What is moxidectin + sarolaner + pyrantel?
Moxidectin + sarolaner + pyrantel (Simparica Trio®) is used in dogs to prevent heartworms and to treat and prevent intestinal parasites (hookworms and roundworms), flea infestations, and tick infestations (lone star tick, Gulf Coast tick, American dog tick, deer tick, and brown dog tick).
It may be used off label (extra label) to treat sarcoptic mange and demodectic mange 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 is moxidectin + sarolaner + pyrantel given?
- Moxidectin + sarolaner + pyrantel comes as a flavored chew tablet to be given orally once a month.
- It can be given with or without food, but make sure that the full dose is consumed.
- Dogs should be tested for heartworm infection before starting this medication.
This medication starts to kill fleas in 4 to 8 hours and ticks within 8 to 24 hours.
What if I miss giving a dose to my pet?
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?
Moxidectin + sarolaner + pyrantel may cause the following side effects:
- Vomiting
- Diarrhea
- Lethargy
- Anorexia (no appetite)
- Increased drinking and urination
- Hyperactivity
Sarolaner belongs to a class of drugs called isoxazolines, which have been associated with neurological side effects. If any of the following signs develop, stop giving moxidectin + sarolaner + pyrantel and contact your veterinarian immediately:
- Tremors
- Ataxia (wobbly gait)
- Seizures
Drug sensitivities can develop over time, with repeated exposure. Your pet may have no reaction after the first few doses but may develop a sensitivity later. It is important to watch for signs of an allergic reaction over the entire course of treatment and notify your veterinarian if you have any concerns.
Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately. 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.
Are there any risk factors for this medication?
DO NOT USE moxidectin + sarolaner + pyrantel in
- Dogs that are hypersensitive or allergic to it
- Dogs that have not been tested for heartworm
USE WITH CAUTION in:
- Dogs with low body fat (sick or very young), as they are more prone to side effects
- Dogs with neurologic conditions, including seizures
- Dogs that are breeding, pregnant, or nursing (safety has not been established)
Some dog breeds are more sensitive than others to medications (e.g., collies, sheepdogs, and collie- or sheepdog-cross breeds). This sensitivity is typically due to a genetic mutation (ABCB1, also known as MDR1) that makes them less able to tolerate high doses of certain medications. Use moxidectin + sarolaner + pyrantel cautiously in these cases. If used at prescribed doses for heartworm prevention, it is considered safe for ABCB1-affected dogs.
Are there any drug interactions I should be aware of?
Several medications should be used with caution when given with moxidectin + sarolaner + pyrantel, including:
- Benzodiazepines
- Levamisole
- Piperazine
In dogs with ABCB1 genetic mutations, several medications should not be used or should be used with caution when given with moxidectin + sarolaner + pyrantel, including:
- Cyclosporine (Atopica™)
- Diltiazem
- Erythromycin
- Itraconazole
- Ketoconazole
- Spinosad (Comfortis™, Trifexis™, Natroba™)
- Spironolactone
- Verapamil
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 + sarolaner + pyrantel?
- Store this medication at or below 86°F (30°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.
