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

The FDA has received 1,792 reports of vomiting in dogs after Afoxolaner + Moxidectin + Pyrantel. That is 19% of all reports for this medicine, compared with 28% across reports for all dog medicines.

1,792Reports

8.0%Marked serious

63%Recovered

2.0%Died or euthanised

Same dayTypical onset

How soon it started

Same day

1,250 72%

1–2 days

294 17%

3–7 days

51 2.9%

1–4 weeks

83 4.8%

Over a month

65 3.7%

How the animals did

Recovered

1,128 63%

Recovered with lasting effects

1 0.1%

Still unwell when reported

129 7.2%

Died

23 1.3%

Euthanised

12 0.7%

Not known

499 28%

Problems reported at the same time

431 24%

297 17%

238 13%

78 4.4%

69 3.9%

68 3.8%

55 3.1%

43 2.4%

Age of the animals

Under 1 year

325

1–3 years

592

4–7 years

388

8–11 years

213

12+ years

101

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 vomiting in dogs?: 1,792 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).

Vomiting with similar medicines

Vomiting after Fluralaner (Bravecto) 26,091 reports · 38% of its reports
Vomiting after Afoxolaner (NexGard) 15,643 reports · 27% of its reports
Vomiting after Sarolaner (Simparica) 4,059 reports · 24% of its reports
Vomiting after Lotilaner (Credelio) 3,043 reports · 31% of its reports
Vomiting after Lotilaner + Moxidectin + Praziquantel + Pyrantel (Credelio Quattro) 1,058 reports · 34% of its reports

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