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Tuesday, February 15, 2011

Best Heartworm/Flea Preventatives?

Krissy, a veterinary student at UC Davis, sent me this question last week.


Thanks again for your insight on your blog, I really enjoy reading. Today we had a rep (a vet) from Bayer (the company that sells advantage) and they said there was this study and that only THEIR heart worm/flea preventative (Advantage Multi) was the only one that prevented heart worm in 8 out of 8 dogs. Very interesting, you can see the info just released this past month.
http://veterinarynews.dvm360.com/dvm/Veterinary+news/Leading-parasitologist-reveals-heartworm-preventiv/ArticleStandard/Article/detail/703785?contextCategoryId=40534
I understand this is a very small data sample, but of course they wanted to have to infect and kill as few dogs as possible. I also know that different products are better than others depending on the situation, like some permethrin tick preventatives are toxic to cats. I think it is difficult as a consumer to understand which product is the best on the market and most cost effective (in this economy). I have found some info on the internet, and in a clinic I worked in previously we primarily used Frontline and Revolution. But I was wondering if you would share your personal thoughts on this topic. If you would like of course! 



Krissy, you'll find that this is a complicated topic, and every pharmaceutical company can present hard data on why THEIR product is better than their competitors.  So you can't completely go by what the reps say, as their job is to convince you to use their product over all of the others.  That doesn't mean that they're wrong or deceptive.  You just have to understand their perspective and reasons for communicating.


I wasn't familiar with the data in the article so it was an interesting read.  I am very familiar with Dr. Blagburn, and have heard him lecture several times as well as have spoken to him personally at a conference.  I have a lot of respect for his opinions and research, and overall trust his judgment.  However, besides the small sample size remember that this was also a laboratory setting.  Real-world data may be different.  So while Advantage Multi may be a good product, I wouldn't use this one study to prove that it's the best product on the market.  Lastly, one of the problems facing parasitologists is the increasing data showing likely resistance of certain populations of heartworms to current preventatives.  I foresee this being a big problem within a decade or so.


Now you asked my opinion, and I'm happy to give it.  But remember that this is my personal opinion.  Yes, it's based on all of the data I've come across, as well as lectures by Dr. Blagburn and others, personal experience, and information gleaned from journal articles.  I certainly don't consider myself an expert in this area, and I'm sure my views can be contested by others.


Heartworm prevention:  Personally I really like Proheart.  Studies have shown that it's just as safe as any other prevention on the market, and it's had limited enough use that I'd be surprised at any resistance.  What I really like is the fact that it's not dependent on the client remembering to give a pill or apply a product every month.  Twice annual injections (once annual in some countries) and you're covered.  I still think the ivermectin-based preventions (Heartgard, Iverhart, etc.) are effective for most pets.  I worry that topical products like Advantage Multi and Revolution can be made less effective by frequent bathing and other factors, though admittedly those are not going to be common situations.  I haven't seen evidence that one prevention completely overwhelms the others.  In my practice we use Proheart 6, Revolution, and an oral ivermectin preventative.


Flea prevention:  There are a lot of strong opinions on this topic.  For my first choices I really like Comfortis and Vectra (sold under the brand FirstShield at Banfield Pet Hospitals....same product, different names), each for different reasons.  My views are based on discussions with Dr. Blagburn (and some pointed questions to him a few years ago) and local dermatology specialists.  I think that the Bayer products (Advantage, K9 Advantix) are still good and I do think they are worthwhile choices.  I haven't been a fan of Frontline for many years.  I also don't like Program/Sentinel, as it doesn't actually kill fleas.


Krissy, I hope this answers your questions.  As flea season is beginning soon, this is a good reminder of the importance of these products.

18 comments:

  1. Why is Frontline not one of your favorites for flea/tick prevention in dogs? While I had my two dogs - I used Frontline on them for many years and the rescue group I now foster a dog through also uses it. Would just like to understand why it may not be the best thing for dogs. (Also - I live in AZ - so this climate is a breeding ground for these critters.)

