Esafoxolaner + Eprinomectin + Praziquantel

What is esafoxolaner + eprinomectin + praziquantel (EEP)?

The combination of esafoxolaner + eprinomectin + praziquantel (NexGard COMBO™) is a topical antiparasitic used to prevent heartworms and to prevent and treat intestinal parasites (hookworms, roundworms, and tapeworms), ear mites, fleas, and ticks (black-legged tick, lone star tick) in cats over eight weeks of age.  This medication combination is currently only approved for use in Canada.

Its use in cats to treat skin mites is “off label”. Many drugs are commonly prescribed for off-label use in veterinary medicine. In these instances, follow your veterinarian’s directions and cautions carefully, as they may be significantly different from those on the label.

How is EEP given?

• EEP is applied topically to the skin on the back of the neck. 
• Follow the label directions for the correct application. 
• During the first 30 minutes after application, monitor to ensure that your cat does not lick the medication. 
• Do not apply this medication to irritated skin. 
• Do not bathe your cat for at least four days after application. 
• Do not touch this area until the medication is no longer noticeable.

What if I miss giving my cat a scheduled dose?

If you miss a dose, give it as soon as you remember, and then start a new monthly dosing schedule. For example, if you forgot to give your pet their dose on June 1 and remember on June 18, give the dose on June 18 and start a new schedule. You will give your cat the next dose on August 18. Do not give the pet two doses at once. Contact your veterinarian if you are concerned about a missed dose.

Are there any potential side effects?

When used as directed in cats, side effects are uncommon, but may include:

• vomiting
• hair loss at the application site
• itching
• diarrhea
• lethargy
• excessive drooling
• salivation and vomiting (if ingested)

Esafoxolaner belongs to the isoxazoline class of drugs, which have been associated with tremors and seizures. 

EEP can also cause neurologic toxicity in cats with two copies of the MDR1 mutation. Signs may include:

• unsteady gait (ataxia)
• drooling
• tremors
• weakness and/or partial paralysis
• coma
• seizures
• death

Other side effects may occur. If you notice anything unusual, contact your veterinarian immediately.

This long-acting medication is designed to work for at least four weeks. However, negative side effects are usually short-lived if they occur at all.

Are there any risk factors for this medication?

EEP should NOT BE USED in:

• are hypersensitive or allergic to any of its components
• are under eight weeks old
• weigh less than 1.8 lb (0.8 kg)
• are sick, debilitated, or underweight
• are known to have two copies of the MDR1 mutation

EEP should be USED WITH CAUTION in:

• cats with known neurologic disorders
• breeding, pregnant, or nursing animals, as safety has not been established

Are there any drug interactions I should be aware of?

Specific interactions with EEP have not been reported. However, theoretical interactions may occur with some medications, including: 

• albendazole
• cimetidine
• dexamethasone
• phenobarbital
• amiodarone
• clarithromycin
• fluoxetine (Reconcile®)
• azole antifungals
• cyclosporine (Atopica®)
• spironolactone

Be sure to tell your veterinarian about any medications (including vitamins, supplements, or herbal therapies) that your cat is taking.

Is any monitoring needed with this medication?

No specific monitoring is required while your pet is taking this medication. Your veterinarian may monitor your pet to be sure that the medication is working.

How do I store this medication?

• Store this medication in its unopened blister pack and box.
• Store between 15°C and 30°C (59°F and 86°F).

What should I do in case of an emergency?

If you suspect an overdose or adverse reaction to the medication, call your veterinary office immediately. If they are not available, follow their directions in contacting an emergency facility.