Afoxolaner/Moxidectin/Pyrantel

What is afoxolaner/moxidectin/pyrantel?

Afoxolaner/moxidectin/pyrantel (brand name Nexgard® Plus) is a prescription combination parasiticide used in dogs. It is labeled for use as follows:

• As a preventative for heartworm caused by Dirofilaria immitis in dogs. 
• To treat and control tick infestations in dogs caused by black-legged ticks, brown dog ticks, American dog ticks, and lone star ticks.
• To treat and control adult roundworm and hookworm infections in dogs.
• To kill adult fleas on dogs and to treat and prevent flea infestations. 

Afoxolaner/moxidectin/pyrantel (Nexgard® Plus) provides protection for 1 month in dogs and puppies 8 weeks of age and older, weighing 1.8 kg or greater.

How do I give my pet afoxolaner/moxidectin/pyrantel?

Afoxolaner/moxidectin/pyrantel (Nexgard® Plus) comes in a chewable tablet form. 

• Tablets are given orally (by mouth).
• This medication may be given with or without food. Make sure the dog eats the entire tablet and does not throw it up.
• Give this medication once a month.
• This medication should be used year-round. If it is used during specific months, give the first dose at least 1 month before mosquitos, fleas, and ticks become active. 
• For heartworm disease prevention, continue once-monthly doses for at least 6 months after the dog’s last exposure to mosquitoes.
• Follow your veterinarian’s directions and administer the exact amount your veterinarian has prescribed.

When used as a preventive or for intestinal parasites: You will not see the effects of this medication on your animal outwardly, but it will begin working within 24 hours.

When used to treat fleas and ticks: Fleas begin to die 4 hours after a dose. Ticks will die within 48 to 72 hours of biting a treated dog. Fleas and ticks must feed on the dog before they will die.

What if I miss giving my pet the medication?

If you miss a dose of afoxolaner/moxidectin/pyrantel, give it as soon as you remember, and then continue with the regular dosing schedule. However, if it is almost time for the next dose, skip the missed dose and resume the regular dosing schedule. Do not give the pet two doses at once. 

Are there any potential side effects from afoxolaner/moxidectin/pyrantel?

Afoxolaner/moxidectin/pyrantel may cause the following side effects:

• vomiting, diarrhea, or loss of appetite
• itching
• tiredness or low energy

The following reactions are rare, but if they occur, contact your veterinarian immediately:

• tremors
• difficulty walking
• seizures

Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of the treatment.

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. This medication is long lasting, meaning the effects will last for the entire month.

Are there any risk factors for this medication? 

This medication SHOULD NOT BE USED in:

• cats
• dogs that are allergic to any of the ingredients
• dogs younger than 8 weeks old
• dogs that weigh less than 4 pounds

This medication should be USED WITH CAUTION in dogs that:

• have a history of seizures or other neurologic disorders
• are breeding, pregnant, or nursing 

Are there any drug interactions I should be aware of?

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.

Certain medications SHOULD NOT BE USED with afoxolaner/moxidectin/pyrantel, including:

• levamisole
• piperazine

Certain medications should be used WITH CAUTION when given with afoxolaner/moxidectin/pyrantel, including:

• benzodiazepines
• p-glycoprotein inhibitors; especially in dogs who may have the MDR1 gene mutation, also known as ABCB1-1delta (e.g., collies, Australian shepherds, shelties, long-haired whippets)
• amiodarone
• carvedilol
• clarithromycin, erythromycin
• cyclosporine
• diltiazem, verapamil
• itraconazole, ketoconazole
• quinidine
• spinosad
• spironolactone

Is any monitoring needed with this medication?

At home, monitor for any side effects such as those noted above. If any side effects occur, discontinue the medication, and contact your veterinarian. 

How do I store afoxolaner/moxidectin/pyrantel?

• Ensure afoxolaner/moxidectin/pyrantel is stored in its original packaging at room temperature, at or below 25°C (77°F). If transporting this medication, exposure of up to 40°C (104°F) is permitted.
• Keep the container out of reach of children and pets.
• Ask your veterinarian for specific disposal instructions. Do not flush medications down the sink or toilet unless instructed to do so.

What should I do in case of emergency?

If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility. Be prepared to provide information about the product and your pet’s weight and symptoms.