Rosiver (Ivermectin 1%) Cream
Rosiver (Ivermectin 1%) Cream
Product Description
Product overview
Rosiver (Ivermectin 1%) Cream by Galderma is a prescription-strength, once-daily topical treatment clinically proven to reduce the inflammatory papules and pustules of rosacea. Formulated with 1% ivermectin — a dual-action antiparasitic and anti-inflammatory agent — it targets Demodex mites widely associated with rosacea flare-ups, delivering measurable skin-clearing results in as little as 2–4 weeks of consistent use.
Anti-Parasitic Action
Ivermectin 1% targets and reduces Demodex mite populations on the skin — a key driver of papulopustular rosacea flare-ups — at the root cause level.
Texture & feel
SENSORYAnti-Parasitic Action
Ivermectin 1% targets and reduces Demodex mite populations on the skin — a key driver of papulopustular rosacea flare-ups — at the root cause level.
Clinically Proven Anti-Inflammatory
In two pivotal Phase 3 double-blind trials, Rosiver demonstrated significantly greater lesion reduction vs. vehicle at 12 weeks, with 71–76% sustained responders at week 52.
Gentle on Sensitive Skin
Free of fragrance, parabens-dominated formulation, and harsh actives. Emollient base with cetyl and stearyl alcohols soothes and hydrates the skin barrier.
Simple Once-Daily Routine
Applied at bedtime in a pea-sized amount per facial zone — chin, nose, forehead, and each cheek — making compliance easy and long-term maintenance realistic.
Outperforms Metronidazole
Network meta-analysis data confirms ivermectin 1% cream once daily achieved significantly greater lesion reduction vs. metronidazole 0.75% cream and azelaic acid 15% gel at 12 weeks.
Galderma — Global Dermatology Leader
Developed by Galderma, a Swiss pharmaceutical company exclusively focused on dermatology, with over 40 years of skin science expertise and a global clinical research network.
Safety & compatibility
SAFEIvermectin topical should not be used during pregnancy unless clearly necessary and benefits outweigh risks. Consult your doctor immediately if you become pregnant while using this product.
It is not known whether topical ivermectin passes into breast milk. Use is not recommended while breastfeeding; consult your healthcare provider before use.
The formula contains isopropyl palmitate and stearyl alcohol — ingredients that can feed Malassezia yeast. Not recommended if you are prone to fungal acne (pityrosporum folliculitis).
Specifically formulated for rosacea-prone skin. Fragrance-free, non-comedogenic, and free of known rosacea triggers such as alcohol and harsh exfoliants.
Compatible with niacinamide, ceramides, and hyaluronic acid serums. Many rosacea patients successfully layer Rosiver under a simple moisturizer for added barrier support.
Do not combine with alcohol-based toners, AHA/BHA exfoliants, retinoids, or astringents — these can worsen rosacea irritation and interfere with the treatment's effectiveness.
While ivermectin does not directly cause photosensitivity, sun exposure worsens rosacea. Daily use of a broad-spectrum SPF 30+ mineral sunscreen is strongly advised.
Rosiver is approved only for adults 18 years and older. Not intended for pediatric use. Keep out of reach of children and pets during use, disposal, and storage.
Ingredient breakdown
INGREDIENTSIvermectin 1% (10mg/g)Proven
The sole active ingredient in Rosiver, ivermectin is a macrocyclic lactone antiparasitic agent derived from the bacterium Streptomyces avermitilis. At 1% topical concentration, it exerts dual antiparasitic and anti-inflammatory effects — reducing overcolonization of Demodex folliculorum mites and suppressing the downstream inflammatory cascade that produces the papules and pustules of rosacea.
- Clinical Evidence: Two Phase 3 RCTs (n=1,371) demonstrated significantly greater IGA success vs. vehicle at 12 weeks; 71–76% sustained responders at 52 weeks.
- Vs. Metronidazole: Network meta-analysis (PMC4956638) confirmed ivermectin 1% QD achieved greater lesion reduction than metronidazole 0.75% BID and azelaic acid 15% BID at 12 weeks.
- Onset: Improvement visible as early as Week 2; full efficacy typically achieved by Week 12.
- Mechanism: Exact rosacea mechanism unknown; both anti-inflammatory activity and selective glutamate-gated chloride channel binding (neurotoxic to mites) are implicated.
