That I don't know, but a good question. I do know that some of the herbal remedies I took caused scattering. And I know that I have the super resistant big boys. I can even feel them in my breast twitching and moving. Cant stand it any longer. Pretty sure I'm full of Ascaris as my stomach has severe distention. I'm thinking of eating something sweet so they will go to my stomach to feed and then I will take the meds on top of that. I hope that helps.