Death after Afoxolaner + Moxidectin + Pyrantel (NexGard PLUS) in dogs

162 reports to the FDA describe death in dogs given Afoxolaner + Moxidectin + Pyrantel. That is 1.7% of all reports for this medicine, compared with 5.2% across reports for all dog medicines, so it is reported less often than average with this medicine.

162Reports
100%Marked serious
0.0%Recovered
99%Died or euthanised
6 daysTypical onset
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How soon it started

Same day
25 18%
1–2 days
31 22%
3–7 days
21 15%
1–4 weeks
39 27%
Over a month
26 18%

How the animals did

Died
95 59%
Euthanised
66 41%
Not known
1 0.6%

Problems reported at the same time

Age of the animals

Under 1 year
8
1–3 years
22
4–7 years
38
8–11 years
38
12+ years
30

About this medicine

Afoxolaner kills fleas and ticks; given as a monthly chewable. Moxidectin prevents heartworm disease (monthly topical, or a 6- or 12-month injection for dogs). Pyrantel treats roundworms and hookworms.

Products with this combination include NexGard PLUS. The FDA hides brand names in its public data, so these reports cover every product with the same active ingredients.

In 2018 the FDA alerted owners and vets that isoxazoline products have been associated with neurologic reactions such as muscle tremors, wobbliness (ataxia) and seizures, including in animals with no history of them.

Questions owners ask

Can Afoxolaner + Moxidectin + Pyrantel cause death in dogs?
162 reports link the two, but a report alone does not prove the medicine was the cause: other illnesses, other medicines or coincidence can be involved. Your vet can judge it for your animal.
How soon after a dose was it reported?
In half of the reports with dates, it started within 6 days of the first dose.
What should I do?
Don't give another dose until you've spoken to your vet, and keep the packaging so you can tell them the product and dose. Your vet can also report it to the FDA (or you can, through the manufacturer or FDA form 1932a).

Death with similar medicines

All reported side effects of Afoxolaner + Moxidectin + Pyrantel in dogs · Medicines most reported with death