Red blood cell disorder after Milbemycin Oxime + Spinosad (Trifexis) in dogs

The FDA has received 159 reports of red blood cell disorder in dogs after Milbemycin Oxime + Spinosad. That is 0.1% of all reports for this medicine, compared with 0.0% across reports for all dog medicines, so it is reported unusually often with this medicine.

159Reports
79%Marked serious
51%Recovered
27%Died or euthanised
11 daysTypical onset
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How soon it started

Same day
39 28%
1–2 days
17 12%
3–7 days
10 7.2%
1–4 weeks
16 12%
Over a month
57 41%

How the animals did

Recovered
43 27%
Recovered with lasting effects
38 24%
Still unwell when reported
20 13%
Died
26 16%
Euthanised
17 11%
Not known
15 9.4%

Problems reported at the same time

Age of the animals

Under 1 year
24
1–3 years
51
4–7 years
42
8–11 years
28
12+ years
13

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 red blood cell disorder in dogs?
159 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 11 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).

Red blood cell disorder with similar medicines

All reported side effects of Milbemycin Oxime + Spinosad in dogs · Medicines most reported with red blood cell disorder