Alternatives to Paromomycin if You Can't Fill Your Prescription

Paromomycin (Humatin) is the go-to luminal amebicide for intestinal parasitic infections in the United States, but it's notoriously difficult to find. If your pharmacy can't fill your prescription or the cost is prohibitive, you have options — but the right alternative depends heavily on your specific diagnosis.

Always talk to your prescriber before switching medications. Different antiparasitic drugs work at different sites — some target the intestinal lumen, others treat invasive infections in tissue. Using the wrong drug for your infection could leave cysts behind and lead to relapse.

What Is Paromomycin Used For?

Paromomycin is FDA-approved for two main uses: intestinal amebiasis caused by Entamoeba histolytica, and adjunctive management of hepatic coma. It's also used off-label for cryptosporidiosis, giardiasis, Dientamoeba fragilis infection, and certain tapeworm infections. Its key advantage is that it stays in the gut — it's barely absorbed into the bloodstream — making it ideal for clearing intestinal cysts.

Alternative 1: Iodoquinol (Yodoxin)

Iodoquinol is the most direct alternative to paromomycin for intestinal amebiasis. Like paromomycin, it is a luminal amebicide — it works in the intestinal lumen and is used to eradicate E. histolytica cysts after initial treatment with a nitroimidazole like metronidazole or tinidazole.

Dose: 650 mg three times daily for 20 days in adults

Availability: More widely stocked at most pharmacies than paromomycin

Caution: Contains iodine; contraindicated in patients with iodine hypersensitivity or thyroid conditions. Longer course than paromomycin.

Alternative 2: Metronidazole (Flagyl)

Metronidazole is the drug of choice for invasive or symptomatic amebiasis. It treats E. histolytica in tissue, unlike paromomycin, which acts only in the gut lumen. The standard treatment for invasive amebiasis is actually metronidazole first (to kill the tissue-invasive parasites), followed by paromomycin or iodoquinol (to clear the remaining intestinal cysts). If paromomycin is unavailable, iodoquinol is the preferred follow-up.

Dose for amebiasis: 750 mg orally three times daily for 7–10 days

Availability: Generic widely available, very affordable, stocked at virtually all pharmacies

Important: Metronidazole is NOT a luminal agent and does not replace paromomycin for clearing intestinal cysts — a luminal agent is still needed after.

Alternative 3: Tinidazole (Tindamax)

Tinidazole is a nitroimidazole closely related to metronidazole and is preferred over metronidazole in some treatment guidelines for amebiasis due to a shorter treatment course and better tolerability. Like metronidazole, it is a tissue amebicide and must be followed by a luminal agent such as iodoquinol when paromomycin is unavailable.

Dose for intestinal amebiasis: 2 g/day for 3 days in adults

Availability: Generic available; more affordable than Humatin

Alternative 4: Nitazoxanide (Alinia)

Nitazoxanide has broad antiparasitic activity and can act against both luminal and invasive forms of E. histolytica. It is particularly useful as an alternative for cryptosporidiosis and giardiasis — two off-label uses of paromomycin. For cryptosporidiosis in immunocompromised patients, nitazoxanide and paromomycin are the most commonly used options.

Dose: 500 mg twice daily for 3 days for giardiasis in adults

Availability: Available at most pharmacies; generic becoming more accessible

Special Case: Paromomycin in Pregnancy

Paromomycin is sometimes preferred for treating giardiasis in pregnancy precisely because it is poorly absorbed and thus less likely to affect the fetus. Metronidazole is generally avoided in the first trimester. If you are pregnant and cannot find paromomycin, discuss safe alternatives with your OB or infectious disease specialist.

Still Trying to Find Paromomycin?

Before switching medications, it's worth making sure no pharmacies in your area have paromomycin available.

medfinder is a paid service that calls pharmacies near you to find which ones have it in stock. You can also read our guide on

how to find paromomycin in stock near you for step-by-step tips.