NOAH Compendium

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Date: Sunday, June 23, 2024 19:55

Description: 2015-Elanco-logo
Telephone: 01256 353131 (24 hr response) Veterinary Technical Services
Release 5.67
PROGRAM Plus film-coated tablets 23mg/460 mg
Species: Dogs
Therapeutic indication: Pharmaceuticals: Endoparasiticides: Anthelmintics for dogs, Pharmaceuticals: Ectoparasiticides: For dogs
Active ingredient: Lufenuron, Milbemycin Oxime
Product:PROGRAM Plus film-coated tablets 23mg/460 mg
Product index: PROGRAM Plus film-coated tablets 23mg/460 mg
Qualitative and quantitative composition
Each tablet contains:
Active substances
Milbemycin oxime 23.0 mg
Lufenuron 460.0 mg
Titanium dioxide (E171) 7.5 mg
Pharmaceutical form
Film-coated tablets
White, pentagonal, biconvex, bevel-edged, coated tablets with “GKG” on one side and “CGV” on the reverse.
Clinical particulars
Target species
Indications for use, specifying the target species
PROGRAM Plus is used for the prevention of fleas (Ct. felis, Ct. canis, preadult stages), and for the concurrent prevention of heartworm (elimination of L3/L4 larval stages of Dirofilaria immitis) and/or treatment of adult stages of gastrointestinal nematodes such as hookworms (Ancylostoma caninum), roundworms (Toxocara canis) and whipworms (Trichuris vulpis).
Do not use in case of hypersensitivity to the active substance, to the adjuvants or to any of the excipients.
Special warnings
Ideally, tablets are administered on the same day each month. If an interval is greater than 6 weeks, treatment should be resumed immediately and be continued at monthly intervals and, in case of heartworm prevention, a veterinarian should be consulted.
Special precautions for use
i)Special precautions for use in animals
In heartworm risk regions, or in case it is known that a dog has been travelling to and from heartworm risk regions, before commencing PROGRAM Plus treatment as with any other heartworm preventive, a veterinary consultation is advised to exclude the presence of any concurrent infestation of Dirofilaria immitis. In the case of a positive diagnosis, adulticidal therapy is indicated before administering PROGRAM Plus.
ii)Special precautions to be taken by the person administering the veterinary medicinal product to animals
In the case of accidental ingestion seek medical advice immediately and show the package leaflet or the label to the physician.
Adverse reactions (frequency and seriousness)
Pale mucous membranes, increased intestinal peristalsis, lethargy, diarrhea have been observed very rarely after treatment. The treatment of dogs with a high number of circulating microfilariae can sometimes lead to the appearance of moderate and transitory hypersensitivity reactions, such as pale
mucous membranes, vomiting, laboured breathing, or excessive salivation. These reactions are associated with the release of proteins from dead or dying microfilariae and are not a direct toxic effect of the product.
Use during pregnancy, lactation or lay
Can be used during pregnancy.
Can be used during lactation.
Interaction with other medicinal products and other forms of interaction
During treatment with PROGRAM Plus, no other antiparasitic macrocyclic lactones should be administered.
Amounts to be administered and administration route
PROGRAM Plus tablets, available in four sizes, are given according to the weight of the dog, consistent with the administration of a minimum dose of 0.5 mg milbemycin oxime and 10 mg lufenuron per kg body weight.
Colour of container
Bodyweight (kg)
mg of milbemycin per tablet
mg of lufenuron per tablet
from 23 to 45 kg
1 tablet/month
PROGRAM Plus should be administered in the following situations:
To prevent flea infestations with concurrent heartworm prevention and/or gastrointestinal nematode infection treatment should start from 2 weeks of age, or from a minimum weight of 1 kg.
Dogs in a non-heartworm region:
Program Plus can be used as part of the seasonal prevention of fleas replacing lufenuron mono (PROGRAM tablets) in cases with diagnosed concurrent gastrointestinal nematode infection. After elimination of the nematode infection confirmed by faecal examination, prevention of fleas should continue with PROGRAM tablets if indicated.
In puppies, treatment with Program Plus is recommended up to one month after weaning. Thereafter, prevention of fleas can be continued with lufenuron mono (Program).
