Elevated cholesterol (total) after Milbemycin Oxime + Spinosad (Trifexis) in dogs

The FDA has received 81 reports of elevated cholesterol (total) in dogs after Milbemycin Oxime + Spinosad. That is 0.1% of all reports for this medicine, compared with 0.3% across reports for all dog medicines, so it is reported less often than average with this medicine.

81Reports

84%Marked serious

37%Recovered

16%Died or euthanised

2 daysTypical onset

How soon it started

Same day

18 42%

1–2 days

6 14%

3–7 days

1 2.3%

1–4 weeks

3 7.0%

Over a month

15 35%

How the animals did

Recovered

10 12%

Recovered with lasting effects

20 25%

Still unwell when reported

19 23%

Died

3 3.7%

Euthanised

10 12%

Not known

19 23%

Problems reported at the same time

61 75%

38 47%

38 47%

38 47%

27 33%

25 31%

18 22%

Elevated gamma-glutamyl transferase (ggt)

16 20%

Age of the animals

Under 1 year

1–3 years

4–7 years

8–11 years

12+ years

About this medicine

Milbemycin Oxime prevents heartworm and controls some intestinal worms (monthly). Spinosad kills fleas; monthly chewable.

Products with this combination include Trifexis. 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 Milbemycin Oxime + Spinosad cause elevated cholesterol (total) in dogs?: 81 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 2 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).

Elevated cholesterol (total) with similar medicines

Elevated cholesterol (total) after Ivermectin + Pyrantel (Heartgard Plus) 96 reports · 0.1% of its reports
Elevated cholesterol (total) after Moxidectin (ProHeart 6) 87 reports · 0.2% of its reports
Elevated cholesterol (total) after Milbemycin Oxime + Praziquantel (Interceptor Plus) 53 reports · 0.2% of its reports
Elevated cholesterol (total) after Milbemycin Oxime (Interceptor) 31 reports · 0.1% of its reports
Elevated cholesterol (total) after Selamectin (Revolution) 36 reports · 0.1% of its reports
Elevated cholesterol (total) after Ivermectin (Heartgard) 24 reports · 0.2% of its reports

All reported side effects of Milbemycin Oxime + Spinosad in dogs · Medicines most reported with elevated cholesterol (total)