Cetyl Alcohol EmollientProven
A fatty alcohol derived from natural fats and oils, cetyl alcohol functions as an emollient and emulsifier in this cream base. Unlike drying alcohols (ethanol, denatured alcohol), fatty alcohols are non-irritating, help create a smooth, spreadable texture, and help lock moisture into the skin. The FDA permits "alcohol-free" labelling on products containing cetyl alcohol.
- Function: Emollient, emulsifier, texture thickener — contributes to the cream's white, smooth consistency.
- Safety: Non-irritating; well-tolerated by sensitive and rosacea-prone skin types.
- Comedogenic Rating: 2/5 — low to moderate; generally well-tolerated by most skin types.
Stearyl Alcohol EmollientProven
A white, waxy fatty alcohol derived from stearic acid, stearyl alcohol acts as an emulsifier and emollient in the Rosiver base. It contributes to the product's rich, spreadable cream texture and helps maintain the emulsion stability of the formulation, ensuring consistent drug delivery with each application.
- Function: Emollient, emulsifier, opacifying agent — improves cream consistency and skin feel.
- Safety: Well-established safety profile; rarely causes irritation in normal use concentrations.
Methyl Parahydroxybenzoate (Methylparaben) PreservativeProven
Methylparaben is a widely used preservative that prevents microbial growth and extends the shelf life of topical formulations. It is one of the most studied cosmetic preservatives with a long history of safe use in dermatological products. Present in Rosiver at concentrations well within regulatory safety limits globally.
- Function: Antimicrobial preservative — prevents bacterial and fungal contamination in the cream.
- Regulatory Status: Approved for use by FDA, EU, Health Canada at standard concentrations (0.1–0.3%).
Propylparaben PreservativeProven
Propylparaben works in synergy with methylparaben to provide broad-spectrum preservation against bacteria and fungi. Together these parabens maintain product integrity throughout the 12-month period after opening. Used at concentrations approved by Health Canada and international regulatory bodies in this prescription formulation.
- Function: Antifungal/antibacterial preservative — complementary spectrum to methylparaben.
- Note: Parabens in topical prescription formulations are regulated and assessed for safety as part of drug approval by Health Canada.
Propylene Glycol Humectant/SolventProven
Propylene glycol serves as both a humectant — drawing moisture into the skin — and a solvent that aids in dispersing and stabilizing the active ingredient ivermectin within the cream base. It also contributes to the smooth skin feel and enhances percutaneous absorption of active components.
- Function: Humectant, solvent, skin-conditioning agent — supports hydration and active delivery.
- Safety: Safe and widely used in pharmaceutical and cosmetic formulations at standard concentrations.
17 ingredients
Active: Ivermectin 1% (10 mg/g)
Non-medicinal (INCI order): Carbomer Copolymer Type B, Cetyl Alcohol, Citric Acid Monohydrate, Dimethicone (20 cSt), Disodium EDTA, Glycerin, Isopropyl Palmitate, PEG-20 Cetostearyl Ether (Macrogol Cetostearyl Ether), Methylparaben (Methyl Parahydroxybenzoate), Oleyl Alcohol, Phenoxyethanol, Propylparaben (Propyl Parahydroxybenzoate), Propylene Glycol, Purified Water, Sodium Hydroxide (10% w/w Aqueous Solution), Sorbitan Stearate Type 1, Stearyl Alcohol
Where it fits in your routine
ROUTINEApply Rosiver as Step 3 atbedtime only. Let it dry completely (~60 seconds) before applying moisturizer on top. In the morning, always finish with a broad-spectrum mineral SPF 30+ to protect rosacea-prone skin from sun triggers.
How to use
HOW TO USECleanse Your Face
Wash your face with a mild, non-foaming, fragrance-free cleanser suitable for sensitive or rosacea-prone skin. Pat dry gently with a soft towel — do not rub.
Apply a Pea-Sized Amount Per Zone
Dispense a small, pea-sized amount of Rosiver for each of the five facial zones: forehead, nose, chin, and both cheeks. Spread as a thin, even layer across each area.
Avoid Eyes and Lips
Apply to the entire face avoiding the eyes, eyelids, lips, and interior of the nose. If accidental contact occurs, rinse thoroughly with water.
Wash Hands Immediately
Wash your hands thoroughly with soap and water after applying Rosiver. Ensure children and pets cannot access the product during application or storage.
Allow to Dry, Then Moisturize
Allow the cream to dry for approximately 60 seconds. Then apply your regular fragrance-free moisturizer on top. Cosmetics may be applied the following morning after the product has dried overnight.
