Compare · Medications

Mirvaso vs Soolantra

Mirvaso: A gel that narrows facial blood vessels to fade redness for about half a day. It treats color only, it does nothing for bumps, and in some people the redness returns worse as it wears off. Soolantra: A once-daily cream for the bumps and pustules of rosacea. It calms inflammation and reduces the mites that live in facial follicles, but it does not treat flushing or fixed redness.

Reviewed by Dr. Schwarz, Board-Certified Dermatologist
Mirvaso — Header ImageSoolantra — Header Image
Which one?At a glanceWhat it treatsDiagramsHow you take itResultsSide effectsSafetyCostWhen you stopQuestions

Which one is right for you?

Choose Mirvaso if…

Choose to fade rosacea redness for a day or an event — it treats color only, not bumps.

  • Background redness is what bothers you most
  • You want a quick result for the day
  • You'll test it first to check for rebound

Choose Soolantra if…

Choose for rosacea bumps and pustules as a once-daily cream that often clears them — it doesn't treat flushing or fixed redness.

  • Rosacea bumps and pimples
  • You want once-daily use
  • You'll give it 12–16 weeks
Often combined

Can you take them together?

They treat different parts of rosacea: Soolantra for bumps, Mirvaso for redness. Apply Soolantra at night and Mirvaso in the morning.

At a glance

● Mirvaso
● Soolantra
Type
Topical vessel-narrowing gel (brimonidine 0.33%)
Topical antiparasitic and anti-inflammatory (ivermectin 1%)
What it does
Temporarily shrinks facial blood vessels
Calms inflammation and reduces Demodex mites
Best for
Persistent rosacea redness
Rosacea bumps and pustules
Prescription
Yes
Yes
Form
Gel
Cream
How often
Once daily
Once daily
Course length
As needed
Ongoing
Time to results
30 minutes; lasts about 12 hours
4–16 weeks
Main side effect
Rebound redness as it wears off
Mild burning or dryness
Blood tests
None
None
Pregnancy
Check with your clinician
Check with your clinician
Cost
Moderate to high
Moderate; generic available

What it treats

Compare uses by strength of evidence. Evidence level describes confidence in a benefit, not its size.

Evidence level
Mirvaso
Soolantra
Strong evidenceMost established uses
—
Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Reduces bumps and pimples.
Moderate evidenceSome supportive research
Redness and fine superficial vessels across a light-skinned cheek and nose.

Rosacea

Reduces persistent redness for the day.
—
Little evidence
—
The finger webs and wrist on fair light skin, with small red bumps, several thin gray burrow lines a few millimetres long, and scratch marks across the area.

Scabies

Scabies needs permethrin or ivermectin tablets.
Not effective
Fine branching superficial spider veins on the lower leg.

Spider Veins

Doesn't remove visible vessels.
Inflamed acne on light skin. The spots sit in a patch of pink, and the ring of redness around each one is easy to see. A few have a yellow-white head, and the skin between them is dry and flaking.

Acne

No role in acne.
Inflamed acne on light skin. The spots sit in a patch of pink, and the ring of redness around each one is easy to see. A few have a yellow-white head, and the skin between them is dry and flaking.

Acne

Not an acne treatment.
Post-Inflammatory Redness.

Post-Inflammatory Redness

Doesn't fade redness alone.
How it works

Mirvaso

Mirvaso. Brimonidine temporarily reduces rosacea redness. 1. Activates vessel receptors: Stimulates alpha-2 receptors in skin blood vessels. 2. Narrows blood vessels: The vessel walls contract, reducing blood flow. 3. Reduces visible redness: The effect is temporary and wears off.
Open full-size diagram
Diagram explanation and sources

Activates vessel receptors: Stimulates alpha-2 receptors in skin blood vessels. Narrows blood vessels: The vessel walls contract, reducing blood flow. Reduces visible redness: The effect is temporary and wears off.

Brimonidine is a relatively selective alpha-2 agonist. This explains temporary vasoconstriction, not permanent removal of blood vessels or cure of rosacea.