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  2. Thanks! That helps a lot, looks like I have more research to do, as always in this profession, everyone has opinions! Thanks for sharing your insight and experiences.

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  3. Good question, Stefanie. Frontline isn't a bad product, and it's far better than the cheaper products like the Hartz line. However, based on conversations with lecturers such as Dr. Byron Blagburn and Dr. Mike Dryden (also a flea/tick expert) I feel that other products are more effective. Vectra covers more of the flea life cycle than Frontline, and Advantage/Advantix have been repeatedly shown to have no resistance world-wide. Neither claim can be made by Frontline. Also, the opinion of Drs. Blagburn and Dryden seem to fall more in favor of Advantix and Vectra. Frontline would be my fourth choice, coming after Comfortis and the above two.

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  4. Frontline would be better than nothing, right?

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  5. Correct, Liz. I don't think that Frontline is a bad product. I just think that other products are better.

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  6. I like Intercetor and Comfortis. I'm excited to see more about the new Trifexis that combines the two into one pill

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  7. Hmm, I hadn't heard of Trifexis. I like Interceptor and Comfortis, so that may be one to watch for.

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  8. I'm kind of concerned about the Trifexis. After one does my four month old labradoodle has been heaving (with his entire body) and lethargic. Don't think I like that.

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  9. Since I posted this a year ago we have carried Trifexis and I really like it. However, both Trifexis and Comfortis have vomiting as a common side-effect. This doesn't mean that there is any toxicity or danger, just an annoying side-effect. If this is significantly affecting your pet, consider an alternate medication. But you don't need to worry about your dog.

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  10. You should be aware that Vectra has been discontinued and is no longer available....

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    1. We still carry Vectra 3d and Vectra for cats in the veterinary clinic that I work in, and I have not heard anything about it being discontinued or unavailable....

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  11. I haven't been able to confirm that. I know that 800 PetMeds no longer carries it and lists it as either discontinued or unavailable. Also, this post is from 2 years ago and I can't to back and update almost 5 years of posts.

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  12. I live in the woods in northern ontario and although we only seem to have problems with tics and flees in the summer (winter is way too cold -30celcius), summer is approaching and i have taken on 2 new members of my family.... taken in 2 rescue cats. So now i'm up to 3 cats, one dog. I prefer to just bring them in and have all of them get an injection all at once. Can you advise which i can ask for at my vet that will be compatible with my dog? These new rescue cats are "outdoor" wanderers so I don't want them bringing back flees or ticks. My other cat and dog are indoor pets.

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  13. There are no injections for fleas and ticks in dogs or cats. The only products available for ticks are all topicals or collars. Anything safe for a cat will also be safe for a dog, but not necessarily vice-versa. Since I don't know what products are available in Canada, just bring this scenario to your vet and ask what they recommend.

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  14. Is it safe to use Trifexis along with a topical for tick control, such as Advantix?

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  15. Absolutely safe. In fact, I'll recommend doing so when there is a bad flea infestation.

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  16. I have read about several canine deaths related to proheart before the recall and after it has been reintroduced. Some vets are asking for blood work before injecting. Do you have any thoughts on this? Thanks, Lisa

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  17. Proheart is as safe as any other medical compound, and any fear is all hype. Because it is an injection, it does have a chance of causing a reaction similar to vaccines. But it's no worse than that and one study showed that it was less likely to cause any sort of a reaction than vaccines. Another study showed no statistically significant difference between ProHeart, Interceptor, and Heartgard. For the first two years after re-introducing the product there were numerous limitations that the company placed on the product to be safe. When two years of using it showed no difference whether or not blood tests were done, and whether or not it was given with vaccines, the company released most restrictions, only requiring a permission authorization and a maximum age restriction. About a year ago they lifted even those. There is no reason to have to do blood tests prior to giving ProHeart, any more than prior to giving vaccines or any other heartworm prevention. And the fear is strictly found in the USA. Many other countries have used the product safely for about 10+ years and have had no issues what soever. I actually use ProHeart on my own dogs, and have had no issues.

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