Delicate textiles: sealed plastic bag for 72 hours at ambient temperature.
• Mattresses and sofas: thorough vacuuming, with the vacuum bag discarded immediately.

School exclusion is not systematic: the child can resume school the day after the first dose.

05Intestinal worms: pinworms and tapeworm#

Pinworms caused by Enterobius vermicularis: nocturnal anal pruritus. Treatment: mebendazole (Vermox 100 mg) as a single dose, repeated at D15-D21. Alternative: flubendazole (Fluvermal). Mebendazole and flubendazole are discouraged during the first trimester of pregnancy (CRAT).

Ascariasis caused by Ascaris lumbricoides: mebendazole 100 mg morning and evening for 3 days (or 500 mg single dose per WHO), or albendazole 400 mg single dose. Albendazole is contraindicated in the first trimester (animal teratogenicity).

Tapeworm (Taenia saginata, T. solium): praziquantel 5-10 mg/kg single dose (intestinal form) or 25 mg/kg (neurocysticercosis). Niclosamide is virtually abandoned in Morocco and France.

06Head lice (pediculosis)#

Pediculosis caused by Pediculus humanus capitis: no link to hygiene. Diagnosis: live lice caught with a fine-toothed comb, nits less than one centimetre from the scalp.

First-line treatment: mechanical insecticides (dimethicone, silicone) that suffocate lice with no risk of resistance. Evening application, 8-12 hours under a cap, followed by meticulous combing. Repeated on D7. Pyrethroids (permethrin, phenothrin) have seen reduced efficacy due to resistance.

Environmental treatment: head linen, pillowcases and hats washed at 60 °C.

07Price and where to buy#

Ivermin 3 mg box of 4 tablets: 80-110 dirhams (regulated public sale price). Ascabiol 10 % lotion 125 ml bottle: 45-65 dirhams. Permethrin 5 % cream: 120-180 dirhams (limited availability). Vermox 100 mg box of 6: 30-45 dirhams. Fluvermal paediatric syrup: 40-55 dirhams. Praziquantel: 150-220 dirhams.

For the official PPM price and AMO reimbursement detail, see the Ivermin 3 mg tablet fact sheet.

Effective listing on the ANAM reimbursable list must be verified at the time of prescription (the list is updated regularly). Where the medicine is reimbursable, 70 % of the national reference tariff (TNR) is covered by basic AMO.

08Side effects#

Oral ivermectin: favourable safety profile, mild transient effects (headache, fatigue, dizziness, nausea). Important clarification: the historical Mazzotti reaction concerns onchocerciasis, not scabies. In scabies, what occurs is a transient pruritus exacerbation on D1-D3 linked to parasite lysis.

Drug interactions:

• Metabolised via CYP3A4: potent inhibitors (ketoconazole, itraconazole, ritonavir, clarithromycin, grapefruit juice) increase exposure.
• Inducers (rifampicin, phenytoin, carbamazepine, St John's wort) decrease it.
• Warfarin: INR monitoring required.
• P-glycoprotein: inhibitors (verapamil, ciclosporin, quinidine, amiodarone) can increase blood-brain barrier passage → risk of neurotoxicity (drowsiness, ataxia, seizures).

Overdose: neurological signs (drowsiness, dizziness, ataxia, mydriasis, and in severe cases seizures and coma). No specific antidote: symptomatic management, activated charcoal if ingestion under 1 hour. Moroccan Poison Centre (CAPM) Rabat: 0801 000 180.

09Scabies in institutional settings: schools and care homes#

A suspected scabies outbreak in a Moroccan institutional setting immediately disrupts the way the establishment is run: notification of the director, communication with families, simultaneous treatment of contacts and disinfection of bedding. The 2012 French HCSP guidance, adopted by the regional health directorates in Morocco, distinguishes three circles of contacts: the first circle (prolonged cohabitation — family, boarding house, dormitory) is treated systematically, the second circle (regular contact — classmates sharing changing rooms or physical activities) is treated when scabies is profuse or cases are multiple, and the third circle is simply informed. The appearance of two or more cases in the same class or care-home unit should trigger the full procedure.

In Moroccan elderly care homes, hyperkeratotic (Norwegian) scabies is the nightmare of nursing teams: a single carrier resident can disseminate the infection in a matter of weeks to dozens of cases among staff and co-residents. Early dermatological diagnosis with a dermatoscope is essential in the elderly, in whom itch is often blunted by dry skin and opioid analgesics. Combined treatment with oral ivermectin plus topical permethrin is mandatory in any profuse or hyperkeratotic scabies, over two or three cycles spaced seven days apart, accompanied by full environmental disinfection (bedding, sheets, clothing, chairs, wheelchairs, blood-pressure cuffs).

School exclusion in Morocco follows the HCSP recommendation: return is allowed from the day after the first dose of ivermectin or the first application of permethrin, provided the first-circle contacts are treated simultaneously. The paediatrician issues a medical certificate specifying the treatment given and the return date.

10Pyrethroid-resistant head lice in Morocco: what to do in 2026#

Francophone paediatric surveys reporting more than 80 % pyrethroid resistance in Western Europe in 2024 are echoed in Morocco, where 30 years of repeated use of permethrin or phenothrin shampoos has selected populations of Pediculus humanus capitis carrying kdr (knockdown resistance) mutations in the sodium channels. After two correctly applied pyrethroid treatments on D0 and D7 have failed, prescribers should switch to a purely mechanical insecticide — dimethicone 4 % lotion (Pouxit, Paranix, Hedrin) or isopropyl myristate, which physically suffocate the louse without selecting resistance.

