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

The FDA has received 20 reports of unpalatable in dogs after Afoxolaner + Moxidectin + Pyrantel. That is 0.2% of all reports for this medicine, compared with 0.6% across reports for all dog medicines, so it is reported less often than average with this medicine.

20Reports

30%Marked serious

50%Recovered

10%Died or euthanised

Same dayTypical onset

How soon it started

Same day

10 53%

1–2 days

3 16%

3–7 days

2 11%

1–4 weeks

1 5.3%

Over a month

3 16%

How the animals did

Recovered

10 50%

Still unwell when reported

3 15%

Died

2 10%

Not known

5 25%

Problems reported at the same time

7 35%

5 25%

4 20%

4 20%

4 20%

4 20%

4 20%

3 15%

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 unpalatable in dogs?: 20 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 the same 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).

Unpalatable with similar medicines

Unpalatable after Fluralaner (Bravecto) 407 reports · 0.6% of its reports
Unpalatable after Afoxolaner (NexGard) 51 reports · 0.1% of its reports
Unpalatable after Sarolaner (Simparica) 21 reports · 0.1% of its reports
Unpalatable after Lotilaner (Credelio) 140 reports · 1.4% of its reports
Unpalatable after Lotilaner + Moxidectin + Praziquantel + Pyrantel (Credelio Quattro) 132 reports · 4.3% of its reports

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