Trifexis....

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HowIMetYourPet

HowIMetYourPet

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Hey guys....sorry if topics like this are a no-no, please let me know if that's the case, but I'm curious as to what the talk is around other areas-and even in vet schools- about Trifexis.

A while back I had heard about a small dog being fostered by a friend of mine who-upon getting their first dose of Trifexis-had a seizure. I thought it was interesting, but the dog was new to the rescue, no history for the dog, so who knows, right? This friend was pretty hollistic when it came to her animals (feeds raw, titers instead of yearly vaccines, etc) so when she decided to stop giving her whole crew trifexis because of this new mystery dog's reaction, I thought it might be overkill....

A few months later, I heard of another strange case, a dog owned by someone at my dog training club who had strange neurological symptoms (head swinging) after taking it.....this made me feel a little uneasy, two cases of people/dogs I know personally, but again, this was a young dog, recently rescued, and no history of the dog was known...

In the mean time, I've seen a million anti-Trifexis posts on facebook from dog friends, etc, BUT I know how things like this get blown out of proportion, and how you can never believe what you read on the internet!!

Well, I had been giving sentinel, and when sentinel stopped being sold, I switched to heartgaurd and no flea meds (treated the yard and monitored closely). With the weather being crazy and spring arriving, I decided to put my "pack" on a more solid flea medicine, so I decided to try Trifexis.....well, the first night I did, my youngest dog started having strange neurological symptoms....(I can go into details if you really want). That's the last dose of Trifexis I, personally, will give. My vet agrees (and is filing a report with the company)

I'm wondering if any of you have seen any dogs come into your clinics, or know PERSONALLY of any dogs with reactions...more for my curiosity than anything...This just seems like a LOT of coincidences.....I know the company did an investigation into claims of deaths of dogs and found no connections, but I'm having some trouble finding reliable information about the neuro symptoms. The company (and the ER vet) claimed its a rare side effect, but to know of three dogs personally to have it seems a little more common than "rare"....

Opinions/thoughts?
 
HowIMetYourPet said:
Hey guys....sorry if topics like this are a no-no, please let me know if that's the case, but I'm curious as to what the talk is around other areas-and even in vet schools- about Trifexis.

A while back I had heard about a small dog being fostered by a friend of mine who-upon getting their first dose of Trifexis-had a seizure. I thought it was interesting, but the dog was new to the rescue, no history for the dog, so who knows, right? This friend was pretty hollistic when it came to her animals (feeds raw, titers instead of yearly vaccines, etc) so when she decided to stop giving her whole crew trifexis because of this new mystery dog's reaction, I thought it might be overkill....

A few months later, I heard of another strange case, a dog owned by someone at my dog training club who had strange neurological symptoms (head swinging) after taking it.....this made me feel a little uneasy, two cases of people/dogs I know personally, but again, this was a young dog, recently rescued, and no history of the dog was known...

In the mean time, I've seen a million anti-Trifexis posts on facebook from dog friends, etc, BUT I know how things like this get blown out of proportion, and how you can never believe what you read on the internet!!

Well, I had been giving sentinel, and when sentinel stopped being sold, I switched to heartgaurd and no flea meds (treated the yard and monitored closely). With the weather being crazy and spring arriving, I decided to put my "pack" on a more solid flea medicine, so I decided to try Trifexis.....well, the first night I did, my youngest dog started having strange neurological symptoms....(I can go into details if you really want). That's the last dose of Trifexis I, personally, will give. My vet agrees (and is filing a report with the company)

I'm wondering if any of you have seen any dogs come into your clinics, or know PERSONALLY of any dogs with reactions...more for my curiosity than anything...This just seems like a LOT of coincidences.....I know the company did an investigation into claims of deaths of dogs and found no connections, but I'm having some trouble finding reliable information about the neuro symptoms. The company (and the ER vet) claimed its a rare side effect, but to know of three dogs personally to have it seems a little more common than "rare"....

Opinions/thoughts?
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Anecdotal evidence is just that...anecdotal. There is a labeled side effect of seizures. Dogs that already have seizures may be at increased risk. Just remember to always take this info with a grain of salt. If you look up sentinel and heartgard online you'll see similar stories.
 
