Which one works better?

The labels do not compare them. They were approved separately on separate trials, and neither document mentions the other.

Does either treat the redness of rosacea?

Neither is approved for it. Both indications are written in terms of inflammatory lesions, the papules and pustules, not the erythema.

Comparison

Metronidazole vs ivermectin for rosacea

Metronidazole topical gel

METRONIDAZOLE TOPICAL

Approved for skin

Encube Ethicals, Inc.Label version 2, effective 12 September 2025

Soolantra

IVERMECTIN

Approved for skin

Galderma Laboratories, L.P.Label version 8, effective 24 October 2024

Each stripe is one section of the label, each division in a stripe one entry in that section.

These are the two topical prescriptions most often set against each other for rosacea. Both are approved for the inflammatory lesions rather than for rosacea as a whole, and both labels are unusually candid about how little is known about why they work.

Side by side, straight from the labels

From the FDA label

This table is generated from the two source labels, not typed out by hand, so it cannot drift from what the regulator approved.

Label section	Metronidazole topical gelMETRONIDAZOLE TOPICAL	SoolantraIVERMECTIN
Active ingredient	MetronidazoleTopical antibacterial	IvermectinTopical antiparasitic and anti-inflammatory
Supply	Prescription	Prescription
What pharmacies payAcquisition cost, not retail	$0.301 per gram, generic	$15.51 per gram, brand
Boxed warning	None	None
What the FDA approved it for	Metronidazole gel USP (topical), 0.75%, is indicated for topical application in the treatment of inflammatory papules and pustules of rosacea.	SOOLANTRA cream is indicated for the treatment of inflammatory lesions of rosacea.
Forms and strengths	Metronidazole gel USP (topical), 0.75%, is supplied as the following: NDC 21922-070-06: 45 g aluminum lube Storage conditions: Store at 20° to 25°C (68° to 77°F).	Each gram of SOOLANTRA cream contains 10 mg of ivermectin in a white to pale yellow cream base. SOOLANTRA cream is supplied in tubes of 30 g, 45 g and 60 g.
How the label says it is taken	Apply and rub in a thin film of metronidazole gel USP (topical), 0.75%, twice daily, morning and evening, to entire affected areas after washing. Areas to be treated should be cleansed before application of metronidazole gel USP (topical), 0.75%. Patients may use cosmetics after application of metronidazole gel USP (topical), 0.75%.	Apply to the affected areas of the face once daily. Use a pea-size amount for each area of the face (forehead, chin, nose, each cheek) that is affected. Spread as a thin layer, avoiding the eyes and lips. SOOLANTRA cream is not for oral, ophthalmic, or intravaginal use.
Most common adverse reactions	The following adverse experiences have been reported with the topical use of metronidazole: burning, skin irritation, dryness, transient redness, metallic taste, tingling or numbness of extremities and nausea.	most common adverse reactions (incidence ≤ 1%) included skin burning sensation and skin irritation.
Contraindications	Metronidazole gel USP (topical), 0.75%, is contraindicated in individuals with a history of hypersensitivity lo metronidazole, parabens, or other ingredients of the formulation.	None. The label states that there are no contraindications.
Drug interactions	Oral metronidazole has been reported to potentiate the anticoagulant effect of coumarin and warfarin resulting in a prolongation of prothrombin time. The effect of topical metronidazole on prothrombin time is not known.	In vitro studies have shown that SOOLANTRA cream, at therapeutic concentrations, neither inhibits nor induces cytochrome P450 (CYP450) enzymes.
Label version	12 September 2025	24 October 2024

Both target the lesions, not the redness

Written by us

The metronidazole label covers the inflammatory papules and pustules of rosacea. The ivermectin label covers the inflammatory lesions of rosacea. Neither is approved for the persistent facial redness or the visible vessels, which are separate features of the condition with their own treatments.

Neither label explains the mechanism

Written by us

The metronidazole label states that the mechanisms by which the gel acts in rosacea are unknown, but appear to include an anti-inflammatory effect. The ivermectin label states flatly that the mechanism of action in treating rosacea lesions is unknown.

Explanations circulate for both, particularly for ivermectin and skin mites. Those explanations are not in the approved labels, so they are not stated as fact here.

Application differs

Written by us

The two labels describe different application schedules and different vehicles. Those details are in the table above, taken from each document.

Common questions

Written by us

Which one works better?: The labels do not compare them. They were approved separately on separate trials, and neither document mentions the other.
Does either treat the redness of rosacea?: Neither is approved for it. Both indications are written in terms of inflammatory lesions, the papules and pustules, not the erythema.

Sources

Every fact above comes from one of these documents. The date is the effective date of the label version this page was built from.

FDA prescribing information for Metronidazole topical gel
Encube Ethicals, Inc.. Label version 2, effective 12 September 2025.
Full label on DailyMed Approval record ANDA077547
FDA prescribing information for Soolantra
Galderma Laboratories, L.P.. Label version 8, effective 24 October 2024.
Full label on DailyMed Approval record NDA206255

Other comparisons in this category

Page last updated: 5 August 2026

Compiled by the HealthyStudy editorial team from FDA source documents. No medical reviewer is credited on this page, because none reviewed it.