Elucidating adverse drug reactions and underlying molecular mechanisms of ivermectin through pharmacovigilance and multi-omics analysis.

Objective: The comprehensive safety profile and underlying molecular mechanisms of ivermectin-associated adverse drug reactions (ADRs) remain to be fully elucidated. Methods: We integrated pharmacovigilance data from the FDA Adverse Event Reporting System (FAERS) with network toxicology and transcriptomic validation. Disproportionality analyses were conducted on 1,421 ivermectin-related reports to detect signals at the System Organ Class (SOC) and Preferred Term (PT) levels. Network-based approaches, including protein-protein interaction (PPI) analysis and molecular docking, were employed to identify core toxicity targets, followed by ADMET property prediction. Results: Significant safety signals emerged for Eye disorders, Nervous system disorders, and General disorders. Frequently reported PTs included asthenia, headache, and pyrexia, alongside notable serious signals such as encephalopathy (ROR = 24.1) and toxic encephalopathy (ROR = 16.18). Network toxicology identified five core targets shared across key SOCs: EGFR, ERBB2, TGFB1, PIK3CA, and HSPG2. KEGG enrichment analysis highlighted pathways related to parasitic diseases, leukocyte migration, and endocrine regulation. Molecular docking confirmed high binding affinity between ivermectin components and EGFR (≤ -8.7 kcal/mol). ADMET predictions indicated elevated risks for genotoxicity, ototoxicity, and skin sensitization. Conclusion: Ivermectin-associated ADRs manifest across multiple organ systems, which are potentially associated with the modulation of predicted candidate targets including EGFR, ERBB2, TGFB1, PIK3CA, and HSPG2.