I worked at a clinic that sold trifexis and to my knowledge we never had any clients with problems. I don't personally use it because I can get other products cheaper (or free) through my school though.
 
dyachei said:
Anecdotal evidence is just that...anecdotal. There is a labeled side effect of seizures. Dogs that already have seizures may be at increased risk. Just remember to always take this info with a grain of salt. If you look up sentinel and heartgard online you'll see similar stories.
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Right, and this was my thinking all along, and why I gave it to my dogs.....its when those grains of salt begin to form a mountain that it concerns me.
I should also point out that the first dog of my friend's and my personal dog are the same breed.

I guess it happening to my dog just made it a little more real.

That being said...does anyone know if there is some kind of public record of formal reports? Or is that something the company keeps private?
 
HowIMetYourPet said:
Right, and this was my thinking all along, and why I gave it to my dogs.....its when those grains of salt begin to form a mountain that it concerns me.
I should also point out that the first dog of my friend's and my personal dog are the same breed.

I guess it happening to my dog just made it a little more real.

That being said...does anyone know if there is some kind of public record of formal reports? Or is that something the company keeps private?
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Report it to them. Your vet should be - we personally had to report it to get the replacement dose for vomiting. The company is interested in finding out this info, believe me, if it truly is due to the medication.
 
dyachei said:
Report it to them. Your vet should be - we personally had to report it to get the replacement dose for vomiting. The company is interested in finding out this info, believe me, if it truly is due to the medication.
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She did 🙂
 
My vets use it on their own patients and have never had any issues. Like any medication, there are minor side effects, but from my understanding, all autopsies and studies in which Trifexis was linked to serious side effects have come back negative.

That being said, if you are nervous, just use something else. There are so many options out there.
 
I've used it and neither of my guys had a problem. We don't sell it at the clinic where I work because our practice owner doesn't really like the idea of combination products. However, we don't discourage clients from buying it elsewhere and we write prescriptions for it as long as the dog doesn't have a history of seizures (like dyachei mentioned). I don't think there's a wrong or a right answer.

I personally stopped using it because #1 - I had to pay full price for it since we don't sell it where I work and #2 - I live in a rural-ish area and we hike a lot so I wanted a product that protects against ticks as well 🙂
 
Part of the problem with this product is that dogs were being put on it as a new product 2-3 years ago and epilepsy can be idiopathic, particalarly in 2-3 year old dogs. There's no way to prove causation without further studies and it IS on the label.
 
So I actually just went to the derm conference this past week. I ended up speaking with someone from Meriel that was talking to me about nexgard and why it is labeled for seizures. So he was explaining to me that each of these studies (or with comfortis, trifexis, etc.) have a few pets in them that have had a history of seizures, and if any of them have any seizures during the course of the study then they are required to label the medication for seizures. So, I am more inclined to take that warning with a grain of salt now...
 
SummerTheLynx said:
So I actually just went to the derm conference this past week. I ended up speaking with someone from Meriel that was talking to me about nexgard and why it is labeled for seizures. So he was explaining to me that each of these studies (or with comfortis, trifexis, etc.) have a few pets in them that have had a history of seizures, and if any of them have any seizures during the course of the study then they are required to label the medication for seizures. So, I am more inclined to take that warning with a grain of salt now...
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I'm wondering why they don't exclude them from the study then? That seems weird.
 
NStarz said:
I'm wondering why they don't exclude them from the study then? That seems weird.
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The way he was making it seem is that they were required to be in the study, or that the distribution of dogs in the study should reflect the distribution of dogs with pre existing health conditions. With an n of 420/430, I am pretty sure you would anticipate a couple of dogs having a history or seizures in there.
 
So, here is my next question (not trying to argue, just...figure this out)....

The first two dogs I know had unknown background...they very well could have a history of sezures, or at least be genetically predisposed to them. This is why I didn't take it to seriously originally.

