Low platelet count after Afoxolaner + Moxidectin + Pyrantel (NexGard PLUS) in dogs

31 reports to the FDA describe low platelet count in dogs given Afoxolaner + Moxidectin + Pyrantel. That is 0.3% of all reports for this medicine, compared with 0.2% across reports for all dog medicines, so it is reported unusually often with this medicine.

31Reports

52%Marked serious

19%Recovered

13%Died or euthanised

1 daysTypical onset

How soon it started

Same day

7 26%

1–2 days

11 41%

3–7 days

2 7.4%

1–4 weeks

3 11%

Over a month

4 15%

How the animals did

Recovered

6 19%

Still unwell when reported

16 52%

Died

2 6.5%

Euthanised

2 6.5%

Not known

5 16%

Problems reported at the same time

14 45%

13 42%

13 42%

9 29%

8 26%

7 23%

7 23%

6 19%

Age of the animals

Under 1 year

1–3 years

4–7 years

8–11 years

12+ years

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 low platelet count in dogs?: 31 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 1 day 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).

Low platelet count with similar medicines

Low platelet count after Fluralaner (Bravecto) 177 reports · 0.3% of its reports
Low platelet count after Afoxolaner (NexGard) 152 reports · 0.3% of its reports
Low platelet count after Sarolaner (Simparica) 29 reports · 0.2% of its reports
Low platelet count after Lotilaner (Credelio) 56 reports · 0.6% of its reports

All reported side effects of Afoxolaner + Moxidectin + Pyrantel in dogs · Medicines most reported with low platelet count