Proteinuria after Milbemycin Oxime + Spinosad (Trifexis) in dogs

The FDA has received 178 reports of proteinuria in dogs after Milbemycin Oxime + Spinosad. That is 0.1% of all reports for this medicine, compared with 0.4% across reports for all dog medicines, so it is reported less often than average with this medicine.

178Reports
75%Marked serious
30%Recovered
17%Died or euthanised
30 daysTypical onset
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How soon it started

Same day
23 19%
1–2 days
15 12%
3–7 days
12 9.8%
1–4 weeks
12 9.8%
Over a month
60 49%

How the animals did

Recovered
16 9.0%
Recovered with lasting effects
38 21%
Still unwell when reported
46 26%
Died
12 6.7%
Euthanised
18 10%
Not known
48 27%

Problems reported at the same time

Age of the animals

Under 1 year
9
1–3 years
33
4–7 years
54
8–11 years
58
12+ years
23

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 proteinuria in dogs?
178 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 30 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).

Proteinuria with similar medicines

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