Source 1

Soolantra

Soolantra. Ivermectin helps settle rosacea bumps and pimples. 1. Reduces Demodex mites: Kills mites that may contribute to rosacea inflammation. 2. May calm immune signals: Anti-inflammatory effects may also help skin settle. 3. Reduces bumps and pimples: Inflammatory rosacea lesions gradually improve.
Open full-size diagram
Diagram explanation and sources

Reduces Demodex mites: Kills mites that may contribute to rosacea inflammation. May calm immune signals: Anti-inflammatory effects may also help skin settle. Reduces bumps and pimples: Inflammatory rosacea lesions gradually improve.

The label states that the rosacea mechanism is unknown. Anti-parasitic and anti-inflammatory actions are supported by a small in-vivo pilot; clinical efficacy has randomized-trial support. Demodex is not the sole cause of rosacea.

Source 1 · Source 2 · Source 3

How you take it

Treatment plan

When to Apply: Once a day on clean dry skin, timed for when you most want the redness down. A pea-sized amount for the whole face, divided between forehead, nose, chin and cheeks and spread thinly. Makeup and sunscreen go on once it has dried.

How to Start: Test one small area, such as one cheek, for several days first. That is the cheapest way to find out whether you get rebound. Use less than a pea-sized amount, and never more than once a day.

If It Irritates: Burning, stinging or itching where you applied it is common early and often settles. If redness worsens, or comes back stronger as the gel wears off, stop and speak to your doctor. Rebound does not settle by pushing through it.

If It's Not Working: There is one strength, and more gel is not the answer. The next steps are oxymetazoline cream, which works on a different receptor, or laser and light treatment, which treats the vessels themselves.

When to Apply: Once a day, usually at night, on clean dry skin. A pea-sized amount for the whole face, spread thinly rather than dabbed on bumps. Keep it off the eyes, lips and inside of the nose. Moisturizer and sunscreen go on top once it has dried.

How to Start: Once daily from day one. No build-up schedule, and twice a day speeds nothing up.

If It Irritates: Mild burning, stinging or dryness early on is common; moisturizer before or after usually settles it. A flare of bumps in the first two to four weeks happens and passes. It does not mean the cream is wrong.

If It's Not Working: Give it twelve weeks before judging, up to sixteen for the full effect. There is one strength, so the next step is adding something else, often azelaic acid or an oral antibiotic, not more cream.

Monitoring

No blood tests for ordinary use. What is monitored is what you can see: does the redness fade, does it come back worse, does burning settle.

A small amount is absorbed, so the gel carries the theoretical body-wide effects of its class — low blood pressure, a slow heart rate, drowsiness, dizziness. These are rare on intact skin, but they are why heart disease, low blood pressure, circulatory problems or an existing brimonidine eye drop should be raised before you start.

Review a few weeks in — is this worth continuing.

No blood tests or laboratory monitoring. Very little is absorbed through intact skin, far below the amounts involved with the tablets.

Monitoring is a conversation at around twelve weeks: have the bumps reduced, is the cream comfortable, is anything separate needed for redness. People stay on it for years without a dose change, because nothing accumulates.

Irritation after months of comfortable use usually points to a change in the routine or a second problem such as contact dermatitis, worth reviewing rather than pushing through.

When you’ll see results

Approximate windows, not promises.

● Mirvaso
● Soolantra
First 30 minutes

First 30 minutesStarting: Redness begins to fade. Some tingling or warmth is normal.

3 to 6 hours

3 to 6 hoursPeak: The face is at its least red. The fixed pink of cheeks, nose and forehead visibly lightens.

9 to 12 hours

9 to 12 hoursWearing off: Color returns, in most people to where it started.

Days 1 to 14

Days 1 to 14Watching for rebound: In a minority, redness comes back worse than it started, sometimes with burning. It can appear on day one or after a week or two.

Ongoing

OngoingNo build-up: It does not accumulate. Day ninety works like day one.

First few minutes

First few minutesApplying it: A pea-sized amount once a day, thinly over the whole face.

Weeks 1 to 2

Weeks 1 to 2Adjusting: Mild burning, dryness or itching. Some get a short flare as mite numbers drop. Little visible change yet.

Weeks 2 to 4

Weeks 2 to 4First change: Fewer new pustules, which clear before the firm red bumps. The face looks calmer before the count is obviously lower.

Weeks 4 to 12

Weeks 4 to 12Working: Steady reduction in bumps and pustules. Most of the gain happens here, and background pink fades as the inflammation settles.

