Head down after Ivermectin + Pyrantel (Heartgard Plus) in dogs

The FDA has received 40 reports of head down in dogs after Ivermectin + Pyrantel. That is 0.0% of all reports for this medicine, compared with 0.0% across reports for all dog medicines, so it is reported less often than average with this medicine.

40Reports
57%Marked serious
43%Recovered
13%Died or euthanised
1 daysTypical onset
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How soon it started

Same day
8 29%
1–2 days
9 32%
3–7 days
4 14%
1–4 weeks
3 11%
Over a month
4 14%

How the animals did

Recovered
17 43%
Still unwell when reported
3 7.5%
Died
2 5.0%
Euthanised
3 7.5%
Not known
15 38%

Problems reported at the same time

Age of the animals

Under 1 year
4
1–3 years
13
4–7 years
4
8–11 years
10
12+ years
8

About this medicine

Ivermectin prevents heartworm disease (monthly). Pyrantel treats roundworms and hookworms.

Products with this combination include Heartgard Plus, Tri-Heart Plus, Iverhart Plus. The FDA hides brand names in its public data, so these reports cover every product with the same active ingredients.

Some herding breeds (for example Collies) carry the MDR1 gene variant and can be more sensitive to this drug class at high doses.

Questions owners ask

Can Ivermectin + Pyrantel cause head down in dogs?
40 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).

Head down with similar medicines

All reported side effects of Ivermectin + Pyrantel in dogs · Medicines most reported with head down