Thrombocytosis after Milbemycin Oxime + Spinosad (Trifexis) in dogs

The FDA has received 109 reports of thrombocytosis 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.

109Reports
85%Marked serious
33%Recovered
19%Died or euthanised
35 daysTypical onset
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How soon it started

Same day
15 21%
1–2 days
7 10%
3–7 days
5 7.1%
1–4 weeks
7 10%
Over a month
36 51%

How the animals did

Recovered
12 11%
Recovered with lasting effects
24 22%
Still unwell when reported
31 28%
Died
12 11%
Euthanised
9 8.3%
Not known
21 19%

Problems reported at the same time

Age of the animals

Under 1 year
4
1–3 years
14
4–7 years
33
8–11 years
35
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 thrombocytosis in dogs?
109 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 35 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).

Thrombocytosis with similar medicines

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