Indications for use for each target species
For dogs with, or at risk from, mixed infestations by external and internal parasites. The veterinary medicinal product is only indicated when use against ticks, fleas, or mites and one or more of the other target parasites is indicated at the same time.
Treatment of flea infestations (Ctenocephalides felis and C. canis). The veterinary medicinal product provides immediate and persistent killing activity for 5 weeks. The product can be used as part of a treatment strategy for the control of flea allergy dermatitis (FAD).
Treatment of tick infestations (Dermacentor reticulatus, Ixodes ricinus, Ixodes hexagonus, Rhipicephalus sanguineus, Hyalomma marginatum). The veterinary medicinal product provides immediate and persistent killing activity for 4 weeks.
Fleas and ticks must attach to the host and commence feeding in order to be exposed to the active substance.
Treatment of demodicosis (caused by Demodex canis).
Treatment of sarcoptic mange (caused by Sarcoptes scabiei var. canis).
Treatment of ear mite infestations (caused by Otodectes cynotis).
Treatment of infestations with adult gastrointestinal nematodes of the following species: roundworms (Toxocara canis and Toxascaris leonina), hookworms (Ancylostoma caninum, Ancylostoma braziliense and Ancylostoma ceylanicum) and whipworm (Trichuris vulpis).
Prevention of heartworm disease (Dirofilaria immitis larvae) with monthly administration.
Prevention of angiostrongylosis (by reduction of the level of infection with immature adult (L5) and adult stages of Angiostrongylus vasorum) with monthly administration.
Prevention of establishment of thelaziosis (adult Thelazia callipaeda eyeworm infection) with monthly administration.
Do not use in cases of hypersensitivity to the active substances or to any of the excipients.
Fleas and ticks need to start feeding on the host to become exposed to afoxolaner; therefore the risk of the transmission of vector-borne diseases cannot be excluded.
Unnecessary use of antiparasitics or use deviating from the instructions given in the SPC may increase the resistance selection pressure and lead to reduced efficacy. The decision to use the product should be based on confirmation of the parasitic species and burden, or of the risk of infestation based on its epidemiological features, for each individual animal.
In the absence of risk of co-infestation by external and internal parasites, a narrow spectrum product should be used.
The possibility that other animals in the same household can be a source of re-infestation with fleas, ticks, mites or gastrointestinal nematodes should be considered, and these should be treated as necessary with an appropriate product.
Ancylostoma ceylanicum is reported as being endemic only in South-East Asia, China, India, Japan, some Pacific islands, Australia, the Arab Peninsula, South Africa and South America.
Maintenance of the efficacy of macrocyclic lactones is critical for Dirofilaria immitis control. To minimise the risk of resistance selection, it is recommended that dogs should be checked for both circulating antigens and blood microfilariae at the beginning of each season of preventative treatment.
Only negative animals should be treated.
Special precautions for use
Special precautions for safe use in the target species:
In the absence of available data, treatment of puppies less than 8 weeks of age and dogs less than 1.35 kg bodyweight should be based on a benefit-risk assessment by the responsible veterinarian.
In heartworm endemic areas, dogs should be tested for existing heartworm infestation prior to administration of NexGard Spectra. At the discretion of the veterinarian, infested dogs should be treated with an adulticide to remove adult heartworms. NexGard Spectra is not indicated for microfilariae clearance.
The recommended dose should be strictly observed in collies or related breeds.
Special precautions to be taken by the person administering the veterinary medicinal product to animals
- This product may cause gastrointestinal disturbances if ingested.
- Keep tablets in the blister packs until required, and keep the blisters in the outer carton.
- In case of accidental ingestion, particularly in the case of children, seek medical advice immediately and show the package leaflet or the label to the physician.
- Wash hands after use.
Special precautions for the protection of the environment:
(1 to 10 animals / 1 000 animals treated):
Lethargy1, anorexia1, Pruritus1
(<1 animal / 10 000 animals treated, including isolated reports):
Neurological signs (convulsion, ataxia and muscle tremor).
1 Generally self-limiting and of short duration.
Reporting adverse events is important. It allows continuous safety monitoring of a veterinary medicinal product. Reports should be sent, preferably via a veterinarian, to either the marketing authorisation holder or its local representative or the national competent authority via the national reporting system. See the package leaflet for respective contact details.
