Ivermectin

Evidence Level: L5

Predicted Indications: 9

Ivermectin

Pharmacist Assessment Report

Ivermectin: From Strongyloidiasis and Onchocerciasis to Vulvovaginal Candidiasis

One-Sentence Summary

Ivermectin is an antiparasitic drug originally used to treat strongyloidiasis and onchocerciasis. The TxGNN model predicts it may be effective for vulvovaginal candidiasis, but no clinical trials and no supporting publications are currently available for this prediction, so it rests on the model score alone.

Quick Overview

Item	Content
Original Indication	Strongyloidiasis, onchocerciasis
Predicted New Indication	Vulvovaginal candidiasis
TxGNN Prediction Score	0.9995
Evidence Level	L5
India Market Status	Listed in a compiled Indian medicine price dataset (at least 20) – CDSCO approval status is not included in this data
Number of Listed Products	at least 20
Recommended Decision	Hold

Why is This Prediction Reasonable?

Currently, detailed mechanism of action data is not available. Based on known information, ivermectin is an antiparasitic agent that acts on glutamate-gated chloride channels in invertebrates. Its efficacy in strongyloidiasis and onchocerciasis is established.

Candida is a fungus, not an invertebrate parasite, and the data compiled for this report documents no antifungal mechanism for ivermectin. The high score (0.9995) comes from the TxGNN model (deep learning) and may reflect similarities the model learned between related diseases, not biological evidence. Other top predictions (esophageal candidiasis, vulvovaginitis, Candida glabrata, neonatal candidiasis and others) show the same pattern: high scores, but no supporting studies.

At this stage the prediction should be treated as a hypothesis only.

Clinical Trial Evidence

Currently no related clinical trials registered.

Literature Evidence

Currently no related literature available for vulvovaginal candidiasis.

Publications linked to other predicted indications were reviewed. They do not support a Candida indication:

PMID 35835488 (2022, case report) describes disseminated strongyloidiasis after prolonged corticosteroid use, which is the original antiparasitic indication.
PMID 10098288 (1999, case report) describes oral ivermectin for crusted scabies in two immunocompromised children, one of whom had chronic mucocutaneous candidiasis. The drug treated the scabies, not the candidiasis.

India Market Information

Ivermectin is marketed in India with 20 valid single-ingredient registrations. Approved indication text is not available for these products. Main registrations:

Authorization Number	Product Name	Dosage Form	Approved Indication
55687	Covermect 12mg Tablet	Strip of 10 tablets	Not specified
108453	Ivrix 12 Tablet DT	Strip of 10 dispersible tablets	Not specified
109363	Iverfine 12 Tablet	Strip of 10 tablets	Not specified
247626	Zen Mectin 12mg Tablet	Strip of 1 tablet	Not specified
242771	Worbend Plus Oral Suspension	Bottle of 10 ml oral suspension	Not specified

Safety Considerations

Disease contraindications (knowledge graph): loiasis and filariasis are listed as contraindicated conditions. This comes from knowledge graph relationships, not from package insert text.
Drug Interactions: 100 interactions were identified. Moderate-level interactions include:
- Warfarin
- Dicoumarol
- Clarithromycin
- Aprepitant
- Cobicistat
- Deferasirox
- Ethanol
- Fostamatinib
- Iodide I-123 and I-131
- Abametapir (topical)
Several others (for example omeprazole, lansoprazole, prednisone, dexamethasone and heparin) are listed with unclassified severity.

Package insert warnings and contraindications were not available. Please refer to the package insert for full safety information.

Conclusion and Next Steps

Decision: Hold

Rationale: The prediction rests on a model score only. There are no clinical trials or relevant publications, and no plausible antifungal mechanism is documented. Effective approved antifungal treatments already exist for candidiasis.

To proceed, the following is needed:

Preclinical data on in vitro activity of ivermectin against Candida species
Detailed mechanism of action data (MOA)
Package insert warnings and contraindications from the India regulator
Route and formulation compatibility assessment (vaginal or topical versus the currently oral products)
Safety evaluation for the target population, including women of reproductive age and neonates
Disclaimer

This content is for research purposes only and does not constitute medical advice. Clinical validation is required before any clinical application.