Weeks 12 to 16

Weeks 12 to 16Judge it here: The point the trials measured, where most people were rated clear or almost clear.

Side effects

Sorted by what to do about them.

Mirvaso

Soolantra

Common
Common
  • Rebound redness or flushing as it wears off
  • Burning or itch
Common
  • Mild burning or stinging
  • Dry skin
Tell your doctor
Tell your doctor
  • Redness worse than before treatment
Tell your doctor
  • Rosacea worsening
Stop and get care
Stop and get care
  • Dizziness or fainting
Stop and get care
  • Swelling or trouble breathing

Safety and who should avoid it

Pregnancy
Use care
Ask the doctor managing your pregnancy.
Use care
Ask the doctor managing your pregnancy.
Breastfeeding
Use care
Discuss with your clinician.
Use care
Discuss with your clinician.
Children
Not used
Adults only.
Not used
Adults only.
Monitoring
None
—
None
Judge at 12–16 weeks.
Key interactions
Check
Antidepressants (MAOIs), blood pressure drugs.
None known
—
Other cautions
Use care
Heart disease, low blood pressure, Raynaud's.
Use care
Keep out of eyes.

Cost and getting it

Getting it and cost

Brand priced for most of its life, and often not covered, because insurers treat facial redness as cosmetic. Generic brimonidine gel has appeared in some markets, bringing the price down unevenly.

A tube lasts a long time if you stick to the pea-sized rule.

If cost is the barrier, the honest question is whether a treatment lasting twelve hours that does not change the disease is where the budget should go, or whether laser or light treatment is the better buy.

Sold as Soolantra, with generic ivermectin 1% cream now available in some markets. Price varies widely between pharmacies and plans, and many plans want metronidazole or azelaic acid tried first.

A tube lasts a while, since a pea-sized amount covers the whole face once a day. If cost is the barrier, price generic ivermectin cream, a pharmacy discount card, or generic metronidazole or azelaic acid.

When you stop

Comes back?
Redness returns each day as the gel wears off.
Bumps can return months after stopping.
Taper needed?
No.
No.
After the last dose
Nothing lasting.
Restarting usually works.

Common questions

Mirvaso:What is rebound redness, and how likely is it?

Redness that comes back worse than it started, as the gel wears off or after several days of use, sometimes with burning. A minority of users, but the main reason people stop. It settles within a couple of weeks of stopping.

Mirvaso:Can I make rebound less likely?

Use less than you think — a pea-sized amount for the whole face, once a day at most — and test one small area for several days first. Over-application is the pattern most linked to trouble.

Mirvaso:Will it help my rosacea bumps?

No. It is a blood vessel treatment. Bumps and pustules need a separate medicine, and the two are often prescribed together.

Mirvaso:How long does one application last?

It begins around thirty minutes, peaks at three to six hours, and is gone by twelve. It does not accumulate, so daily use is not needed if you want it for occasions.

Mirvaso:Can I wear makeup over it?

Yes, once it has dried.

Mirvaso:Does it work on broken capillaries?

Not really. Those are visible individual vessels; they need laser or light. Brimonidine pales the background around them, which can make them look less obvious.

Soolantra:Does it get rid of the redness in my face?

Not the kind most people mean. It reduces redness from inflamed bumps, so the face looks calmer. It does not stop flushing or remove visible vessels; those need brimonidine or oxymetazoline, or laser and light.

Soolantra:Why did my rosacea get worse in the first two weeks?

A short early flare is common, probably because dying mites release material the immune system reacts to. It settles within a few weeks.

Soolantra:Is this the same as taking ivermectin tablets?

Same drug, completely different medicine. The cream goes on the face, almost none enters the bloodstream, and it treats skin only.

Soolantra:How long will I need to use it?

Rosacea is managed, not cured, so most people use it long term. Bumps return within a few months of stopping.

Soolantra:Can I use it alongside other rosacea treatments?

Yes, and combinations are common: a redness treatment in the morning and ivermectin at night, or ivermectin with oral doxycycline.

Soolantra:Do I need to change my pillowcases because of the mites?

No. These mites live in the follicles of nearly every adult face. They are not caught from bedding, pets or people, and cleaning does not change their numbers.

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