* Both Arcane Curse and Last Word punishes casters with spammable spells such as Sand King.
* As a strength caster, Intelligence Steal reduces Sand King's mana pool even more.
* Global Silence silences Sand King, effectively reducing Sand King's initiation and counter-initiation potential. It can also interrupt channeling of Epicenter.

* Silencer burns easily through her effective HP from Mana Shield, by taking away her intelligence.
* Arcane Curse punishes her repeatedly casting Mystic Snake to keep her mana pool high. He can force her to use Manta Style before he has cast Global Silence and Medusa usually does not want to build Black King Bar.

* Burrowstrike is one of the best and easiest steals for Rubick and Sand King should be careful when playing against him - it's much better to give away Sand Storm.

* Because of her need to get status items early to tank it up, Rubick can greatly reduce her damage early with Fade Bolt
* Her stationary nature and the slow cast time of her spells makes it easier for Rubick to steal Stone Gaze or Mystic Snake
* Aghanim's Scepter's Mystic Snake is often better used by Rubick than by Medusa

* Ravage, being an AoE disable, cancels Epicenter's channeling from a long range, limiting his potential to counter-initiate.
* This can be remedied, however, by first using a Black King Bar, then channel Epicenter, then finally initiate with Blink Dagger.

* Other heroes who has armor and slow debuffs won't allow Medusa to disengage from combat: Tidehunter, Bristleback, Slardar.

* Deals damage over time: Venomancer, Huskar, Ember Spirit, Dark Seer, Sand King, Doom
* The nature of some abilities turn them into an easy target for a turnover from Spiked Carapace:
* Slow-moving projectiles: Skywrath Mage, Tinker, Necrophos
* Large area-of-effect with delay or require channeling: Enigma, Crystal Maiden, Invoker, Shadow Fiend, Pugna, Keeper of the Light
* Deals damage over time: Venomancer, Huskar, Ember Spirit, Dark Seer, Sand King, Doom

* With her passive Split Shot, Medusa can be easily interrupted by Spiked Carapace during combat, especially during her precious Stone Gaze.
* Mana Burn quickly destroys Mana Shield, especially if Medusa only increases her mana pool by bolstering intelligence (which has the added bonus of increasing Mana Burn's damage).
* Uncontrollable damage from Mystic Snake and Split Shot can trigger Spiked Carapace.
* Medusa lacks single target damage, making a Burrowed Nyx Assassin hard to kill.
Additional:
* Level 4 Mana Burn burns 38.5% of Medusa's mana every 4 seconds if Medusa only increases her mana pool with intelligence. Additionally, 70% of the Mana Burn damage gets mitigated by Mana Shield, burning even more mana.
* Due to the passive nature of Mystic Snake and Split Shot, it can possibly proc Nyx's Spiked Carapace if he's within range of Medusa's abilities and isn't invisible.
* Medusa lacks single target damage, making Nyx with Aghanim's Scepter extremely hard to deal with if Medusa is the team's main damage source.

* Other heroes who has armor and slow debuffs won't allow Medusa to disengage from combat: Tidehunter, Bristleback, Slardar.

* Quill Spray will hit Sand King inside Sand Storm, damaging him and putting Sand King's Blink Dagger on cooldown, preventing him from escaping.
* Epicenter's numerous damage ticks will trigger Bristleback's passive repeatedly during teamfights.

* Medusa lacks mobility or escape mechanisms. Earth Spike and Hex can neutralize her strong damage potential and allow for Lion's team to focus her down.
* In addition to easily breaking her commonly bought Linken's Sphere with its low cooldown, Mana Drain can quickly drain her Mana Shield, making her far less tanky.

* Zeus usually stays at the back in teamfights and it is hard for Sand King to find Zeus and knock him down before Zeus deals his damage.
* All of Zeus' abilities, especially Thundergod's Wrath, disables Sand King's Blink Dagger, effectively reducing Sand King's initiation and counter-initiation potential.
* Lightning Bolt deals damage to Sand King in Sand Storm and reveals him. It also interrupts channeling of Epicenter.

* Ghostship helps your team soak up damage from Epicenter, especially if he initiates during the battle.
* Sand King can't dodge X Marks the Spot - Torrent combo by his abilities. Torrent drags him out of his Sand Storm

* Pugna's Nether Ward damages Sand King when he channels Epicenter, preventing him from using Blink Dagger afterward.

* Nether Ward causes an unfriendly area for Medusa that drains her mana.

* Sand King has nothing to deal with Supernova, as none of his spells are effective.
* The damage-over-time abilities of Phoenix disable Sand King's Blink Dagger very often.

* Fiend's Grip provides mana drain, which can heavily damage Mana Shield and prevent Medusa from using Stone Gaze.
* Even if she does use Stone Gaze, Nightmare can buy enough time to protect allies and reset the fight.
Additional:
* Fiend's Grip leaves Medusa defenseless, if Bane's teammates can cover him or he initiates at the right time by Spell immunity.

