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Thursday, July 31, 2014

Trifexis Safety Concerns: Poor Reporting And Media Hype

Anyone want to take bets on how long it takes for someone to make a disparaging or hateful comment on today's blog post?  Or how quickly someone accuses me of being stupid, uninformed, or a shill for Elanco?  I'm expecting it because I know that there are some people who are pretty heated about this topic.  Well, so am I, so prepare for my rant.

Last November WSB TV in Atlanta, Georgia "broke" a story about possible dog deaths related to the owners having given them Trifexis, a common and popular oral preventative for fleas, heartworms, and several intestinal parasites.  Living in the metro area near Atlanta and carrying Trifexis, I was of course interested in the story and even a little concerned.  Then I watched it and had to shake my head in amazement at the hack job that was done.  I have always liked WSB and watch them in the morning when I'm getting ready for work.  But the reporter, Jim Strickland, did such a horrible job of presenting the facts that I can no longer fully trust their news department and when I see his reports I wonder what he's leaving out.

Here's a link to the original story, including a video of the broadcast segment.  I encourage you to watch it, as I'll be discussing specifics about it.

It seems pretty damning, right?  But let's analyze how the story was presented.  You get a mention that a University of Georgia pathologist concluded that the hearts of these puppies were inflamed, consistent with a bacterial infection and that there were no signs consistent with a drug toxicity.  Okay, seems like the toxicity has been ruled out.  Nope!  Just a little after that we see a huge "31 DEATHS" fill the screen, even though these were not confirmed to be related to Trifexis.  Which part do you think people will remember?  Does anyone really think that the reporter was trying to present a fair and balanced representation of the facts?

A couple of weeks later a follow-up story was broadcast.  This one proudly proclaimed "Owners blame 700 dog deaths on Trifexis"!  And during the lead-in to the story Strickland says "Since the pill was launched on the market on average every 36 hours a pet owner reports that Trifexis killed a dog."  Shortly after that you see a big yellow "700 DEATHS" fill the screen.  The story goes on and a couple of times the reporter mentions that these are reports made by owners and not confirmed deaths.  He admits that there is no proof of the connection.  Hmmmm....How different would people have taken the story if they mentioned 700 deaths reported but then flashed a big yellow "NO PROOF" on the screen?  Manipulation, folks.  And many people bought into it.

There was also a whooooole lot that was left out and that is pertinent to interpreting the case.
  • Trifexis is made of spinosad and milbemycin oxime, neither of which are new compounds.
  • Milbemycin is the same antiparasitic used in Interceptor and Sentinel.  It has been on the market since the 1990s and has been used consistently since then with no significant adverse effects reported, especially deaths.
  • Spinosad is the same compound used in Comfortis.  It has been on the market and used extensively since 2006.  The only significant side-effect reported is vomiting.
  • Trifexis has been on the market since 2011 and tens of millions of doses have been sold in 15,000 veterinary clinics across the US.  The only thing "new" about Trifexis is that it is the first time that two already existing chemicals were combined into one product.
  • There is extensive testing before any pharmaceutical makes it to market.  While this certainly does not eliminate all possible reactions or problems, it rules out many of the common ones.
  • The reporter never looked into whether or not any of these dogs had any underlying health conditions or were on other medications.  Some investigation!  He never even seemed to consider the possibility of other causes of death or illness.  I'm sure he never bothered to look at the medical records of these dogs to see whether or not the people's thoughts were supported by science and diagnostics.  Investigative reporter my lily white toches!!!  It's obvious that Strickland was more interested in emotions than facts.
Stop and think about this for a moment.  If either spinosad or milbemycin was a dangerous chemical, why are there no reported deaths with the products prior to this news report?  And why are we not getting reports about deaths with Interceptor, Sentinel, or Comfortis?  I think that knowing the history behind the chemicals puts good perspective on how not dangerous they really are.

Speaking of perspective, let's delve into how the Food and Drug Administration handles reporting.  If a client contacts them and says "Product X killed my dog!", they have to put down that Product X is a potential cause of the death.  The "700 deaths" reported are simply the owner claiming that it happened and is prior to any investigation of the facts and other details of the cases.  I'm not knocking the clients as they likely legitimately feel that Product X was the cause.  But when someone like one of the clients in the Trifexis story are convinced that the product killed her dog, then an independent pathologist reports heart disease unrelated to toxicity, which one is a fact and which is an opinion?  And even if the conclusion is that the dog's death was unrelated to Product X, the FDA report will still list it as a "possible" death.  The big yellow "700 DEATHS" is owner-reported and isn't necessarily connected to the truth at all.  And there is no way to remove cases that are confirmed to be unrelated.  So even cases confirmed to be unrelated stay in these preliminary reports.  People don't seem to understand that a report of death doesn't mean that it's confirmed.

