Esafoxolaner + Eprinomectin + Praziquantel

What is esafoxolaner + eprinomectin + praziquantel?

The combination of esafoxolaner + eprinomectin + praziquantel (NexGard COMBO™) is a topical antiparasitic used to prevent heartworms and to prevent and treat intestinal parasites (hookworms, roundworms, and tapeworms), ear mites, fleas, and ticks (black-legged tick, lone star tick) in cats over eight weeks of age.  This medication combination is currently only approved for use in Canada.

Its use in cats to treat skin mites is “off-label”. 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 esafoxolaner + eprinomectin + praziquantel (EEP) given?

EEP is applied topically to the skin on the back of the neck. Follow the label directions for the correct application. During the first 30 minutes after application, monitor to ensure that your cat does not lick the medication. Do not apply this medication to irritated skin. Do not bathe your cat for at least four days after application. Do not touch this area until the medication is no longer noticeable.

What if I miss giving my cat a scheduled dose?

Give the dose as soon as you remember and start a new monthly dosing schedule. For example, if you forgot to give your pet his/her dose on June 1st and remember on June 18th, give the dose on June 18th and start a new schedule. The next dose your cat will receive would be on August 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 cats, side effects are uncommon but may include vomiting, hair loss at the application site, itching, diarrhea, lethargy, and excessive drooling. If the product is ingested by your cat, side effects include salivation and vomiting. Esafoxolaner belongs to the isoxazoline class of drugs, which have been associated with tremors and seizures.

This long-acting medication is designed to work 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?

EEP should not be used in cats that are hypersensitive or allergic to any of its components, cats under eight weeks old, or cats weighing less than 1.8 lb (0.8 kg). Do not use this medication in sick, debilitated, or underweight cats.

Use caution in cats with known neurologic disorders. Safety in breeding, pregnant, or nursing animals has not been established.

Are there any drug interactions I should be aware of?

Specific interactions with EEP have not been reported, however, theoretical interactions may occur with some medications, including albendazole, cimetidine, dexamethasone, phenobarbital, amiodarone, clarithromycin, fluoxetine (Reconcile®), azole antifungals, cyclosporine (Atopica®), and spironolactone. Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your cat 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 this medication?

EEP should be stored in its unopened blister pack and box between 15°C and 30°C (59°F – 86°F).

What should I do in case of an emergency?

If you suspect an overdose or adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.