Use Once Daily at Bedtime — Every Night
Apply every night at bedtime for a minimum of 12 weeks. Do not skip doses. If no improvement is seen after 3 months, consult your dermatologist. Consistent use is essential for sustained results.
Who is it for?
WHOPerfect for you if:
- You have been diagnosed with papulopustular rosacea (inflammatory bumps and pustules)
- Metronidazole or azelaic acid treatments have not given you satisfactory results
- You suspect Demodex mite overcolonization is driving your rosacea flares
- You are an adult aged 18+ seeking a once-daily, prescription-based solution
- You prefer a fragrance-free, gentle cream formula for sensitive facial skin
- You want clinically validated, long-term rosacea management (up to 52 weeks of data)
Consider alternatives if:
- You are pregnant or breastfeeding — use is not recommended
- You are under 18 years of age
- Your primary rosacea symptom is persistent redness/erythema only (consider brimonidine or oxymetazoline instead)
- You have confirmed fungal acne (pityrosporum folliculitis) — formula contains isopropyl palmitate
- You are allergic to ivermectin or any listed ingredient
- You have ocular rosacea — a separate ophthalmological treatment is needed
Skin type compatibility
SKIN TYPESSpecifically designed for papulopustular rosacea. Reduces inflammatory lesions, targets Demodex mites, and soothes reactive skin without known rosacea triggers.
Fragrance-free, alcohol-free, and formulated with gentle emollient fatty alcohols. In clinical trials, adverse event rates were low and comparable to vehicle.
The lightweight cream absorbs well and leaves a natural finish. Suitable for combination skin as part of a once-nightly rosacea management routine.
Emollient base with cetyl alcohol, stearyl alcohol, glycerin, and dimethicone provides mild hydration. Layer a richer moisturizer on top if dryness is a concern.
Applied nightly in a pea-sized amount, the thin cream layer absorbs without significant greasiness. Rated comedogenic 2/5 — generally suitable for oily rosacea skin.
Contains isopropyl palmitate and stearyl alcohol which can feed Malassezia yeast. Use with caution if fungal acne (pityrosporum folliculitis) is a concern. Patch test first.
Results timeline
MONTHS 6–12Initial Adjustment — Potential Purge Phase
Some users report a temporary worsening of pustules during the first 1–2 weeks as Demodex die-off occurs and the skin adjusts to treatment. This is a known phenomenon — do not stop use during this period. Skin may appear temporarily redder or bumpier.
~30% notice initial flareFirst Visible Improvement
Clinical data shows early improvement in inflammatory lesion counts as soon as Week 2 in some patients. Pustule size and frequency begin to reduce. Skin texture may feel smoother and less reactive.
~40% see early improvementMeaningful Lesion Reduction
Continued significant reduction in papule and pustule count. Redness associated with active inflammatory lesions begins to fade. Many patients report their skin looking noticeably clearer and calmer by week 6–8.
~60% see significant clearingPeak Clinical Efficacy Reached
The 12-week primary endpoint of the Phase 3 trials showed the highest responder rates. In pivotal studies, the majority of patients achieving IGA success (clear or almost clear) did so by week 12. Skin significantly clearer, smoother, and more stable.
~71–76% sustained respondersLong-Term Sustained Remission
Open-label 40-week extension data showed 71% and 76% of patients in Studies 1 and 2 respectively maintained treatment success at Week 52. Continued once-daily use is required to prevent rosacea recurrence — symptoms may return if treatment is stopped.
~73% sustained at 52 weeksRatings by platform
75K+ REVIEWSPros & cons
BALANCEDPraised
- Clinically superior to metronidazole 0.75% at 12 weeks in head-to-head data
- Targets the root cause (Demodex mites) not just the symptoms
- Once-daily bedtime application — simple routine compliance
- Fragrance-free, gentle on sensitive and rosacea skin
- Long-term efficacy data up to 52 weeks available
- Works for papulopustular rosacea where other creams have failed
- Results visible as early as Week 2 in some patients
- No systemic drug-drug interactions at topical therapeutic concentrations
Criticized
- High cost — over $200 CAD per 60g tube without insurance coverage
- Prescription-only — cannot be purchased OTC
- Initial purge phase (weeks 1–2) can be alarming and causes many to quit early
- Does not treat rosacea erythema/redness — only inflammatory lesions
- Not safe during pregnancy or breastfeeding
- Contains isopropyl palmitate — potential concern for fungal-acne prone skin
- No generic version widely available in Canada
- Requires continued use to prevent relapse — not a cure
Budget-friendly alternatives (dupes)
DUPESIdentical active ingredient (ivermectin 1%) and the same Galderma formulation sold under the brand name Soolantra in the USA and Europe. Rosiver is the Canadian brand name. Bioequivalent — same clinical evidence base. The main difference is country of distribution and insurance coverage pathways.
