Moxidectin Imidacloprid Topical | VCA Animal Hospitals

What is moxidectin + imidacloprid topical?

Moxidectin + imidacloprid topical (Advantage Multi®, Imoxi™) is used to prevent heartworms and treat intestinal parasites (hookworms, roundworms, and whipworms) and to treat and prevent fleas in cats, dogs, and ferrets (Advantage Multi® only).

In dogs, this combination product is also approved to treat sarcoptic mange and treat circulating heartworm microfilaria (immature heartworms). In cats, it may also be used to treat ear mites.

Its use in dogs to treat adult heartworm in combination with doxycycline (Vibramycin®) is off label and is not the recommended first-choice treatment. 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 is moxidectin + imidacloprid given?

Moxidectin + imidacloprid topical is applied topically to the skin.
When applying, part the hair to ensure that the medication is placed on the skin and not into the hair. Follow the label directions for where to apply it to your pet.
For the first 30 minutes after application, monitor to ensure your pet does not lick the product.
Do not apply this medication to irritated skin.
Do not bathe your pet for at least 4 days after application.

Moxidectin + imidacloprid topical will start working in about 24 hours to kill ticks and intestinal parasites and begins to kill fleas within 4 hours.

What if I miss giving my pet the scheduled dose?

If you miss a dose, give it as soon as you remember and 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 monthly schedule. You will give your pet the next dose on July 18. Do not give your pet two doses at once. Contact your veterinarian if you are concerned about a missed dose.

Are there any potential side effects?

In cats, moxidectin + imidacloprid topical may cause the following side effects:

Behavioral changes such as agitation, excessive grooming, hiding, pacing, and spinning
Scratching, rubbing
Application site reactions
Lethargy
Hyperactivity
Uncoordinated walking
Trembling
Excessive salivation
Increased drinking
Coughing or gagging

If your cat ingests moxidectin + imidacloprid topical, side effects may include:

Increased salivation
Tremors
Vomiting
Decreased appetite

If your dog ingests moxidectin + imidacloprid topical, side effects may include:

Depression
Salivation
Dilated pupils
Incoordination
Panting
Generalized muscle tremors
Coma and death are possible in dogs that are sensitive to moxidectin

In ferrets, moxidectin + fluralaner topical may cause the following side effects:

Itching
Scabbing
Inflammation
Lethargy

This long-acting medication is designed to last for at least 4 weeks. However, negative side effects are usually short-lived if they occur at all. In healthy dogs, even when the medication is accidentally ingested, side effects should not last more than 24 hours.

Are there any risk factors for this medication?

DO NOT USE moxidectin + fluralaner topical in:

Pets that are hypersensitive or allergic to moxidectin or other avermectin products

USE WITH EXTREME CAUTION in:

Pets that are sick, debilitated, or underweight
Dogs under 7 weeks of age
Cats under 9 weeks of age

USE WITH CAUTION in:

Pets that are breeding, pregnant, or nursing (safety has not been established)

Some dog breeds (e.g., collies, sheepdogs, and collie- or sheepdog-cross breeds) are more sensitive to moxidectin than others. This is typically due to a specific genetic mutation (ABCB1, previously known as MDR1) that makes them less able to tolerate high doses of moxidectin. Use moxidectin + fluralaner topical cautiously in these cases. If used at prescribed doses for heartworm prevention, moxidectin + fluralaner topical is considered safe for ABCB1-affected dogs.

Note: The cat formulation of this product contains different drug combinations and should not be used in dogs.

Are there any drug interactions I should be aware of?

Certain medications should be used with caution when given with moxidectin + imidacloprid topical, including:

Azole antifungals
Benzodiazepines
Cyclosporine
Diltiazem
Macrolide antibiotics

In dogs with ABCB1 genetic mutations, certain medications should not be used or should be used with caution with moxidectin + imidacloprid topical, including:

P-glycoprotein inhibitors

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 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 moxidectin + imidacloprid topical?

Store moxidectin + imidacloprid topical between 39°F and 77°F (4°C and 25°C).
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.