Wet combing with a fine-toothed comb (metal combs with teeth spaced less than 0.3 mm apart, such as Nopoux or Assy 2000) is the most neglected and the most effective step: strand-by-strand combing on conditioner-soaked hair, every 4 days for 14 days, removes residual nymphs and eggs. No insecticide kills 100 % of nits; without combing, eradication is an illusion.

Environmental treatment is limited — head lice survive only 24-48 hours off the scalp. Head linen, pillowcases, hats, scarves, combs and brushes should be washed at 60 °C or frozen for 48 hours in a sealed plastic bag. Furniture, sofas and mattresses do not require aerosol insecticide.

11Worms in children: the annual school cycle and deworming#

Enterobiasis is the most common paediatric parasitic infection in Morocco, with prevalence estimated at 15-30 % in school-aged children according to surveys by the National Helminth Control Programme. The classic picture: nocturnal anal pruritus, restless sleep, secondary nocturnal enuresis, and sometimes vulvovaginitis in young girls. Diagnosis relies on a perianal adhesive tape test in the morning before washing, repeated for 3 consecutive days.

The reference treatment remains mebendazole (Vermox 100 mg) or flubendazole (Fluvermal) as a single dose on D0 repeated at D15-D21 to cover eggs resistant to the first dose. The entire household must be treated simultaneously, including asymptomatic adults. Associated measures: very short fingernails, repeated hand-washing throughout the day (especially on waking), changes of bedding and underwear, disinfection of toilet seats. Without these measures, the relapse rate at 4-6 weeks reaches 30 %.

Ascariasis and trichuriasis persist in rural Moroccan regions with limited faecal hygiene (Souss-Massa, Drâa-Tafilalet, parts of the Rif). Mass paediatric deworming with albendazole 400 mg as a single dose, recommended by the WHO in areas with prevalence over 20 %, is not systematic in Morocco but is carried out in rural schools partnering with the National Programme. Taeniasis (T. saginata via undercooked beef, T. solium via pork — exceptional in Morocco) is treated with praziquantel or niclosamide where available.

12Ivermectin 200 µg/kg protocol: common errors#

Dosing errors with Ivermin 3 mg tablets are the leading cause of treatment failure in scabies in Moroccan community pharmacy practice. The rule is simple but often poorly applied: 200 µg/kg, on an empty stomach, with a large glass of water, two hours away from any meal. Food increases absorption 2.5-fold, which may seem helpful but skews the blood-to-skin ratio and exposes patients to transient neurological side effects.

The practical calculation for a 70 kg adult: 70 × 200 = 14 000 µg = 14 mg, i.e. 4 to 5 tablets of 3 mg (the AMM grid specifies 5 tablets for the 66-79 kg band). A single dose on D0 is not enough: 30 % of patients still carry viable eggs at D7 according to dermatoscopic skin burden studies. The second dose at D7-D14 is therefore systematic, never optional, except in profuse or hyperkeratotic scabies where a third dose at D21 may be required.

Recurrent errors observed in Moroccan pharmacies: taking the dose after lunch (reduced efficacy), forgetting the second dose at D7 (the patient feels cured because the itch has dropped), failure to treat contacts simultaneously, and underdosing in obese patients (calculation done on a standard 70 kg instead of the real weight — a 110 kg patient needs 6 tablets, not 4). The Moroccan pharmacist should systematically weigh the patient or ask for the exact weight to adjust the prescription, especially in rural areas where the pharmacy scale is not always used.

13When to consult#

Red flags that warrant consultation:

• Infant under 3 months.
• Pregnant or breastfeeding woman.
• Immunocompromised patient (HIV, chemotherapy, long-term corticosteroids, anti-TNF biologics, transplant recipient).
• Suspected hyperkeratotic scabies (Norwegian), highly contagious — palmoplantar hyperkeratosis, scaling erythroderma, paradoxically moderate itch.
• Bacterial superinfection (impetiginisation by Staphylococcus aureus or Streptococcus pyogenes) requiring topical or systemic antibiotics.
• Treatment failure at D15 despite a correctly conducted protocol.
• Extensive lesions on the face or scalp (atypical in adults, common in infants).
• Associated fever suggesting an infectious complication.
• Family nocturnal pruritus lasting more than 2 weeks without a diagnosis.
• Appearance of neurological signs under ivermectin (abnormal drowsiness, ataxia, visual disturbances) requiring immediate discontinuation and consultation.

Reference dermatology services: Ibn Sina (Rabat), Ibn Rochd (Casablanca), Mohammed VI (Marrakech), Hassan II (Fez) and Mohammed VI (Oujda) university hospitals.

For persistent intestinal parasitosis: stool parasitology repeated 3 times at 2-3 day intervals, supplemented when needed by serology (strongyloidiasis, hydatidosis) and imaging (hepatic ultrasound).

Referral via sahha.ma. [Sahha Live teleconsultation](/teleconsultation) for initial advice or renewal of an antiparasitic prescription between two dermatology consultations.

This article is for general information and does not in any way replace personalised medical advice. The use of ivermectin, mebendazole, albendazole or praziquantel remains subject to a valid medical prescription in Morocco.