The previous gold-standard topical for rosacea — metronidazole 0.75% cream — is widely available as a generic at significantly lower cost. Clinical data shows Rosiver outperforms metronidazole on inflammatory lesion reduction at 12 weeks, but metronidazole may be more effective for redness/erythema and is generally better tolerated in cost-conscious patients.
Azelaic acid 15% gel targets rosacea through anti-inflammatory and antibacterial mechanisms. Network meta-analysis confirms ivermectin 1% achieves greater lesion reduction vs. azelaic acid 15% BID at 12 weeks. However, azelaic acid has the advantage of also improving post-inflammatory hyperpigmentation and is considered safer in pregnancy (Category B).
Comparison with competitors
SIDE-BY-SIDEMirvaso — Brimonidine 0.33% Gel (Galderma)
Storage & shelf life
12 MONTHS12 months after opening. Discard the tube 12 months after first use or by the expiry date printed on the packaging, whichever comes first.
Store at room temperature between 15°C and 30°C (59°F–86°F). Do not refrigerate or freeze. Keep in a dry place away from direct sunlight and heat sources.
60g aluminium tube with a sealed screw cap. Tube format minimises air exposure and maintains product integrity throughout use. White to pale yellow cream texture.
Yes — the 60g tube is within the 100ml limit for carry-on liquids. As a prescription medication, carry the original packaging and your prescription documentation when travelling internationally.
Frequently asked questions
FAQNo — Rosiver should not be used during pregnancy unless your doctor has determined that the benefits clearly outweigh the risks. There is insufficient safety data for use during pregnancy. Contact your doctor immediately if you become pregnant while using Rosiver. Similarly, for breastfeeding, it is unknown whether topical ivermectin passes into breast milk; use is not recommended while nursing. Always consult your healthcare provider for guidance specific to your situation.
Use with caution. Rosiver contains isopropyl palmitate and stearyl alcohol — both of which can potentially feed Malassezia yeast and may worsen pityrosporum folliculitis (fungal acne). If you are prone to fungal acne, discuss this concern with your dermatologist before starting Rosiver. Note that rosacea and fungal acne can coexist, and it is important to correctly diagnose which condition you are treating.
No — you should avoid using Rosiver alongside alcohol-based cleansers, astringents, exfoliating acids (AHAs/BHAs), retinoids, or other irritating actives while treating rosacea. These ingredients can trigger rosacea flares, increase skin sensitivity, and reduce the tolerability of the ivermectin cream. In vitro data confirms ivermectin does not inhibit or induce CYP450 enzymes, meaning there are no known systemic drug–drug interactions at topical doses — but skin-level irritation interactions are a real concern. Stick to a simplified, gentle routine: mild cleanser, Rosiver, fragrance-free moisturizer, mineral SPF.
Rosiver is specifically designed for adults with papulopustular rosacea — regardless of underlying skin type (normal, oily, combination, or dry). It is particularly well-suited for sensitive, reactive skin given its fragrance-free, gentle emollient formula. It is not appropriate for those with primarily erythematous (redness-only) rosacea without inflammatory lesions — alternatives like brimonidine gel may be more appropriate in that case. Those prone to fungal acne should use with caution.
Early improvement may be visible as soon as Week 2 for some patients, though many notice meaningful clearing between Weeks 4–8. Peak clinical efficacy — as measured in Phase 3 trials — is reached at Week 12. If you see no improvement after 3 months of consistent nightly use, stop the medication and consult your dermatologist. Be aware of the initial adjustment period (weeks 1–2) where skin can temporarily worsen before improving — this is common and does not mean the treatment is not working. Patience and consistency are essential.
Rosiver is applied at Step 3 in your evening (bedtime) routine only: 1) Gentle fragrance-free cleanser → 2) Optional toner/essence → 3) Apply Rosiver cream → 4) Let dry 60 seconds → 5) Fragrance-free moisturizer. In the morning, apply moisturizer followed by a broad-spectrum mineral SPF 30+. Cosmetics may be applied the following morning after Rosiver has dried overnight. Do not apply Rosiver in the morning as part of your daytime routine.
