What can be used instead of Xdemvy? Exploring Alternatives

October 9, 2025 •

4 min read

Affecting millions of people, Demodex blepharitis is a common eyelid condition caused by an overpopulation of tiny mites. While XDEMVY (lotilaner ophthalmic solution) is the only FDA-approved medication that specifically targets and kills these mites, several other treatment options exist for managing the condition and its symptoms. These alternatives range from other prescription medications to over-the-counter cleansers and in-office procedures.

Quick Summary

This guide provides an overview of alternatives to XDEMVY for Demodex blepharitis. It covers prescription and over-the-counter treatments, comparing approaches for managing the condition.

Key Points

Prescription options: Alternatives include topical ivermectin and metronidazole, used off-label to reduce mite density and inflammation.
Over-the-counter cleansers: Eyelid washes and wipes containing tea tree oil (TTO) are effective for hygiene and can help kill mites, but require careful application.
Oral medications: In some cases, oral antibiotics like doxycycline or antiparasitics like ivermectin may be prescribed for systemic treatment.
In-office procedures: Professional treatments such as BlephEx, IPL, and thermal pulsation can provide a deeper clean and reduction of mites and inflammation.
Consult a professional: Choosing the right treatment strategy, which may involve a combination of therapies, should be done in consultation with an eye care provider.

Understanding Demodex Blepharitis and Xdemvy

Demodex blepharitis is an inflammatory eye condition resulting from an excessive number of Demodex mites inhabiting the eyelashes and their follicles. This infestation leads to eyelid redness, irritation, and the formation of 'collarettes'—waxy, cylindrical crusts at the base of the eyelashes. XDEMVY works by disrupting the mites' nervous system, causing paralysis and death. It was approved by the FDA in July 2023 as the first specific treatment for the root cause of the condition. However, patients may seek alternatives due to cost, insurance coverage, or personal preference.

Prescription Alternatives to Xdemvy

For patients unable to use XDEMVY, an eye care specialist may prescribe other medications, often used off-label, meaning they are used for a purpose other than their FDA-approved indication.

Topical Ivermectin Cream

Topical ivermectin 1% cream, commonly known by the brand name Soolantra, is approved for treating rosacea but is often used off-label for Demodex blepharitis. Ivermectin acts as an antiparasitic agent that reduces the density of Demodex mites.

How it's used: A small amount is applied to the eyelid margins, typically once per week for 15 minutes.
Effectiveness: Studies have shown it can reduce mite counts and improve symptoms.
Side Effects: May cause mild eye and skin irritation.

Topical Metronidazole

Metronidazole cream or gel (Metrogel) is an antibiotic treatment that also possesses anti-inflammatory properties. While it has been used to treat rosacea for years, it can also be prescribed off-label for Demodex blepharitis to help reduce mite populations and associated inflammation.

How it's used: A topical application to the eyelid area.
Effectiveness: Helps manage symptoms and reduce mite density.
Side Effects: Can cause mild irritation and has potential drug interactions.

Oral Antibiotics and Antiparasitics

In some cases, a healthcare provider might prescribe oral medications to address the infestation from the inside out. Oral options include ivermectin, metronidazole, and doxycycline. These medications may have systemic side effects, such as gastrointestinal upset.

Over-the-Counter (OTC) Eyelid Washes and Cleansers

Lid hygiene with specialized cleansers is a primary method for managing Demodex blepharitis and can be used with prescription therapies.

Tea Tree Oil (TTO) Cleansers: Products containing terpinen-4-ol (T4O), the active ingredient in tea tree oil, have antiparasitic and anti-inflammatory effects. Examples include Cliradex and OCuSOFT Oust.
Hypochlorous Acid Sprays: Products like OCuSOFT HypoChlor can help relieve symptoms.
Application: These are typically applied to eyelid margins using wipes or foam. Caution is needed due to potential TTO irritation.

In-Office Procedures

In-office procedures offer an alternative for more severe cases.

Microblepharoexfoliation (BlephEx): Exfoliates eyelids to remove debris and reduce mites.
Intense Pulsed Light (IPL): Uses light energy to reduce inflammation and mite density.
Thermal Pulsation/Expression: Applies heat and pressure to clear clogged oil glands.

Comparison of Demodex Blepharitis Treatment Options


Feature	XDEMVY (Lotilaner Ophthalmic Solution)	Topical Prescription (e.g., Ivermectin)	OTC Tea Tree Oil Cleansers	In-Office Procedures (e.g., BlephEx, IPL)
Mechanism of Action	Directly kills Demodex mites.	Reduces mite density and inflammation.	Kills mites and provides anti-inflammatory effects.	Physical removal of debris and mites, reduces inflammation.
FDA Status	First and only FDA-approved treatment for Demodex blepharitis.	Off-label use for this specific condition.	No specific FDA approval for these products as a mite treatment.	Performed by eye care specialists; not an FDA-approved drug.
Application Method	Prescription eye drops, twice daily for 6 weeks.	Cream or gel applied topically to the eyelid.	Cleansing wipes or foams applied daily.	Performed by a healthcare professional in a clinical setting.
Effectiveness	High efficacy in clinical trials for mite eradication and symptom improvement.	Effective at reducing mite counts and improving symptoms.	Effectiveness can vary; best for maintenance, less potent than prescription.	Highly effective for deep cleaning and mite reduction.
Common Side Effects	Stinging and burning at instillation site (10%), chalazion.	Mild eye or skin irritation.	Potential for severe eye irritation, contact dermatitis.	Mild discomfort during procedure.
Cost	Can be expensive depending on insurance coverage.	Varies, potentially lower than XDEMVY if off-label.	Relatively inexpensive.	Varies greatly; can be costly depending on procedure.

Choosing the right alternative for you

The best treatment approach considers the severity of your condition, health history, potential drug interactions, and cost. Consult your eye care provider before starting any new treatment. Combining treatments, such as in-office procedures with OTC cleansers, can be effective.

Conclusion

While XDEMVY is the only FDA-approved medication specifically for Demodex blepharitis, various alternatives exist. These include off-label prescription options like topical ivermectin and metronidazole, OTC tea tree oil cleansers, and in-office procedures. Consulting an eye care professional is vital to determine the most suitable and safest treatment plan. For more pharmacological details, the {Link: Drugs.com database https://www.drugs.com/} is a useful resource.

Frequently Asked Questions

While tea tree oil is used in many over-the-counter cleansers, it can cause eye irritation and is not an FDA-approved treatment. It is best to use commercially prepared cleansers with carefully controlled concentrations and consult your doctor before using any home remedies.

No, there is currently no generic version of XDEMVY (lotilaner ophthalmic solution) available in the United States. Patients should be cautious of fraudulent online pharmacies selling illegal generic versions.

XDEMVY has shown high efficacy in clinical trials for targeting the mites directly, with results unmatched by previous treatments. However, off-label prescriptions like topical ivermectin and metronidazole have also been shown to be effective at reducing mite counts and improving symptoms.

The most common side effect reported in clinical trials was a stinging and burning sensation at the instillation site, affecting about 10% of patients.

Yes, in-office procedures like microblepharoexfoliation (BlephEx) and Intense Pulsed Light (IPL) can be very effective alternatives, particularly for physically removing debris and reducing mite density. They are often part of a more comprehensive treatment plan.

It is not uncommon to combine different approaches for optimal results, such as an in-office procedure followed by consistent use of over-the-counter eyelid cleansers. Your eye care provider will recommend the best combination for your specific situation.

The timeframe for improvement varies depending on the treatment. Xdemvy has a specified six-week course. Other treatments, especially OTC cleansers, may require consistent, longer-term use to manage symptoms.