My dog is a different story. I bred this particular dog, I own both her parents, her grandmother, and am familiar with every dog behind her for the last three generations-all of whom are alive and well, and who have never had any neurological problems. Many of the siblings/aunts/uncles/nephews/etc have been "kept up with" and the same thing-no history of any neurological problems. The breed as a whole is not susceptible to neuro problems....cataracts/patellas are the only real health problems in the breed (and possibly SA, but only in certain lines so far). Nothing else changed in the dogs environment within a week or two, no new cleaning products, no stressors, etc. The reaction happened about 5 hours after the dose (the same time frame it gives to start working). Also, the reaction wasn't a seizure....(neither was the 2nd dogs)....it was other strange behaviors......It started with her just staring at the ceiling....she *could* look away, if I physically moved her head, but as soon as I would let her go, it would gradually rise back up....she then started trembling, and rocking her head back and forth (like some do when they come out of anesthesia).....this is when I took her to the ER vet because I was worried that she could have gotten into some kind of poison.....she never vomited, she never lost consciousness, and she was never unresponsive. This doesn't sound seizure like to me (but what do I know 😉 )

If nothing else, I would be curious as to the mechanism of this.....how are these drugs (or their vehicle?) affecting these dogs neurologically?
 
The reason seizures are listed as a side effect for Trifexis and it's not recommended for use in dogs that are known to be epileptic (according to our Elanco rep) is that during the course of the drug trial one of the dogs had a seizure. It isn't known if it was due to spinosad and since there's no way to show it was or wasn't they're required to include it on the label. It could have been completely incidental but when anything abnormal happens during the course of a drug trial it must be listed as a side effect until it can be ruled out as a cause. It's part of the reason side effect lists are so lengthy.

I use Trifexis in all of my family's dogs without an issue. The most common reaction is vomiting, especially when given on an empty stomach. It's lipophilic, and so we usually recommend giving it with a full meal along with something fatty, like a spoonful of peanut butter (bonus points for the dogs that refuse to take it like a treat) and have had much fewer clients phone with adverse reactions that way. That being said, there are plenty of safe and effective alternatives if you aren't comfortable using it anymore, so if your dog just doesn't so well with it just choose a different preventative that she tolerates better.
 
HowIMetYourPet said:
So, here is my next question (not trying to argue, just...figure this out)....

The first two dogs I know had unknown background...they very well could have a history of sezures, or at least be genetically predisposed to them. This is why I didn't take it to seriously originally.

My dog is a different story. I bred this particular dog, I own both her parents, her grandmother, and am familiar with every dog behind her for the last three generations-all of whom are alive and well, and who have never had any neurological problems. Many of the siblings/aunts/uncles/nephews/etc have been "kept up with" and the same thing-no history of any neurological problems. The breed as a whole is not susceptible to neuro problems....cataracts/patellas are the only real health problems in the breed (and possibly SA, but only in certain lines so far). Nothing else changed in the dogs environment within a week or two, no new cleaning products, no stressors, etc. The reaction happened about 5 hours after the dose (the same time frame it gives to start working). Also, the reaction wasn't a seizure....(neither was the 2nd dogs)....it was other strange behaviors......It started with her just staring at the ceiling....she *could* look away, if I physically moved her head, but as soon as I would let her go, it would gradually rise back up....she then started trembling, and rocking her head back and forth (like some do when they come out of anesthesia).....this is when I took her to the ER vet because I was worried that she could have gotten into some kind of poison.....she never vomited, she never lost consciousness, and she was never unresponsive. This doesn't sound seizure like to me (but what do I know 😉 )

If nothing else, I would be curious as to the mechanism of this.....how are these drugs (or their vehicle?) affecting these dogs neurologically?
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Spinosad targets nicotinic neural synapses, so I don't think it's specific to just ectoparasites (like the growth regulators that target specific components of the parasite's life cycle), so, yes, you could see neurological signs if given way beyond the therapeutic dose. However, I could be wrong and it might only target nAChR in insects. I've already purged a lot of Parasit info from my brain, so I don't remember. The products aren't labeled at those doses, so it's very unlikely you would have that issue, but for whatever reason, there may be a dog that is sensitive to them (like Collies and ivermectin even though I think that is still technically like 100x the therapeutic dose). The other component of Trifexis (Milbemycin oxime) targets GABA gated chloride channels and opens them leading to paralysis. Same thing with them. The mechanism isn't specific to just the parasite, but the therapeutic dose is super low.

