Indications for use
For the treatment of flea and tick infestations in dogs when the concurrent prevention of heartworm disease (Dirofilaria immitis larvae), angiostrongylosis (reduction in level of immature adults (L5) and adults of Angiostrongylus vasorum), thelaziosis (adult Thelazia callipaeda) and/or treatment of gastrointestinal nematode infestations is indicated.
Treatment of flea infestations (Ctenocephalides felis and C. canis) in dogs for 5 weeks.
Treatment of tick infestations (Dermacentor reticulatus, Ixodes ricinus, Ixodes hexagonus, Rhipicephalus sanguineus) in dogs 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 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).
Treatment of demodicosis (caused by Demodex canis).
Treatment of sarcoptic mange (caused by Sarcoptes scabiei var. canis).
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.
Special warnings for each target species
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.
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.
Parasite resistance to any particular class of parasiticides may develop following the frequent, repeated use of a product of that class. Therefore, the use of this product should be based on the assessment of each individual case and on local epidemiological information about the current susceptibility of the target species in order to limit the possibility of a future selection for resistance.
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 in animals
In the absence of available data, treatment of puppies less than 8 weeks of age and dogs less than 2 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 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.
Vomiting, diarrhoea, lethargy, anorexia, and pruritus were uncommonly observed. These occurrences were generally self-limiting and of short duration.
Post-marketing safety experience
Erythema and neurological signs (convulsions, ataxia and muscle tremors) have been reported very rarely.
The frequency of adverse reactions is defined using the following convention:
- very common (more than 1 in 10 animals treated displaying adverse reaction(s)).
- common (more than 1 but less than 10 animals in 100 animals treated)
- uncommon (more than 1 but less than 10 animals in 1,000 animals treated)
- rare (more than 1 but less than 10 animals in 10,000 animals treated)
- very rare (less than 1 animal in 10,000 animals treated, including isolated reports).
Use during pregnancy, lactation or lay
Laboratory studies in rats and rabbits have not produced any evidence of teratogenic effects, or any adverse effect on the reproductive capacity in males and females.
The safety of the veterinary medicinal product has not been established during pregnancy and lactation or in breeding dogs. Use only according to the benefit-risk assessment by the responsible veterinarian.
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.
Amounts to be administered and administration route
For oral use.
Dose: The product should be administered at a dose of 2.50–5.36 mg/kg bodyweight of afoxolaner and 0.50–1.07 mg/kg bodyweight of milbemycin oxime in accordance with the following table:
2 - 3.5
1 x NexGard Spectra (XS) 9 mg/2 mg tablet
> 3.5 - 7.5
1 x NexGard Spectra (S) 19 mg/4 mg tablet
>7.5 - 15
1 x NexGard Spectra (M) 38 mg/8 mg tablet
>15 - 30
1 x NexGard Spectra (L) 75 mg/15 mg tablet
>30 - 60
1 x NexGard Spectra (XL) 150 mg/30 mg tablet
For dogs above 60 kg appropriate combinations of chewable tablets should be used.
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.
Treatment schedule: The treatment schedule should be based on veterinary diagnosis and on the local epidemiological situation.
Treatment of flea and tick infestations and gastrointestinal nematodes:
NexGard Spectra 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 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 product for two consecutive months. Further monthly administration of the product may be required based on clinical assessment and skin scrapings.
Prevention of heartworm disease:
NexGard Spectra 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 NexGard Spectra 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 product for heartworm prevention.
Prevention of angiostrongylosis:
In endemic areas, monthly administration of the 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 product prevents establishment of infection with adult Thelazia callipaeda eyeworm.
No adverse reactions were observed in eight-week old healthy puppies after 6 treatments at up to 5 times the maximum dose.