Use during pregnancy, lactation or lay
Pregnancy and lactation:
Can be used in pregnant and lactating dogs.
Can be used in breeding females. The safety of the veterinary medicinal product has not been established in breeding males.
In breeding males, use only according to the benefit-risk assessment by the responsible veterinarian.
Laboratory studies in rats and rabbits have not produced any evidence of teratogenic effects, or any adverse effect on the reproductive capacity in males.
Interactions with other medicinal products and other forms of interaction
Milbemycin oxime is a substrate for P-glycoprotein (P-gp) and therefore could interact with other P-gp substrates (for example, digoxin, doxorubicin) or other macrocyclic lactones. Therefore, concomitant treatment with other P-gp substrates could lead to enhanced toxicity.
Administration routes and dosage
For oral use.
The veterinary medicinal product should be administered at a dose of 2.50 to 6.94 mg/kg of afoxolaner and 0.50 to 1.39 mg/kg of milbemycin oxime in accordance with the following table:
For dogs above 60 kg appropriate combinations of chewable tablets should be used.
To ensure a correct dosage, body weight should be determined as accurately as possible.
The chewable tablets should not be divided. Underdosing could result in ineffective use and may favour resistance development.
Method of administration:
The tablets are chewable and palatable to most dogs. If the dog does not accept the tablets directly they may be administered with food.
The treatment schedule should be based on veterinary diagnosis and on the local epidemiological situation.
Treatment of flea and tick infestations and gastrointestinal nematodes:
The veterinary medicinal product can be used as part of the seasonal treatment of fleas and ticks (replacing treatment with a monovalent flea and tick product) in dogs with diagnosed concurrent gastrointestinal nematode infestations. A single treatment is effective for the treatment of gastrointestinal nematodes. After treatment of the nematode infestations, further flea and tick treatment should be continued with a monovalent product.
Treatment of demodicosis (caused by Demodex canis):
Monthly administration of the veterinary medicinal product until two negative skin scrapings are obtained one month apart. Severe cases may require prolonged monthly treatments. As demodicosis is a multi-factorial disease, where possible, it is advisable to also treat any underlying disease appropriately.
Treatment of sarcoptic mange (caused by Sarcoptes scabiei var. canis):
Monthly administration of the veterinary medicinal product for two consecutive months. Further monthly administration of the product may be required based on clinical assessment and skin scrapings.
Treatment of ear mite infestations (caused by Otodectes cynotis):
A single dose of the veterinary medicinal product should be administered. A further veterinary examination one month after the initial treatment is recommended as some animals may require a second treatment.
Prevention of heartworm disease:
The veterinary medicinal product kills Dirofilaria immitis larvae up to one month after their transmission by mosquitoes therefore the product should be administered at regular monthly intervals during the time of the year when vectors are present, starting in the month after the first expected exposure to mosquitoes.
Treatment should continue until 1 month after the last exposure to mosquitoes. To establish a treatment routine, it is recommended that the same day or date be used each month. When replacing another heartworm preventative product in a heartworm prevention programme, the first treatment with the veterinary medicinal product should start on the date when the former medication was due to have been administered.
Dogs living in heartworm endemic areas, or those which have travelled to endemic areas, may be infested with adult heartworms. No therapeutic effect against adult Dirofilaria immitis has been established. It is therefore recommended that all dogs 8 months of age or more, living in heartworm endemic areas, should be tested for existing adult heartworm infestation before being treated with the veterinary medicinal product for heartworm prevention.
Prevention of angiostrongylosis:
In endemic areas, monthly administration of the veterinary medicinal product will reduce the level of infection with immature adults (L5) and adults of Angiostrongylus vasorum in the heart and lungs.
Prevention of thelaziosis:
Monthly administration of the veterinary medicinal product prevents establishment of infection with adult Thelazia callipaeda eyeworm.
Symptoms of overdose (and where applicable, emergency procedures and antidotes)
No adverse reactions were observed in eight-week old healthy puppies after 6 treatments at up to 5 times the maximum dose.