Are there documented pharmacovigilance case reports describing drug–drug interactions between ivermectin and specific oncology supportive medications (antiemetics, growth factors, or antibiotics)?
Executive summary
No explicit pharmacovigilance case reports documenting confirmed drug–drug interactions between ivermectin and specific oncology supportive medications (antiemetics, growth factors, or antibiotics) are identified in the provided reporting; instead, the literature and drug‑interaction databases describe plausible mechanisms—CYP3A4 metabolism and P‑glycoprotein (P‑gp) involvement—and list multiple potential interactions and anecdotal toxicity reports that raise concern for oncology patients [1] [2] [3].
1. What the formal surveillance literature shows — sparse direct case reports
A systematic read of the supplied sources finds reviews and commentary noting observational reports of toxicity when cancer patients self‑medicate with ivermectin, but none of the provided items presents a named pharmacovigilance case series or regulatory signal explicitly documenting verified ivermectin interactions with antiemetics, growth factors, or specific antibiotics in oncology supportive care [3] [4].
2. Mechanisms that make interactions biologically plausible
Pharmacokinetic pathways make such interactions plausible: ivermectin is metabolized primarily by CYP3A4 and its absorption and disposition are P‑glycoprotein dependent, and ivermectin itself can inhibit P‑gp—mechanisms that could alter exposure of co‑administered drugs commonly used in oncology supportive care [1].
3. Drug interaction databases and clinical warnings — breadth without oncology specificity
Interaction compendia list many potential interacting drugs—Drugs.com reports 106 medications with documented interactions with ivermectin, including one major and many moderate interactions—indicating a broad interaction potential though not isolating anticancer supportive agents in the supplied excerpts [2].
4. Preclinical and clinical oncology studies emphasize combination effects, not adverse event reports
Preclinical studies and small clinical explorations emphasize synergistic or resistance‑modulating effects when ivermectin is combined with chemotherapeutics such as paclitaxel, gemcitabine, and sorafenib, focusing on efficacy and resistance pathways rather than pharmacovigilance‑style adverse interaction case reports; these studies therefore do not substitute for post‑marketing interaction documentation with supportive care drugs [5] [6] [7].
5. Real‑world concerns documented by oncologists and reviews — toxicity and unknown interactions
Clinical commentaries and reviews warn that oncologists are seeing increased patient interest and self‑medication with ivermectin, and they caution about unknown interactions that could alter efficacy or increase toxicity of established cancer treatments and supportive medications; these are observational warnings rather than formal pharmacovigilance case reports naming specific antiemetic, growth‑factor, or antibiotic interactions [8] [9] [3].
6. Regulatory and patient‑safety signals — reported harms but not interaction case series in these sources
Reviews note instances where self‑medication has led to toxicity in oncology patients and emphasize the risk of overdose and neurological harm from ivermectin, and regulators have warned about interactions with drugs like anticoagulants, but the supplied material does not provide a published pharmacovigilance case series unequivocally linking ivermectin to adverse interactions with specific oncology supportive agents [3] [10] [11].
7. Alternative interpretations and hidden incentives in the discourse
The discourse contains competing narratives: preclinical work and small exploratory trials highlight potential anticancer synergy (an incentive for drug‑repurposing research), while clinicians and public‑health commentators emphasize the risk of misinformation and self‑medication amplified by anecdote‑driven social media and policy moves to expand access—an implicit agenda that can push uptake without robust safety data [5] [9] [11].
8. Conclusion and gap in evidence — what remains to be done
Given the biologic plausibility (CYP3A4 and P‑gp involvement), broad interaction listings in drug databases, and clinical reports of toxicity from self‑use, there is clear rationale to suspect interactions between ivermectin and oncology supportive drugs; however, the provided reporting does not contain documented pharmacovigilance case reports naming specific antiemetics, growth factors, or antibiotics as interacting with ivermectin, leaving a documented evidence gap that requires targeted pharmacovigilance analyses and prospective pharmacokinetic studies [1] [2] [3].