What is esafoxolaner + eprinomectin + praziquantel (EEP)?
The combination of esafoxolaner + eprinomectin + praziquantel (NexGard® COMBO) is a topical antiparasitic used to prevent heartworms and to prevent and treat intestinal parasites (hookworms, roundworms, and tapeworms), ear mites, fleas, and ticks (black-legged tick, lone star tick) in cats over eight weeks of age. This medication combination is currently only approved for use in Canada.
In February 2026, the U.S. Food and Drug Administration (FDA) granted emergency use authorization for NexGard® COMBO (esafoxolaner + eprinomectin + praziquantel) in the treatment of New World screwworm infestations in dogs and cats.
Its use in cats to treat skin mites is off label (extra label). “Off label” means the drug is being used in a way that has not been reviewed or approved by the U.S. Food and Drug Administration (FDA) or Health Canada. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.
How is EEP given?
- EEP is applied topically to the skin on the back of the neck.
- Follow the label directions for the correct application.
- During the first 30 minutes after application, monitor to ensure that your cat does not lick the medication.
- Do not apply this medication to irritated skin.
- Do not bathe your cat for at least four days after application.
- Do not touch this area until the medication is no longer noticeable.
What if I miss giving my cat a scheduled dose?
If you miss a dose, give it as soon as you remember, and then start a new monthly dosing schedule. For example, if you forgot to give your pet their dose on June 1 and remember on June 18, give the dose on June 18 and start a new schedule. You will give your cat the next dose on July 18. Do not give the pet two doses at once. Contact your veterinarian if you are concerned about a missed dose.
Are there any potential side effects?
When used as directed in cats, side effects are uncommon, but may include:
- Vomiting
- Hair loss at the application site
- Itching
- Diarrhea
- Lethargy
- Excessive drooling
- Salivation and vomiting (if ingested)
Esafoxolaner belongs to the isoxazoline class of drugs, which have been associated with tremors and seizures.
EEP can also cause neurologic toxicity in cats with two copies of the MDR1 mutation. Signs may include:
- Unsteady gait (ataxia)
- Drooling
- Tremors
- Weakness and/or partial paralysis
- Coma
- Seizures
- Death
Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. This long-acting medication is designed to work for at least four weeks. However, negative side effects are usually short-lived if they occur at all.
Are there any risk factors for this medication?
DO NOT USE EEP in:
- Cats that are hypersensitive or allergic to any of its components
- Cats that are under eight weeks old
- Cats that weigh less than 1.8 lb (0.8 kg)
- Cats that are sick, debilitated, or underweight
- Cats that are known to have two copies of the MDR1 mutation
USE WITH CAUTION in:
- Cats with known neurologic disorders
- Cats that are breeding, pregnant, or nursing (safety has not been established)
Are there any drug interactions I should be aware of?
Specific interactions with EEP have not been reported. However, theoretical interactions may occur with some medications, including:
- Albendazole
- Amiodarone
- Azole antifungals
- Cimetidine
- Clarithromycin
- Cyclosporine (Atopica®)
- Dexamethasone
- Fluoxetine (Reconcile®)
- Phenobarbital
- Spironolactone
Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your cat is taking before starting any treatment..
Is any monitoring needed with this medication?
No specific monitoring is required while your pet is taking this medication. Your veterinarian may monitor your pet to be sure that the medication is working.
How do I store this medication?
- Store this medication in its unopened blister pack and box.
- Store between 15°C and 30°C (59°F and 86°F).
What should I do in case of an emergency?
If you suspect an overdose or adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.