In the time that I've been in and around veterinary medicine I've seen similar hype that turned out to be simply hot air.  When I first started practicing in the late 1990s Rimadyl (carprofen) had recently come onto the market as a pain medication for dogs.  It was great and helped a lot of pets, especially with chronic arthritis.  But then all of the message boards (remember, we're pre-Facebook and pre-Twitter here) started blowing up over "Rimadyl killed my dog!"  There were "thousands" of dogs who had died from it, or at least that's what the internet was claiming.  The manufacturer and FDA investigated and found that there was no connection.  In fact, some of the details were pretty ridiculous once you looked into them.  I remember one dog died from lymphoma, yet it had been originally reported with Rimadyl being a possible cause of death.  Some of the deaths happened months after being given Rimadyl.  This is why the "700 deaths" above really doesn't mean anything without more details.  What happened to Rimadyl?  Well, almost 20 years later it is now the single most common pain medication used for dogs in veterinary medicine.  It is trusted and used by tens of thousands of vets in millions of dogs world-wide and we haven't seen wide-spread problems since that initial set of reports (and those were not really "wide-spread problems").

Back in the early 2000s a heartworm preventative called ProHeart6 came onto the US market.  It's an injection that lasts for six months, keeping people from having to remember a pill every month and possibly missing doses.  After a couple of years of use there was an internet blow-up about dogs dying from ProHeart6 injections.  This spread like wildfire as people talked about it via email and forums.  It reached the FDA as people wanted it pulled from the market because of its extreme danger.  Around 2006 the manufacturer volutarily pulled it from the market to conduct further research on safety.  The worked with a well-know epidemiology specialist and compared reaction rates of all heartworm preventatives in the US market.  The study (peer-reviewed and published) showed that reaction rates were statistically the same across all types of heartworm prevention.  There was no difference in illnesses or death regardless of whether the pet took Heartgard, Interceptor, or ProHeart6.  In 2008 it was brought back on the US market with significant restrictions, which were then mostly lifted in 2010.  Over the last six years it has been very closely tracked and monitored, and there haven't been the wide-spread deaths that people seemed to claim.  You know what else?  During all of this investigation it was available outside of the US at a much higher dose that gave a full 12 months of protection, all without the reports of deaths that were seen in the US.

Okay, so the Trifexis report was last November, why bring it up now?  Because apparently WSB and Jim Strickland believe that there is still a story there, and on July 30th broadcast an update.  What was the new, breaking information that caused them to visit it?  There wasn't any.  Seriously.  There really wasn't anything new.  There apparently have been more reports to the FDA of adverse reactions, but once again these are concerns that clients had, and not illnesses or deaths directly related to Trifexis.  So far, every case has shown other causes related to the illnesses or deaths. Thankfully, he was more obvious about stating that these cases were not proven to be related to Trifexis.  But if they weren't proven, where is the story?  What is it other than speculation and emotions?

Here's something else frustrating about these news reports....there is more information on the TV station's website that isn't mentioned in the broadcasts.  So to get more details you have to be willing to go to their site and click on links other than the video.  For example, here is part of a statement from the FDA that you can find on the WSB site:

FDA is aware of adverse event reports in connection with Trifexis and continues to closely monitor them. It is very important to realize that reports of adverse events do not necessarily mean that the product caused the event. Other factors, such as existing disease, exposure to chemicals or contaminants, foods, or other medications may have triggered or contributed to the cause of the event.

I also bet you don't remember Strickland saying anything like the following in his reports: 

For any given ADE report, there is no certainty that the reported drug caused the adverse event. The adverse event may have been related to an underlying disease, using other drugs at the same time, or other non-drug related causes.  And, this listing does not include information about underlying diseases, other drugs used at the same time, other non-drug related causes, or the final outcome of the reaction.

