NexGard® and NexGard® PLUS for Dogs, NexGard® COMBO for Cats

PetMD’s medications content was written and reviewed by veterinary professionals to answer your most common questions about how medications function, their side effects, and what species they are prescribed for. This content shouldn’t take the place of advice by your vet.

NexGard® products are a series of medications used to treat and prevent external and internal parasites in dogs and cats. Dogs and cats can be exposed to and infected with parasites throughout the year, regardless of season or climate.

NexGard® products are available in several strengths and formulations, in combination with other medications. Use only specific NexGard® products as advised by your veterinarian.

These medications are dosed separately for dogs and cats and given by weight, so it is important to use the correct species and sized medication for your pet. Using cat medications on dogs or using dog medications on cats can cause serious problems, including lack of efficacy or an overdose.

What Is NexGard® for Dogs?

NexGard® is a prescription veterinary oral chewable tablet used in dogs for the treatment and prevention of fleas and four types of ticks (American dog tick, black-legged tick, lone star tick, and brown dog tick).

NexGard® is used in dogs and puppies eight weeks of age and older and weighing more than four pounds.

NexGard® is also used extra-label to treat demodectic mange, sarcoptic mange, and ear mites in dogs. The term extra-label or off-label use means that a medication can be used in a way or in a particular species that is not specified on the medication label. While veterinarians often prescribe medications for extra-label uses, your veterinarian will determine whether this medication is right for your dog.

NexGard should be used with caution in dogs with a history of seizures or neurological disorders.

Safety studies had not been performed to evaluate the safety and effectiveness of NexGard® in breeding, pregnant, and nursing dogs at the time of this publication.

What Is NexGard® PLUS for Dogs?

NexGard® PLUS is a prescription veterinary oral chewable tablet used in dogs for the prevention of heartworms and the treatment and prevention of hookworms, roundworms, fleas and four types of ticks (American dog tick, black-legged tick, lone star tick, and brown dog tick).

NexGard® PLUS is used in dogs and puppies eight weeks of age and older and weighing more than four pounds.

Because it contains the active ingredient afoxolaner, NexGard® PLUS is also used extra-label to treat demodectic mange, sarcoptic mange, and ear mites in dogs. The term extra-label or off-label use means that a medication can be used in a way or in a particular species that is not specified on the medication label. While veterinarians often prescribe medications for extra-label uses, your veterinarian will determine whether this medication is right for your dog.

NexGard® PLUS should be used with caution in dogs with a history of seizures or neurological disorders. Safety studies had not been performed to evaluate the safety and effectiveness of NexGard® PLUS in breeding, pregnant, and nursing dogs at the time of this publication.

The manufacturer of NexGard® PLUS has tested it for safety in dogs with the MDR1 mutation, and no adverse effects were observed. Dogs with the MDR1 mutation are not at increased risk for adverse effects.

What Is NexGard® COMBO for Cats?

NexGard® COMBO is a prescription veterinary topical medication used in cats for the prevention of heartworms and the treatment and prevention of roundworms, hookworms, tapeworms, fleas, and two types of ticks (black-legged tick and lone star tick).

NexGard® COMBO is used in cats and kittens eight weeks of age and older and weighing more than 1.8 pounds.

NexGard® COMBO has also been used extra-label in cats for the treatment of ear mites, notoedric mange, and cat lice. The term extra-label or off-label use means that a medication can be used in a way or in a particular species that is not specified on the medication label. While veterinarians often prescribe medications for extra-label uses, your veterinarian will determine whether this medication is right for your cat.

NexGard® COMBO should be used with caution in cats with a history of seizures or neurological disorders.

Safety studies have not been performed to evaluate the safety and effectiveness of NexGard® COMBO in breeding, pregnant, and nursing cats at the time of this publication.

How NexGard® and NexGard® PLUS Works In Dogs

The active ingredient in NexGard® is afoxolaner, which belongs to a newer class of flea and tick preventatives called isoxazolines. Isoxazolines eliminate fleas and ticks by over-exciting their nervous system, causing paralysis and death.

Nexgard® PLUS contains afoxolaner and includes two additional anti-parasitic medications: moxidectin, which adds heartworm, hookworm, and roundworm prevention, and pyrantel, a dewormer for hookworms and roundworms. Moxidectin works by causing an electrolyte overload in the nervous system of worms, resulting in paralysis and death. Pyrantel works by blocking receptors in the nervous system of worms to cause paralysis and death.

How NexGard® COMBO Works In Cats

NexGard® COMBO contains three ingredients—esafoxolaner, eprinomectin, and praziquantel.

Esafoxolaner belongs to the class of flea and tick preventatives called isoxazolines, which eliminate fleas and ticks by overexcitement of the nervous system, resulting in paralysis and death. Eprinomectin works by causing an electrolyte overload in the nervous system of worms, resulting in paralysis and death.

Praziquantel works by causing holes in the tapeworm’s skin, resulting in death of the worm, where it is then digested in the pet’s gastrointestinal tract or passed in the pet’s stool.

NexGard® Directions for Dogs

Follow the directions on the drug label or as provided by your veterinarian. This medication is given once a month year-round by mouth in dogs weighing four pounds or more and eight weeks of age or older. You can give NexGard® with or without food. If your dog vomits this medication within two hours of giving it, redose with another full chew.

