What is ivermectin + pyrantel + praziquantel?
Ivermectin + pyrantel + praziquantel (Iverhart Max®, QuadriGuard®) is a combination of anti-parasitic medications used to prevent heartworms and control roundworm, hookworm, and tapeworm in dogs.
How is ivermectin + pyrantel + praziquantel given?
Ivermectin + pyrantel + praziquantel is given by mouth and is usually formulated as a flavored chewable tablet. It may be given with or without food. If your dog vomits or seems sick after getting the medication on an empty stomach, give the next dose with food. If vomiting continues, contact your veterinarian.
This medication should take effect within two hours; however, effects may not be visibly noticed and laboratory tests may be needed to evaluate this medication’s effectiveness.
What if I miss giving my pet a scheduled dose?
Give the missed dose as soon as you remember and then wait the amount of time between doses recommended by your veterinarian before giving the next dose. Do not give your dog two doses at once or give extra doses.
If you are using ivermectin + pyrantel + praziquantel as a heartworm preventive and more than eight weeks have passed without giving this medication, contact your veterinarian for guidance.
Are there any potential side effects?
Ivermectin + pyrantel + praziquantel is generally well-tolerated at prescribed doses but some dogs experience decreased appetite, vomiting, diarrhea, or burping. If you notice any side effects such as diarrhea, dilated pupils, unsteadiness when walking, or a dazed demeanor, or if more mild side effects described above persist longer than 24 hours, contact your veterinarian.
This short-acting medication should stop working within 24 hours, although effects can be longer in pets with liver or kidney disease.
Are there any risk factors for this medication?
Ivermectin + pyrantel + praziquantel should not be used in dogs younger than eight weeks of age, in dogs weighing less than 10 pounds, in sick/weak/underweight dogs, in dogs without a current negative heartworm test, or in dogs who are allergic to pyrantel, praziquantel, ivermectin or similar medications, such as selamectin and moxidectin.
Some dog breeds (e.g., collies, sheepdogs, and collie- or sheepdog-cross breeds) are more sensitive to ivermectin than others. This is typically due to a specific genetic mutation (MDR1) that makes them less able to tolerate high doses of ivermectin. Doses used for heartworm prevention, such as those found in the combination of ivermectin + pyrantel + praziquantel, are safe to use in MDR1-affected dogs.
Although ivermectin is considered safe in pregnant and nursing dogs, the other drugs in this combination product have not been tested in pregnant and nursing dogs. Your veterinarian will advise you on the safety of this combination product’s use in your dog.
Are there any drug interactions I should be aware of?
There are some medications that increase the effects of ivermectin in a pet’s brain, such as azole antifungals, cyclosporine (Atopica®), erythromycin, amlodipine besylate, and nifedipine. Interactions with pyrantel can occur with levamisole, morantel, organophosphates, and piperazine; therefore, combined use is not recommended. Interactions with praziquantel can occur with albendazole, cimetidine, dexamethasone, phenobarbital, and azole antifungals.
Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking.
Is there any monitoring that needs to be done with this medication?
For dogs with a potential ivermectin sensitivity, screening may be done ahead of receiving the medication. DNA testing can determine whether a dog has the genetic mutation responsible for adverse reactions to higher doses of ivermectin. However, ivermectin + pyrantel + praziquantel can be used without testing because it has a low dose of ivermectin.
How do I store ivermectin + pyrantel + praziquantel?
Store this product at room temperature, in a dry place away from heat and direct sunlight. Exposure to heat or moisture may reduce its effectiveness. Make sure your dog cannot get access to it, as, for some, the flavor is too tempting to resist eating the whole packet at once.
What should I do in case of an emergency?
If you suspect an overdose or an adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.