Dogs travelling to a heartworm region:
To prevent flea infestations with concurrent heartworm prevention, dogs travelling to a heartworm risk region should begin medication within one month after arrival. Treatment should continue monthly, with the last administration given after the dog has left the region.
Dogs in a heartworm region:
To prevent flea infestations and to prevent heartworm, medication should begin within one month after the appearance of mosquitoes, or one month before the appearance of fleas, and continue throughout the risk period with the last dose given within one month after the mosquito and flea season finishes.
If dogs have a high level of flea infestation at the start of treatment, it may be necessary to apply a flea adulticide during the first one to two months. It is important to treat all dogs and cats in the household for fleas. Cats in the same household should be treated with PROGRAM oral or injectable suspension.
Overdose (symptoms, emergency procedures, antidotes), if necessary
At 10x recommended dose rate (i.e. 5 mg milbemycin oxime, 100 mg lufenuron per kg) and higher dose rates clinical signs such as transient ataxia, trembling, depression, salivation, and mydriasis may be observed. There is no specific antidote.
Withdrawal period(s)
Not applicable.
Pharmacological particulars
Pharmacotherapeutic group: Milbemycin oxime Anthelmintic, Lufenuron Insect Growth Regulator
ATC Vet Code: QP54AB51
Pharmacodynamic properties
Milbemycin belongs to the group of macrocyclic lactones, isolated from the fermentation of Streptomyces hygroscopicus var. aureolacrimosus. Out of the selected analogues, the one currently used for medicinal purposes is Milbemycin A3/A4 oxime (ratio ≤20 : ≥80). As one of the active principles in Program Plus, it is effective against larval stages (L3, L4, and the microfilariae) of Dirofilaria immitis, and anthelmintic activity against the following nematodes: Toxocara canis, Trichuris vulpis, Ancylostoma caninum. The activity of milbemycin is correlated with its action on invertebrate neurotransmission: it potentiates GABA (gamma-amino-butyric acid), an inhibitor of neuromuscular transmission, leading to paralysis.
Lufenuron belongs to the chemical group of benzoylureas, and is considered an IGR (Insect Growth Regulator) or IDI (Insect Development Inhibitor). It inhibits the development of fleas by interfering with the normal synthesis, polymerisation and deposition of the chitin, the principal component of the
arthropod exoskeleton. The adult flea absorbs lufenuron via its bloodmeal. At therapeutic levels, lufenuron has no effect upon adult fleas, but passes transovarially to act upon certain stages of the development of the insect (egg and larva), thus interrupting the insect life cycle. Also, adult flea faeces containing lufenuron exert a larvicidal effect when ingested by the larvae directly.
Pharmacokinetic particulars
Milbemycin oxime is characterised by gastro-enteric absorption. It reaches peak plasma concentrations of about 200 - 300 ng/mL within about 2 to 5 hours after oral administration at recommended dose. Thereafter, milbemycin oxime concentrations decrease in plasma with a half life of about 1 to 3 days.
Following oral administration, lufenuron is distributed via the blood to the adipose tissue, from which, metabolically unmodified, it is constantly released above the minimum effective concentration for at least one month.
Pharmaceutical particulars
List of excipients
Titanium dioxide (E171)
Macrogol 8000
Cellulose, microcrystalline
Lactose monohydrate
Pregelatinised maize starch
Croscarmellose sodium
Magnesium stearate
None known.
Shelf life
Shelf-life of the veterinary medicinal product as packaged for sale: 3 years.
Special precautions for storage
Do not store above 25°C
Keep the blister strips in the outer carton.
Nature and composition of immediate packaging
Carton containers, each containing 6 or 8 pentagonal tablets in PVDC/PVC blisters, thermosealed with aluminium foil, boxed in a free-opening, labelled carton.
Not all pack sizes may be marketed.
Special precautions for the disposal of unused veterinary medicinal product or waste materials derived from the use of such products
Any unused veterinary medicinal product or waste materials derived from such veterinary medicinal product should be disposed of in accordance with local requirements.
Marketing Authorisation Holder (if different from distributor)
Marketing Authorisation Number
Vm 00879/4030
Significant changes
Date of the first authorisation or date of renewal
December 2020
Date of revision of the text
September 2021
Any other information
This product is to be discontinued; the datasheet will remain in the compendium until expiry of its last batch
Legal category
Legal category: POM-V