Milbemax 2.5 mg/25 mg chewable tablets for small dogs and puppies: Dogs (1 - 5 kg).

Milbemax 12.5 mg/125 mg chewable tablets for dogs: Dogs (≥ 5 kg).

For dogs with, or at risk from mixed infections of cestodes, gastrointestinal nematodes, eyeworm, lungworms and/or heartworm.

This veterinary medicinal product is only indicated when use against cestodes and nematodes or prevention of heartworm disease/angiostrongylosis is indicated at the same time.

Treatment of tapeworms: Dipylidium caninum, Taenia spp., Echinococcus spp., Mesocestoides spp.

Treatment of:

Hookworm: Ancylostoma caninum,

Roundworms: Toxocara canis, Toxascaris leonina,

Whipworm: Trichuris vulpis.

Treatment of Thelazia callipaeda (see specific treatment schedule under section “Administration routes and dosage”).

Treatment of:

Angiostrongylus vasorum (Reduction of the level of infection by immature adult (L5) and adult parasite stages; see specific treatment and prevention disease schedules under section “Administration routes and dosage”),

Crenosoma vulpis (Reduction of the level of infection).

Prevention of heartworm disease (Dirofilaria immitis) if concomitant treatment against cestodes is indicated.

Milbemax 2.5 mg/25 mg chewable tablets for small dogs and puppies: Do not use in dogs weighing less than 1 kg.

Milbemax 12.5 mg/125 mg chewable tablets for dogs: Do not use in dogs weighing less than 5 kg.

Do not use in cases of hypersensitivity to the active substances or to any of excipients.

See also "Special precautions for use".

The possibility that other animals in the same household can be a source of re-infection should be considered, and these should be treated as necessary with an appropriate veterinary medicinal product.

It is recommended to treat all the animals living in the same household concomitantly.

When infection with the cestode D. caninum has been confirmed, concomitant treatment against intermediate hosts, such as fleas and lice, should be discussed with a veterinarian to prevent re-infection.

Parasite resistance to any particular class of anthelmintic may develop following frequent, repeated use of an anthelmintic of that class.

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 veterinary medicinal product should be based on confirmation of the parasitic species and burden, or of the risk of infection based on its epidemiological features, for each individual animal.

The use of the veterinary medicinal product should follow the implementation of appropriate diagnostic measures towards mixed infections by nematodes and cestodes with consideration of animal history and characteristics (e.g. age, health status), environment (e.g. kennelled dogs, hunting dogs), feeding (e.g. access to raw meat), geographical location and travel. Judgement of the administration of the veterinary medicinal product in dogs at risk from mixed re-infections or in specific at risk situations (such as zoonotic risks), should be made by the responsible veterinarian.

In the absence of risk of co-infection with nematodes or cestodes, a narrow spectrum veterinary medicinal product should be used.

Resistance of Dipylidium caninum to praziquantel as well as cases of multi-drug resistance of Ancylostoma caninum to milbemycin oxime and resistance of Dirofilaria immitis to macrocyclic lactones have been reported.

It is recommended to further investigate cases of suspected resistance, using an appropriate diagnostic method. Confirmed resistance should be reported to the marketing authorisation holder or to the competent authorities.

The use of this veterinary medicinal product should take into account local information about susceptibility of the target parasites, where available.

Studies with milbemycin oxime indicate that the margin of safety in certain dogs of Collie or related breeds is less than in other breeds. In these dogs, the recommended dose should be strictly observed.

The tolerance of the veterinary medicinal product in young puppies from these breeds has not been investigated. Clinical signs in Collies are similar to those seen in the general dog population when overdosed (see “Overdose” section).

Treatment of dogs with a high number of circulating microfilariae can sometimes lead to the appearance of hypersensitivity reactions, such as pale mucous membranes, vomiting, trembling, 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 veterinary medicinal product. The use in dogs suffering from microfilaremia is thus not recommended.

In heartworm risk-areas, or in the case it is known that a dog has been travelling to and from heartworm risk regions, before using the veterinary medicinal product, 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 the veterinary medicinal product.

