Third eyelid extrusion after Milbemycin Oxime + Spinosad (Trifexis) in dogs

The FDA has received 40 reports of third eyelid extrusion in dogs after Milbemycin Oxime + Spinosad. That is 0.0% 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.

40Reports
45%Marked serious
50%Recovered
2.5%Died or euthanised
1 daysTypical onset
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How soon it started

Same day
14 45%
1–2 days
4 13%
3–7 days
1 3.2%
1–4 weeks
1 3.2%
Over a month
11 35%

How the animals did

Recovered
20 50%
Still unwell when reported
5 13%
Died
1 2.5%
Not known
14 35%

Problems reported at the same time

Age of the animals

Under 1 year
11
1–3 years
22
4–7 years
7
8–11 years
0
12+ years
0

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 third eyelid extrusion 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).

All reported side effects of Milbemycin Oxime + Spinosad in dogs · Medicines most reported with third eyelid extrusion