Yet that statement is on the WSB website from last November, specifically attributed to him.  Knowing other underlying conditions and treatments is extremely important in fully evaluating adverse events like the ones currently in question.  I think it's worthwhile to point out a few of those cases so that the average person can see just how much is left out of these stories and how biased the media is in presenting the case.
  • The case that started these reports was related to three Viszla puppies who died after receiving Trifexis.  All three puppies had necropsies preformed by an independent pathologist and reviewed by another pathologist.  In all three puppies there were no signs related to the Trifexis and all three had changes in the heart consistent with a bacterial infection.  Elanco has provided a copy of this report to vets, which I've read, and it is very clear that the pathologists who were not paid by Elanco concluded that the deaths were unrelated to Trifexis.  How much of that made it into the news reports?
  • A Scottish terrier was reported to have had a reaction after a single dose of Trifexis in 2013, having vomiting, lethargy, and ataxia lasting a few minutes, but the recovered.  Okay, that sounds like a problem, right?  And this may be the same dog in the most recent broadcast story, though Elanco's case report doesn't list the client's name.  That same dog had been reported to have vomiting and lethargy after Comfortis in 2012 (remember, same flea ingredient).  The dog also had been diagnosed with cerebellar atrophy in 2004-2005, though that wasn't initially disclosed by the client.  In 2010 there was an elevation in one of the liver values.  Prior to taking Trifexis the dog had other health problems, including hypothyroidism, and was on various homeopathic nutritional supplements.  A liver biopsy after the Trifexis dose showed long-term cirrhosis of the liver.  You see on the news report "my dog took Trifexis, did poorly, and died."  You don't get the full story of the multiple factors and problems involved.  You aren't told that the dog had previous history of liver and neurological problems.  With all of these underlying issues there were multiple potential causes of the dog's illness.  It may also have reacted poorly to the Trifexis due to pre-existing liver problems.  Did these already existing problems make it on the news report?  Only a brief mention, which isn't as impactful as the owner getting emotional.
  • Watch the bulldog case on the same video.  The dog suffered seizures "after her third Trifexis dose".  And her other dogs continued to take it without any problems.  But the woman breaks down crying over this tragic death.  When you read the full report of the case you see that the dog had Trifexis for over six months, with a seizure starting in October 2013.  The vet she saw at that time concluded that the seizures happened unrelated to the Trifexis.  Seizures continued off and on for a month, but seemed to resolve from November until January 2014.  They became worse and by March the dog was euthanized due to seizures being uncontrolled.  The timing and likelihood of underlying problems weren't reported on the news.
The news reports the upset, crying owners, which pulls at the hearstrings.  I completely understand that these owners honestly believe that Trifexis was responsible for their dogs' death and illness.  Their grief is real and in their minds they know the answer.  I'm not belittling their feelings and genuinely wish this hadn't happened to them.  But when you get past emotions and look at ALL of the details objectively, a different picture comes to mind of other health problems.

Could Trifexis be a problem?  Possibly.  I'm open to that possibility, especially if further objective investigation leans in that direction.  But so far I've seen nothing that convinces me that this is a general problem of the medication's safety.  I still consider it safe for the majority of dogs and continue to recommend it to my clients.  If information comes out that confirms deaths and other serious adverse reactions, I'm willing to change my opinion.

Could an individual dog have a sensitivity to the ingredients in Trifexis and have serious health concerns?  Absolutely.  In fact, that may be what has happened in some cases.  However, unexpected or rare reactions are unpredictable and don't indicate a pervasive problem with the product.  We can never tell when a pet is going to have an unexpected reaction.  But the same thing happens in people.  I think most people consider aspirin to be safe, and never think to look at the warnings on the label.  Well, I did, and here are some of the possible side effects listed
Body as a Whole: Fever, hypothermia, thirst.
Cardiovascular: Dysrhythmias, hypotension, tachycardia.
Central Nervous System: Agitation, cerebral edema, coma, confusion, dizziness, headache, subdural or intracranial hemorrhage, lethargy, seizures.
Fluid and Electrolyte: Dehydration, hyperkalemia, metabolic acidosis, respiratory alkalosis.
Gastrointestinal: Dyspepsia, GI bleeding, ulceration and perforation, nausea, vomiting, transient elevations of hepatic enzymes, hepatitis, Reye's Syndrome, pancreatitis.
Hematologic: Prolongation of the prothrombin time, disseminated intravascular coagulation, coagulopathy, thrombocytopenia.
Hypersensitivity: Acute anaphylaxis, angioedema, asthma, bronchospasm, laryngeal edema, urticaria.
Musculoskeletal: Rhabdomyolysis.
Metabolism: Hypoglycemia (in children), hyperglycemia.
Reproductive: Prolonged pregnancy and labor, stillbirths, lower birth weight infants, antepartum and postpartum bleeding.
Respiratory: Hyperpnea, pulmonary edema, tachypnea.
Special Senses: Hearing loss, tinnitus. Patients with high frequency hearing loss may have difficulty perceiving tinnitus. In these patients, tinnitus cannot be used as a clinical indicator of salicylism.
Urogenital: Interstitial nephritis, papillary necrosis, proteinuria, renal insufficiency and failure.
Holy, freakin' heck!  If you take an aspirin it might kill you!!!!

