All Cat Demodicosis Treatment Protocols in One Place

Demodicosis, or subcutaneous mite infestation, is a common disease worldwide that is especially difficult to treat in cats due to their sensitivity to prolonged therapy. Over the past 15 years, treatment approaches have changed thanks to the introduction of effective and safe medications.

The content of this article is based on the latest clinical guidelines from the World Association for Veterinary Dermatology (WAVD) .

Demodicosis is caused by the overgrowth of Demodex mites, which normally live in the hair follicles of mammals without causing issues, thanks to immune system control. In cats, these mites are transmitted from mother to kittens within the first days of life. The disease, accompanied by severe itching, wound infections, and alopecia, usually develops only when the immune system is weakened—due to serious illnesses, immunosuppressive therapy, or genetic predisposition. Often, mite control can self-restore, but in more complex cases, cats will need our help.

Medications for Treating Demodicosis

This section covers current medications with world-practice-verified dosages and recommendations for use, including at-home treatments.

Amitraz

Amitraz, the only formamidine used in veterinary medicine, was long the primary treatment for various acariases, including demodicosis, in the form of a leave-on solution. It remains a widely available parasiticide with good tolerability. It works as a monoamine oxidase inhibitor and an alpha-2 adrenergic receptor agonist, helping reduce inflammation and suppress mite activity.

Dosages and methods of use: Amitraz is usually used in concentrations of 0.0125% to 0.025%, with up to 0.1% allowed for small skin areas if tolerated well. It is applied weekly for low concentrations or every two weeks for stronger solutions. The medication is an oily liquid, so an emulsifier is needed to mix it for home use. Twenty milliliters of glycerin per liter of water is sufficient for mixing.

To create a 0.0125% solution, dilute:

• 1 ml of 12.5% amitraz in 999 ml of warm water;
• Or for a smaller volume: 0.1 ml of amitraz in 99.9 ml of water;
• Use an insulin syringe with 0.01 ml markings.

Topical applications of amitraz:

• Trim the fur in the treatment area if possible.
• Bathe the cat with antibacterial shampoo.
• Use a sponge or soft cloth to apply the solution, or spray it with an atomizer. The solution must soak the skin, not just the fur.
• Let the cat dry naturally after treatment.
• Typically, the procedure is repeated every 7-14 days.

Important precautions:

• Wear gloves and avoid inhaling the aerosol if spraying the solution.
• Monitor the cat during and after the procedure. Stop use immediately if any signs of toxicity occur (lethargy, loss of appetite, tremors). Prevent the cat from licking treated areas.

Side effects are mild and may include itching or skin hyperthermia. Overdose of amitraz can cause lethargy, drowsiness, and digestive disorders in cats. Always test on a small area of skin to rule out allergic reactions.

Ivermectin

The macrocyclic lactone ivermectin was once used to treat demodicosis in dogs and cats, now officially used only for heartworm prevention. Despite its effectiveness, it is poorly tolerated, especially in injectable form. Off-label, it is used orally for subcutaneous mites in cats at doses of 300–600 mcg/kg daily for 4-8 weeks.

Side effects include lethargy, vomiting, tremors, coordination issues, and even seizures in severe cases.

Milbemycin Oxime

Milbemycin oxime, another macrocyclic lactone, is registered for the treatment of demodicosis in dogs and is also effective for cats. It is typically prescribed at a dose of 0.5–2 mg/kg daily and is used monthly for worm prevention.

Milbemycin is generally well-tolerated, but dosage should be gradually increased for allergic animals.

The drug is also available in combinations: lotilaner + milbemycin, afoxolaner + milbemycin. These are highly effective for demodicosis in cats and dogs and are suitable for home use.

Moxidectin

Moxidectin, a macrocyclic lactone derived from the fermentation of Streptomyces spp., is effective in oral doses of 0.3-0.4 mg/kg daily, showing 72-85% efficacy. A dose of 0.5 mg/kg every 72 hours is also effective. Subcutaneous administration at 0.5-1 mg/kg every 72 hours has an efficacy rate of about 86%.

Side effects are more common with subcutaneous use than with oral or topical applications.

2.5% moxidectin combined with 10% imidacloprid in topical drops is well-tolerated even by cats sensitive to ivermectin. More frequent application, such as biweekly, increases effectiveness, especially in kittens infected by their mother.

