Hypercalcaemia after Milbemycin Oxime + Spinosad (Trifexis) in dogs

The FDA has received 67 reports of hypercalcaemia in dogs after Milbemycin Oxime + Spinosad. That is 0.1% of all reports for this medicine, compared with 0.2% across reports for all dog medicines, so it is reported less often than average with this medicine.

67Reports
79%Marked serious
27%Recovered
25%Died or euthanised
38 daysTypical onset
SponsoredWorried about your pet? Ask a veterinarian online, 24/7

How soon it started

Same day
9 22%
1–2 days
3 7.3%
3–7 days
2 4.9%
1–4 weeks
3 7.3%
Over a month
24 59%

How the animals did

Recovered
4 6.0%
Recovered with lasting effects
14 21%
Still unwell when reported
21 31%
Died
4 6.0%
Euthanised
13 19%
Not known
11 16%

Problems reported at the same time

Age of the animals

Under 1 year
12
1–3 years
12
4–7 years
12
8–11 years
21
12+ years
10

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 hypercalcaemia in dogs?
67 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 38 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).

Hypercalcaemia with similar medicines

All reported side effects of Milbemycin Oxime + Spinosad in dogs · Medicines most reported with hypercalcaemia