And I too have heard these stories, but from hearing reps talk, if one dog has that side effect on the trial, it has to go on the label. I don't know of anyone personally who has had any issues. I have some Trifexis to try but it won't be for a while since I have a ton of Sentinel to go through still.
 
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A veterinary clinic that I follow on Facebook shared a post about this today. The point they made was that if there was any reason to believe it was truly a risk to your pet's health, it wouldn't be FDA approved. That's not to say that FDA approved drugs have not been later pulled off the market, but just keep in mind that with the current anti-pharmaceutical culture pervading the interwebs, any anecdotal evidence of a problem is going to get blown out of proportion.

That said, in the same post that clinic also warned that one of their clients had ordered Trifexis through an online pharmacy (most likely 1800PetMeds or something similar) and what they received in the mail were two Trifexis boxes with the expiration dates and serial numbers scratched out, and the product in the box was not real Trifexis. It sounds like you got your meds directly from your vet so this may not be relevant to your case, but if you have friends who are having problems it may be worthwhile to ask about where they're buying their meds.
 
I've used it on all but one personal dog (she has seizures) and all rescue dogs since it hit the market. No problems ever. Most I have heard of at my clinic is vomiting but we tell them to give with a full meal as suggested by the company. I have also gone to several CE meeting about the product. I like it a lot but I really can't stand topicals because I have short coated dogs.
 
The GP I worked for sold Trifexis ALOT! & In my 4 years of working there I Never heard of any reaction other than vomiting (which could be due to owners not giving with food as directed, or just bc the dogs body wanted to puke it up lol)
 
There are always mutations, even in well bred dogs.

Just because your dog took the drug and had a reaction doesn't make it inherently bad. Different drugs affect dogs (and people) differently. It's probably just not a good fit.
 
HowIMetYourPet said:
So, here is my next question (not trying to argue, just...figure this out)....

The first two dogs I know had unknown background...they very well could have a history of sezures, or at least be genetically predisposed to them. This is why I didn't take it to seriously originally.

My dog is a different story. I bred this particular dog, I own both her parents, her grandmother, and am familiar with every dog behind her for the last three generations-all of whom are alive and well, and who have never had any neurological problems. Many of the siblings/aunts/uncles/nephews/etc have been "kept up with" and the same thing-no history of any neurological problems. The breed as a whole is not susceptible to neuro problems....cataracts/patellas are the only real health problems in the breed (and possibly SA, but only in certain lines so far). Nothing else changed in the dogs environment within a week or two, no new cleaning products, no stressors, etc. The reaction happened about 5 hours after the dose (the same time frame it gives to start working). Also, the reaction wasn't a seizure....(neither was the 2nd dogs)....it was other strange behaviors......It started with her just staring at the ceiling....she *could* look away, if I physically moved her head, but as soon as I would let her go, it would gradually rise back up....she then started trembling, and rocking her head back and forth (like some do when they come out of anesthesia).....this is when I took her to the ER vet because I was worried that she could have gotten into some kind of poison.....she never vomited, she never lost consciousness, and she was never unresponsive. This doesn't sound seizure like to me (but what do I know 😉 )

If nothing else, I would be curious as to the mechanism of this.....how are these drugs (or their vehicle?) affecting these dogs neurologically?
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My Morkie had the same reaction last night. She's been taking Trifexis without issue for a year. Last night I gave her her pill and 3.5 to 4 hours later she woke me up. She was in my bed, facing a bare wall and staring at the ceiling. She is usually pretty verbal, but she didn't make a sound. We could move her head but she'd slowly raise it up. I reported the issue to the manufacturer, but the agent didnt offer a solution aside from "keep an eye on her." I'm most concerned about long-term effects. She seems lethaegic today. Is there an antidote for this medication?
 
SDN is not intended for medical advice. Any questions you have should be discussed with your pet's veterinarian. As such, I am closing this thread.
 
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