Moxidectin + Sarolaner + Pyrantel

By Krista Williams, BSc, DVM, CCRP

What is moxidectin + sarolaner + pyrantel?

Moxidectin + sarolaner + pyrantel (Simparica Trio®) is used in dogs to prevent heartworms and 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” for the treatment of sarcoptic mange and demodectic mange. Many drugs are commonly prescribed for off-label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions very carefully as their directions may be significantly different from those on the label.

How is moxidectin + sarolaner + pyrantel given?

This combination product comes as a flavored chew tablet to be given orally once a month. It can be given with or without food, but it is important to make sure that the full dose is consumed.

What if I miss giving a dose to my pet?

Give the dose as soon as you remember and start a new monthly dosing schedule. For example, if you forgot to give your pet a dose on June 1st and remember on June 18th, give the dose on June 18th and start a new monthly schedule. The next dose your pet will receive would be on July 18th. 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?

When used as directed in dogs, side effects are uncommon but may include vomiting, diarrhea, lethargy, anorexia (no appetite), increased drinking and urination, and hyperactivity.

Sarolaner belongs to a class of drugs called isoxazolines. These drugs have been associated with neurologic side effects, such as tremors, ataxia (wobbly gait), and seizures.

This long-acting medication is designed to last 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?

Moxidectin should not be used in pets that are hypersensitive or allergic to it. Use cautiously in animals with low body fat (sick or very young) as they are more prone to side effects. Dogs should be tested for heartworm infection before starting this medication.

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 (MDR1) that makes them less able to tolerate high doses of moxidectin. If used at prescribed doses for heartworm prevention, it is considered safe for MDR1-affected dogs.

As sarolaner is an isoxazoline, this medication should be used cautiously in dogs with neurologic conditions, including seizures.

Safety in breeding, pregnant, or nursing animals has not been established.

Are there any drug interactions I should be aware of?

Specific interactions with moxidectin have not been reported, however, benzodiazepines should be closely monitored when used with moxidectin. In dogs with MDR1 genetic mutations, the following medications should not be used or should be used with caution with moxidectin: amiodarone, carvedilol, clarithromycin, cyclosporine (Atopica), diltiazem, erythromycin, itraconazole, ketoconazole, quinidine, Spinosad (Comfortis, Trifexis, Natroba™), spironolactone, tamoxifen, verapamil.

Pyrantel should not be used with levamisole, morantel, organophosphates, or piperazine due to the increased risk of adverse effects or interfering drug action.

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?

There is no specific monitoring that needs to be done 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 moxidectin + sarolaner + pyrantel?

This medication should be stored at or below 86°F (30°C).

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.

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