Rosiver has a moderate-low comedogenic rating of approximately 2/5. The formula contains cetyl alcohol (rating 2) and stearyl alcohol (rating 2), which are considered low-risk fatty alcohols. Isopropyl palmitate has a higher comedogenic potential (rated 4/5) and is the ingredient of greatest concern for pore-clogging. For most rosacea patients using a pea-sized amount nightly, clogged pores from Rosiver are uncommon, but those who are highly acne-prone should discuss this with their dermatologist.
Rosiver has a Period After Opening (PAO) of 12 months. Given that only a pea-sized amount is used per facial zone (5 zones, ~0.25g per zone = ~1.25g per application), one 60g tube contains approximately 48 days of use at full-face application. However, many patients report a single tube lasting 2–4 months depending on the size of the treatment area. Always observe the expiry date printed on the packaging and store at room temperature between 15–30°C.
Verdict: Rosiver (Ivermectin 1% Cream) by Galderma is the gold-standard prescription topical treatment for papulopustular rosacea, backed by robust Phase 3 clinical evidence and superior head-to-head efficacy vs. metronidazole 0.75% and azelaic acid 15%. Its dual anti-inflammatory and anti-parasitic mechanism makes it the only rosacea cream that directly addresses Demodex mite overcolonization — widely considered a key driver of inflammatory rosacea. The once-daily, fragrance-free, gentle formula ensures good long-term tolerability even in sensitive skin. The primary limitations are its high prescription cost in Canada, unsuitability during pregnancy, and the challenging initial purge phase that discourages some patients from completing treatment. For adult rosacea sufferers who have tried other topicals without success, Rosiver remains one of the most clinically compelling options available.
Product Overview
Quick product notes are a great way to check if a product is free from commonly avoided ingredients by skincare enthusiasts. These preferences come about for different reasons depending on the ingredient such as personal experiences, sensitivities, health preferences & etc.
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Quick Product Notes
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We help you identify key notable ingredients that have been shown to help with effects such as acne-fighting, brightening, UV-protection, wound healing & anti-aging to help you achieve your skincare goals smarter. Please note that different notable ingredients have varying levels of research behind them, some are extremely well proven yet some have mixed research in their efficacy.
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Notable Effects & Ingredients
Why are some products great for some people and horrible for others? Well everyone has different skin types and different reactions to the same ingredients.
We've identified a range of ingredients that are commonly regarded as potentially good or bad for those with Dry, Oily/Acne-Prone or Sensitive skin.
A product that contains good or bad ingredients for your skin type doesn't always flat out make the entire product good or bad for your skin. There are other factors such as ingredient quality, concentration and formulation that will ultimately determine your skins reaction.
One of the best ways to use this section is to troubleshoot products you've had bad experiences with in the past. Check if it contains any of the marked ingredients to point out suspect ingredients to avoid in the future!
Ingredients Related to Skin Types
Ingredient Safety Breakdown refers to the percentage % of ingredients in different risk categories as classified by EWG (Environment Working Group) if they are available. There are almost endless cosmetic ingredients and they are one of the few organisations globally that have assigned ratings to a lot of the more commonly used ingredients which is why we reference them.
EWG is seen by many to be more on the alarmist side in their assignment of health ratings resulting in rating ingredients as riskier than they actually are. We recommend using this a reference point rather than a strict guide of ingredient safety and to always do further research if into ingredients that you may find suspect.
Ingredient Safety Breakdown
Product ingredient list
| EWG | CIR | Ingredient Name & Cosmetic Functions | Notes |
|---|---|---|---|
| 0 |
Ivermectin
|
|
|
| 1 |
Cetyl Alcohol
Emulsion Stabilising, Fragrance, Opacifying, Emulsifying, Surfactant, Foam Boosting, Viscosity Increasing Agent, Emollient, Masking, Viscosity Controlling
|
|
|
| 1 |
Stearyl Alcohol
Emulsion Stabilising, Fragrance, Emulsifying, Surfactant, Viscosity Increasing Agent, Emollient, Foam Boosting, Masking, Opacifying, Refatting, Viscosity Controlling
|
|
|
| 0 |
Methyl Dihydroxybenzoate
|
|
|
| 7 |
Propylparaben
Perfuming, Fragrance, Preservative
|
|





