Nexgard COMBO for Cats

How to Order Prescriptions

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Description

NexGard® COMBO is indicated for the prevention of heartworm disease caused by Dirofi laria immitis and for the treatment and control of roundworm (fourth stage larval and adult Toxocara cati), hookworm (fourth stage larval and adult Ancylostoma tubaeforme; adult Ancylostoma braziliense), and tapeworm (Dipylidium caninum) infections. NexGard® COMBO kills adult fleas (Ctenocephalides felis) and is indicated for the treatment and prevention of flea infestations and the treatment and control of Ixodes scapularis (black-legged tick) and Amblyomma americanum (lone star tick) infestations for one month in cats and kittens 8 weeks of age and older, and weighing 1.8 lbs or greater.

Dosage and Administration

NexGard® COMBO is dosed at a minimum of 0.055 mL/lb (0.12 mL/kg), which delivers a minimum dose of 0.65 mg/lb (1.44 mg/kg) esafoxolaner, 0.22 mg/lb (0.48 mg/kg) eprinomectin, and 4.53 mg/lb (9.98 mg/kg) praziquantel.

For heartworm disease prevention, apply once monthly for at least three months after last exposure to mosquitoes (see Effectiveness). Administer the entire contents of a NexGard® COMBO unit applicator topically once a month as specified in the following table: 

Cat Weight (lb)	Volume (mL)	Esafoxolaner (mg)	Eprinomectin (mg)	Praziquantel (mg)
1.8-5.5	0.3	3.6	1.2	24.9
5.6-16.5	0.9	10.8	3.6	74.7
16.6-22	0.3 + 0.9	14.4	4.8	99.6
22.1-33	0.9 + 0.9	21.6	7.2	149.4

A veterinarian or veterinary technician should demonstrate or instruct the pet owner regarding the appropriate technique for applying NexGard® COMBO topically to cats and kittens prior to first use. Keep product in original packaging until ready to use.

1. Use scissors to cut the blister along the dotted line.
2. Then pull the lid away.
3. Remove the applicator from the package and hold it upright. Pull back the plunger slightly.
4. Twist and pull off the cap. 
5. Part the hair on the midline of the neck, between the base of the skull and the shoulder blades until the skin is visible. Place the tip of the applicator on the skin and apply the entire contents directly onto the skin in one spot. The product should be applied to dry skin on an area where the cat cannot lick it off. If the weight of the cat requires a second application, apply the contents in the same manner as described above in the same location. 
6. Wash hands after use with soap and water. 

Heartworm Prevention

For the prevention of heartworm disease, NexGard® COMBO should be administered once a month year-round. At a minimum, administration of NexGard® COMBO should start at least 1 month before the cat’s first expected exposure to mosquitoes and monthly thereafter until at least 3 months after the cat’s last seasonal exposure to mosquitoes (see Effectiveness). If a dose is missed and a 30-day interval between doses is exceeded, administer NexGard® COMBO immediately and resume the monthly dosing schedule. Treatment with fewer than 3 monthly doses may not provide complete heartworm prevention. When replacing another monthly heartworm preventive product in a heartworm prevention program, the fi rst treatment with NexGard® COMBO should be given within one month of the last dose of the former medication. At the discretion of the veterinarian, cats older than 6 months of age may be tested to determine the presence of existing heartworm infection before treatment with NexGard® COMBO. Cats already infected with adult heartworms can be given NexGard® COMBO monthly to prevent further infections.

Flea Treatment and Prevention

For the treatment and prevention of flea infestations, the use of NexGard® COMBO may begin at any time of year. NexGard® COMBO should be administered year-round at monthly intervals or begin at least one month before fleas become active. However, an environmental infestation may persist for a short time after beginning treatment with NexGard® COMBO because of the development of adult fleas from eggs that were laid prior to the initiation of treatment.

Tick Treatment and Control

For the treatment and control of infestations with Ixodes scapularis and Amblyomma americanum, the use of NexGard® COMBO may begin at any time of year. NexGard® COMBO should be administered year-round at monthly intervals or begin at least one month before the ticks become active.

Treatment and Control of Roundworms, Hookworms, and Tapeworms

NexGard® COMBO provides treatment and control of roundworms (adult and fourth stage larval Toxocara cati), hookworms (adult and fourth stage larval Ancylostoma tubaeforme; adult Ancylostoma braziliense), and tapeworms (Dipylidium caninum). For the treatment of hookworm, roundworms and tapeworm infections, NexGard® COMBO should be administered once as a single dose. Monthly use of NexGard® COMBO will control any subsequent infections. Cats may be exposed to and can become infected with roundworms, hookworms, and tapeworms throughout the year, regardless of season or climate.

Precautions

Esafoxolaner, one of the ingredients in NexGard® COMBO, is a member of the isoxazoline class. This class has been associated with neurologic adverse reactions including tremors, ataxia, and seizures. Seizures have been reported in cats receiving isoxazoline class drugs, even in cats without a history of seizures. Use with caution in cats with a history of seizures or neurologic disorders. Do not administer orally. Cats may salivate excessively if NexGard® COMBO is accidentally administered orally or is ingested through licking/grooming the application site (see Target Animal Safety). The safety of NexGard® COMBO has not been tested in breeding, pregnant, or lactating cats. The safety of NexGard® COMBO has not been tested in kittens less than 8 weeks of age or weighing less than 1.8 lbs (0.8 kg).