NexGard® PLUS Directions for Dogs

Follow the directions on the drug label or as provided by your veterinarian. This medication is given once a month year-round by mouth in dogs weighing four pounds or more and eight weeks of age or older. You can give NexGard® PLUS with or without food.

NexGard® COMBO Directions for Cats

Follow the directions on the drug label or as provided by your veterinarian.

After the fur has been parted, NexGard® COMBO should be applied to the exposed skin of the midline of the neck, between the base of the head and the shoulder blades, where your cat is unable to lick.

If the weight of your cat requires a second application, apply the contents of the second NexGard® COMBO in the same manner in the same location.

This medication is applied once a month year-round in cats eight weeks of age or older that weigh 1.8 pounds or greater.

Avoid contact with the application site for four hours until dry. Do not allow your cat or any other pets in the household to lick the application site.

Missed a Dose?

Speak with your veterinarian about what to do if you forget to give a dose of NexGard® or NexGard® PLUS to your dog. Generally, they may instruct you to give it when you remember and then to resume a monthly dosing schedule. Do not give extra or double doses.

Speak with your veterinarian about what to do if you forget to administer a dose of NexGard® COMBO to your cat. Generally, your veterinarian may instruct you to apply it when you remember and then to resume a monthly dosing schedule. Do not give extra or double doses.

It’s important to give these medications at monthly intervals year-round.

NexGard® and NexGard® PLUS Possible Side Effects in Dogs

NexGard® and NexGard® PLUS are well tolerated in most dogs. Uncommon side effects may include:

• Gastrointestinal upset (vomiting, diarrhea, or loss of appetite)
• Dry or itchy skin
• Low energy (lethargy)
• Allergic reactions: hives or facial swelling

Neurologic side effects have been seen after using medications in this class of drugs. Tell your veterinarian if your dog has a history of seizures or other neurologic disease. Neurologic side effects may include:

• Muscle tremors
• Loss of balance, difficulty walking
• Seizures

Contact your veterinarian immediately if your dog has any of these symptoms.

NexGard® COMBO Possible Side Effects in Cats

Cats may drool (salivate) excessively if NexGard® COMBO is accidentally administered by mouth or if it is ingested through licking/grooming the application site.

NexGard® COMBO is well tolerated in most cats. Uncommon side effects may include:

• Vomiting
• Hair change at the application site
• Loss of appetite
• Low energy (lethargy)

Neurologic side effects have been seen after using medications in this class of drugs. Tell your veterinarian if your cat has a history of seizures or other neurologic disease. Neurologic side effects may include:

• Muscle tremors
• Loss of balance, difficulty walking
• Seizures

Contact your veterinarian immediately if your cat has any of these symptoms.

Human Side Effects

These medications are not intended for use in humans.

Specific warnings regarding NexGard® COMBO topical medication include:

• Wash hands with soap and water after administration.
• NexGard® COMBO may irritate the eyes. If this medication gets into the eyes, rinse thoroughly with water. If wearing contact lenses, flush eyes first with water, then remove lenses, then continue to flush thoroughly with water.

Due to possible side effects, humans should never use medicine dispensed for their pets and pets should not be given any medicine dispensed for a human’s use.

If you accidentally ingest a pet medication, or if eye or skin irritation occurs, call your physician or the national Poison Control Center hotline at 800-222-1222.

Monitoring

Prior to administration of NexGard® PLUS chews, dogs should be tested for existing heartworm infection.

No specific monitoring is required by the manufacturer for NexGard® or NexGard® COMBO, but your veterinarian may recommend routine testing depending on your pet’s individual needs, other medications they may be on, and/or the issue that initially caused your pet to be placed on this medication.

Call Your Vet If:

• Severe side effects are seen (see above)
• Your pet’s condition worsens or does not improve with treatment
• You see or suspect an overdose
• You have additional questions or concerns about the use of NexGard®, NexGard® PLUS, or NexGard® COMBO

NexGard® and NexGard® PLUS Overdose Information in Dogs

NexGard® and NexGard® PLUS both have a wide margin of safety. Vomiting may be the only sign of an overdose of NexGard®.

If you suspect an overdose, immediately contact your veterinarian, seek emergency veterinary care, or call an animal poison control center. Consultation fees often apply.

Pet Poison Helpline (855) 764-7661

ASPCA Animal Poison Control (888) 426-4435

NexGard® COMBO Overdose Information in Cats

NexGard® COMBO has a wide margin of safety. Rarely, neurological symptoms such as loss of balance, muscle tremors, low body temperature, and dilated pupils may be seen.

If you suspect an overdose, immediately contact your veterinarian, seek emergency veterinary care, or call an animal poison control center. Consultation fees often apply.

Pet Poison Helpline (855) 764-7661

ASPCA Animal Poison Control (888) 426-4435

NexGard® and NexGard® PLUS, NexGard® COMBO Storage

NexGard® should be stored at controlled temperatures at or below 86 F and brief exposure to temperatures up to 104 F is acceptable.

NexGard® PLUS should be stored at controlled temperatures at or below 77 F and brief exposure to temperatures up to 104 F is acceptable.

NexGard® COMBO should be stored at 59–86 F and brief exposure to temperatures up to 104 is acceptable.

Keep the medication in the provided blister packs until ready to use to protect from moisture and light.

Keep out of reach of children and pets.