No studies have been performed with severely debilitated dogs or individuals with seriously compromised kidney or liver function. The veterinary medicinal product is not recommended for such animals or only according to a benefit/risk assessment by the responsible veterinarian.

In dogs less than 4 weeks old, tape worm infection is unusual. Treatment of animals less than 4 weeks old with a combination veterinary medicinal product may therefore not be necessary.

Wash hands after use.

People with known hypersensitivity to any of the ingredients should avoid contact with the veterinary medicinal product.

In case of accidental ingestion of the tablets, particularly by a child, seek medical advice immediately and show the package leaflet or the label to the physician.

Special precautions for the protection of the environment:

See section 'Special precautions for the disposal of unused veterinary medicinal products or waste materials derived from the use of such products'

Echinococcosis represents a hazard for humans. As Echinococcosis, is a notifiable disease to the World Organisation for Animal Health (WOAH), specific guidelines on the treatment and follow up and on the safeguard of persons need to be obtained from the relevant competent authority (e.g. experts or institutes of parasitology).

Dogs:

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.

The safety of the veterinary medicinal product has been established during pregnancy and lactation.

Can be used during pregnancy and lactation.

Can be used in breeding animals.

No interactions were observed when the recommended dose of the macrocyclic lactone selamectin was administered during treatment with the veterinary medicinal product at the recommended dose.

Although not recommended, the concomitant use of the veterinary medicinal product with a spot on containing moxidectin and imidacloprid at recommended dose rates following a single application was well tolerated in one experimental study by beagle dogs at the age 11 months or older. Transient neurological adverse reactions (poor proprioception, flaccid frontal and hind legs, incoordination, slight tremors and high stepping gait of the hind limbs only) were observed after concurrent administration of both veterinary medicinal products in another study conducted in puppies aged 8-12 weeks. Such signs were however not observed in this study after giving the veterinary medicinal product alone.

The safety and efficacy of this combination have not been investigated in field studies.

In the absence of further studies, caution should be taken in the case of concurrent use with any other macrocyclic lactone. Also, no such studies have been performed with breeding animals, Collies, related breeds and their crosses.

Oral use.

Underdosing could result in ineffective use and may favour resistance development.

To ensure a correct dosage, body weight should be determined as accurately as possible.

Minimum recommended dose rate 0.5 mg milbemycin oxime and 5 mg praziquantel per kg are given as a single dose.

The veterinary medicinal product should be administered with or after some food.

Depending on the bodyweight of the dog, the practical dosing is as follows:

Weight	Milbemax 2.5 mg/25 mg chewable tablets for small dogs and puppies Number of tablets
1 - 5 kg	1 tablet

Weight	Milbemax 12.5 mg/125 mg chewable tablets for dogs Number of Tablets
5 – 25 kg	1 tablet
>25 - 50 kg	2 tablets
>50 - 75 kg	3 tablets

In cases when heartworm disease prevention is used and at the same time treatment against tapeworm is required, the veterinary medicinal product can replace the monovalent veterinary medicinal product for the prevention of heartworm disease.

For treatment of Angiostrongylus vasorum infections, milbemycin oxime should be given four times at weekly intervals. It is recommended, where concomitant treatment against cestodes is indicated, to treat once with the veterinary medicinal product and continue with the monovalent veterinary medicinal product containing milbemycin oxime alone, for the remaining three weekly treatments.

In endemic areas administration of the veterinary medicinal product every four weeks will prevent angiostrongylosis by reducing immature adult (L5) and adult parasite burden, where concomitant treatment against cestodes is indicated.

For the treatment of Thelazia callipaeda, milbemycin oxime should be given in 2 treatments, seven days apart. Where concomitant treatment against cestodes is indicated, the veterinary medicinal product can replace the monovalent veterinary medicinal product containing milbemycin oxime alone.

The adverse reactions observed are the same as those observed at the recommended dose (see section “Adverse events”) but more pronounced.

Not applicable.

Not applicable.