What is milbemycin oxime + lufenuron + praziquantel?
Milbemycin oxime + lufenuron + praziquantel (brand name Sentinel Spectrum®) is a heartworm preventive that also treats internal parasites (e.g., hookworms, roundworms, whipworms, and tapeworms) and controls fleas in dogs. Milbemycin oxime + lufenuron + praziquantel is also used off label (extra label) in dogs. Many drugs are commonly prescribed for off-label use in veterinary medicine. “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 do I give my pet milbemycin oxime + lufenuron + praziquantel?
- Milbemycin oxime + lufenuron + praziquantel is given by mouth as a flavored chew tablet.
- It must be given with a meal or immediately after a meal to be absorbed most effectively.
This medication should take effect within 2 days for internal parasites and within 24 hours for external parasites. Improvements in clinical signs should follow.
What if I miss giving a dose to my pet?
If you miss a dose, give it as soon as you remember, and then wait the recommended time for the next dose, as prescribed by your veterinarian. Do not give the pet two doses at once or give extra doses. If you are using this medication for heartworm prevention and more than 8 weeks have passed since giving the last dose, contact your veterinarian for guidance.
Are there any potential side effects?
Milbemycin oxime + lufenuron + praziquantel may rarely cause the following side effects:
- Mild vomiting
- Diarrhea
Serious adverse reactions may occur. If any of the following signs develop, stop giving milbemycin oxime + lufenuron + praziquantel and contact your veterinarian immediately:
- Depression
- Lack of energy
- Weakness, stumbling, collapse
- Itching or hives
- Dilated (big) pupils
- Excessive drooling
- Seizures
- Coma
Are there any risk factors for this medication?
DO NOT USE milbemycin oxime + lufenuron + praziquantel in:
- Dogs that are heartworm positive or have not recently been tested for heartworm
- Puppies younger than 4 weeks of age
- Puppies or dogs weighing less than 2 lb (900 g)
- Dogs that are allergic to any component of the drug combination
USE WITH CAUTION in:
- Pregnant or nursing dogs
Some dog breeds are more sensitive than others to milbemycin (e.g., collies, sheepdogs, and collie or sheepdog-cross breeds). This sensitivity is typically due to a specific genetic mutation (ABCB1, previously known as MDR1) that makes them less able to tolerate high doses of certain medications. Doses used for heartworm prevention in milbemycin oxime + lufenuron + praziquantel are safe to use in these dog breeds.
Are there any drug interactions I should be aware of?
Several medications should be used with caution when given with milbemycin oxime + lufenuron + praziquantel, including:
- Albendazole
- Azole antifungals
- Cimetidine
- Cyclosporine (Atopica®)
- Dexamethasone
- Diltiazem
- Erythromycin
- Phenobarbital
Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your pet is taking before starting any new treatment.
Is any monitoring needed with this medication?
- Your pet should be tested for heartworm before receiving any product containing milbemycin oxime. A life-threatening reaction can occur if your pet has a high load of immature worms and is given milbemycin oxime.
- For dog breeds with a potential milbemycin oxime sensitivity, DNA screening may be done before receiving the medication to determine if your dog has the genetic mutation responsible for adverse reactions to milbemycin oxime.
- Your veterinarian will let you know when and how they want to reassess your pet to ensure the medication is working and not causing side effects.
- At home, monitor for any side effects such as those noted above. If any occur, stop using the medication and contact your veterinarian.
How do I store milbemycin oxime + lufenuron + praziquantel?
- Store milbemycin oxime + lufenuron + praziquantel at room temperature (59°F to 77°F, 15°C to 25°C).
- Store in a dry location, away from heat and direct sunlight.
- Do not store this medication in the bathroom, near a sink, or in other damp places. Exposure to heat or moisture may reduce its effectiveness.
- Keep the container out of reach of children and pets. 
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. Be prepared to provide information about the product and your pet's weight and symptoms.