* Will-O-Wisp will keep Medusa busy after she got hit by Blinding Light.

* Unlike other illusion heroes, Tempest Double won't be instantly destroyed by Stone Gaze since it is considered a clone and not an illusion.
* He can use either his own or his double's Flux to bypass the spellblock from Linken's Sphere, using the leftover Flux + Spark Wraith to slow Medusa's move speed to a crawl.
* Arc Warden has a farming advantage with double Hand of Midas, and can generally bully Medusa with other items that benefit from duplication.

* Anti-Mage easily destroys Mana Shield with Mana Break, especially once he has Manta Style.
* Anti-Mage effectively avoids Stone Gaze with Blink, and can reinitiate after its duration is over.
Additional:
* Mana Break burns Medusa's mana easily, especially when coupled with a Manta Style.
* Can easily initiate on Medusa with Blink, burning her mana or forcing her to use Stone Gaze.
* Mana Void is effective against Medusa's big mana pool and mana usage, presenting a huge hazard to Medusa's allies around her since her Mana Shield still gives her some protection if she has mana.

* EMP allows Invoker to burn Medusa's mana to weaken Mana Shield.
* Medusa's lack of mobility makes her easy to kite with Invoker's spells.
Additional:
* EMP is a large mana burn nuke which can hit Medusa's Mana shield with enough damage to lose even more mana.
* Deafening Blast disarms Medusa's ability to deal pseudo-AOE damage during teamfights.
* Cold Snap allows the opposing team to repeatedly stun Medusa in short succession, preventing her from successfully casting her ultimate due to its long cast time.

* Boulder Smash will push Sand King out of Sand Storm to reveal his position or an activated Epicenter off of Earth Spirit's allies, potentially wasting his combo
* Rolling Boulder and Geomagnetic Grip allow Earth Spirit to easily stun and silence Sand King and interrupt the channeling of Epicenter, completely ruining his initiation.

* He won't be around waiting for Medusa to Stone Gaze and pin him until she bears a true sight.
* With Smoke Screen, Riki will silence and catch Medusa in a surprise with high miss chance flushing her from positions easily in team fights.
* He can still deal huge amount of damage through Cloak and Dagger via backstabs, drying out Medusa's protection at a whim.

* Other heroes with mana burning or manipulating abilities will make Medusa much less tanky: Lion, Mirana, Weaver.

* Heroes that build Diffusal Blade or can fit it well into their item build will also make Medusa much less tanky: Riki, Naga Siren, Terrorblade, Juggernaut, Spectre, Slark,Drow Ranger.

* Heroes who take a long time to become strong are in for a rough mid game, such as Outworld Destroyer, Magnus, Medusa, and Anti-Mage.

* Heroes with blink or movement abilities, which are disabled by Pounce's leash: Anti-Mage, Earth Spirit, Faceless Void, Magnus, Mirana, Monkey King, Morphling, Pangolier, Phantom Assassin, Phoenix, Puck, Queen of Pain, Riki, Sand King, Spirit Breaker, Timbersaw, Tusk.

* Medusa cannot chase Slark in any way and has no disable beyond her ultimate, making her unable to stop him getting away and regenerating before coming back to finish her off.
* Essence Shift removes 1 of every attribute, lowering Medusa's mana pool's cap and leaving her much more vulnerable in prolonged fights.
Additional:
* Medusa is especially vulnerable to Essence Shift, as both strength and intelligence contribute to her effective HP, while agility contributes to her damage.
* Dark Pact when timed right can be used to dispel Stone Gaze right after it petrifies Slark, allowing him to keep attacking Medusa throughout the duration.

* Heroes that build Diffusal Blade or can fit it well into their item build will also make Medusa much less tanky: Riki, Naga Siren, Terrorblade, Juggernaut, Spectre, Slark,Drow Ranger.

* Other heroes with mana burning or manipulating abilities will make Medusa much less tanky: Lion, Mirana, Weaver.

* Bulwark can make each of Medusa's attacks target him instead, reducing Medusa's contribution on team fights.
* Spear of Mars stuns Medusa and also pushes her away from teamfights, taking advantage of Medusa's low mobility.
* Arena Of Blood blocks Medusa's attacks from outside the arena.

* Medusa is a fairly immobile hero that deals damage around her with Split Shot. Sniper should outrange her and should stay out of harm's way from Split Shot.
* More importantly, Sniper should have enough attack range to fire at Medusa during her Stone Gaze without turning to stone, so the ultimate is mostly wasted against him.
Additional:
* Sniper can outrange both Medusa's arrows and Stone Gaze, allowing him to focus her down during a teamfight.

* Medusa's tankiness doesn't help her very much against Fury Swipes in long teamfights.
* With no escape mechanism and a slow movement speed, getting jumped on by Ursa usually spells a quick end for Medusa in the early game.
Additional:
* Ursa's status resistance from Enrage ignores Medusa's gaze.
* Ursa can stack damage with Fury Swipes easily against her Mana Shield in a prolonged team match.