The average treatment duration is 6-7 weeks, followed by monthly preventive treatments.

Doramectin

Doramectin, a long-acting macrocyclic lactone, can be administered subcutaneously (0.6 mg/kg once weekly) or orally twice a week at the same dosage. The average treatment duration is about 7 weeks, continuing 3-4 weeks after the second negative test.

Side effects are rare and usually limited to local reactions at the injection site or temporary coordination issues that resolve after treatment ends.

Modern Medications: Isoxazolines

A relatively new group of drugs, isoxazolines, have shown high efficacy against demodicosis in cats. These substances act on receptors linked to chloride channels, blocking chloride transmission across parasite cell membranes and causing their death. Isoxazoline treatment is currently the most expensive but has several undeniable advantages over other treatments.

Fluralaner

Fluralaner, in the form of chewable tablets, is rapidly absorbed, reaching peak concentration within 24 hours and remaining in the plasma for up to 112 days after a single dose. Food intake enhances absorption. The drug is also available as a topical spot-on solution.

The recommended dose is 25 mg/kg every three months. After a single dose of fluralaner, most cats show improvement, including negative skin scrapings within two months.

Side effects are rare and mainly limited to temporary gastrointestinal reactions. The drug has a broad therapeutic range and can be used safely in breeds predisposed to allergic reactions to macrocyclic lactones.

Isoxazoline treatment preserves the normal skin microflora.

Sarolaner

Sarolaner comes in chewable tablets that are well-tolerated. In treating demodicosis, sarolaner reduces the number of mites by more than 99% within a month. Most animals show a significant reduction in clinical symptoms, and skin tests become negative within weeks. Complete mite eradication is achieved in 93% of cats within three months and in 100% within five months.

Side effects are rare and mainly include vomiting (in 3.5% of animals) and decreased activity (in 2.5%).

Lotilaner

Lotilaner is the newest member of the isoxazoline group. It is administered orally at a dosage of 20 mg/kg with a 28-day interval. After the first dose, mite numbers decrease by more than 99.9%, and live mites are no longer found after two months. Lotilaner shows high efficacy against demodicosis and can be a convenient treatment option.

Alternative Treatment Methods

In addition to standard antiparasitic medications, various immunomodulating agents have been investigated for treating generalized demodicosis.

Inactivated parapoxvirus suis was administered subcutaneously alongside amitraz treatment. Animals receiving combined therapy recovered faster. This is the only controlled study confirming the benefit of immunostimulants in demodicosis.

Cats with demodicosis have been found to have lower serum levels of vitamin E, although it is unclear whether this is a cause or effect of the disease. Adding vitamin E to amitraz therapy slightly accelerated recovery.

Other treatments have been tested. Lufenuron, a chitin synthesis inhibitor, showed no improvement after 2-3 months of use. Topical deltamethrin in a 12.5% solution was effective but required prolonged prevention of licking by cats.

Homeopathic remedies like Sulphur 200 and Psorinum 200 reduced symptom severity but did not provide a complete cure. An herbal spray with extracts of Cedrus deodara, Azadirachta indica, and Embelia ribes resulted in negative skin scrapings after six weeks, but the quality of the studies was poor.

Closantel, an anthelmintic from the salicylanilide group, was used subcutaneously, but remission was observed in only 6 out of 9 animals after six injections.

Treatment Costs

The cost of treating demodicosis varies significantly depending on the chosen method. Amitraz treatment remains the most affordable but requires more time and effort for applications. Macrocyclic lactones fall into the middle price range. Modern isoxazolines are the most expensive method, yet they are accessible to most breeders and are the simplest and most effective treatment.

The cost of medications is still several times lower than the expense of tests and veterinary visits.

Prognosis and Outlook

Modern isoxazoline medications effectively address demodicosis and are likely to remain the primary treatment method in the coming years. Resistance to these drugs develops more slowly than to other antiparasitic agents due to the unique way they work. Treating cats with fluralaner before breeding (10 days before mating and again after three months) significantly reduced the incidence of demodicosis in offspring: in 14 out of 15 litters, the disease did not develop, and in the remaining litter, only two kittens showed mild symptoms. It is important to remember that treatment does not replace responsible breeding — cats prone to demodicosis should not be used in breeding programs.