EVERY medication carries potential side effects, some of them potentially serious.  There are no medicines on the market, even natural supplements, that have a completely 0 risk of adverse effects.  It simply doesn't happen!  Seriously, the next time you buy any over-the-counter medication, take a look at the product labeling and worry about the problems you might have.  Could Trifexis have caused some side-effects?  Yes.  But there is no evidence that it is a "dangerous" medication.

If anyone doesn't believe in media manipulation of facts, they need to seriously analyze these stories by Jim Strickland and WSB.  This is pure and simple one-sided fear-mongering and manipulation of emotions.  This is not real reporting, as a true investigation would easily bring up the facts that I've written here.  But that would not make good ratings, and that's all this story is about.  It's designed to make people watch because they fear for their pets.  It's not presenting all of the facts.

Now I know that there are plenty of web sites and reports from people who are convinced that Product X is deadly and should be removed from the market.  I've visited many of them in relation to Trifexis, Rimadyl, and ProHeart6.  I know that there is a good likelihood of someone making a comment, screaming at me for my ignorance, willingness to ignore "facts", and being a "Big Pharma sheep".  In fact, I'm expecting it.  But let's get beyond emotions and look at facts.  Let's look at the full details on cases, not just the emotional people that make it on the news, or the 10 second snippet from pet owner.  And let's put everything in the same font and style, rather than filling the screen with "935 DEATHS". 

With both Rimadyl and ProHeart6 there was a hue and cry about dogs getting sick and dying left and right.  When it was fully investigated it was learned that there was no basis to wide-spread problems and subsequent use over years and years proved the fears to be unfounded.  I fully expect the same thing to happen with Trifexis.

The question I then frequently get is "What do you use with your own dogs?"  I use ProHeart6 for heartworms and Comfortis for fleas.  If ProHeart6 wasn't available, I would use Trifexis.  Yes, even after all of these recent reports.   

35 comments:

  1. Thanks for posting about this as I just heard about the latest WSB report today. I had wondered what your opinion might be.

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  2. I'm the lead volunteer photographer at the city animal shelter in Jacksonville, Florida, and enjoy readying your blog for the extra insight it gives me in working with those dogs (oh, the dreaded Pit mix..which I've found to be great dogs, but that's another blog post and another misconception perpetuated by the media. Don't even get me started on BSL). I've been giving my dogs Trifexis for about a year and they've had no issues with it. It was recommended to me by two different vets. I appreciate you sharing all the facts.

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  3. Great job. Everyone needs to read this.

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  4. Are you sure about Comfortis? I used it on my 9 year old Borzoi. Immediately her health began to fall off. Purely anecdotal, but I doubt I'll use it again.,

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    1. Dont use it, i lost a dog to comfortis, now use coconut oil...all you need!

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  5. Absolutely sure. As I mentioned there is always the chance of an individual reaction to a medication. That is nothing that can be predicted or determined ahead of time and doesn't mean that the medicine overall is dangerous. I have several patients that can't take a certain antibiotic, steroids, or other medications because of side-effects, even though the majority of other patients don't have a problem with that same drug. In these cases you certainly wouldn't want to use it, but that doesn't mean that nobody should. I've used Comfortis in my dogs for years and haven't had any problems.

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  6. Thanks for this. I took my dogs off Trifexis less because of the wild claims of its toxicity--of which I was aware--and more because my Yorkie threw-up each time he took it. My American Staffordshire Terrier tolerated it well. My vet switched to Sentinel anyway (less expensive, too), and each dog does not have adverse reactions. It is good to read a well-reasoned, thoughtful discussion of the subject.

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  7. I don't buy into this! While statistics support the thesis, I feel the need to remind folks that while statistics do not lie; statisticians do, Just because the statistics show no correlation between the drug and the deaths of precious pets do not mean anything. Veterinarians, especially those licensed in Georgia are very bought into the "Of the Day" drugs This brings up an interesting question. How much "buy in" do these vets have in promoting drugs known to produce adverse effects? Are they getting kick backs? The vets are the only ones who know. Keep in mind that no one knows a pet like their owner. If the owner suspects a drug is having an adverse effect, stop the drug immediately. If a pet owner's gut feeling is the drug is too strong or something is just not right, stop the medication immediately and take your pet to a competent vet--not in Georgia. Research all meds before you give them to you loved one. Demand records every time your take your little one to the vet. If I had done all the things I am advocating, my Pomeranian would be alive today. Trifexis is not the only drug that kills. Vetoryl and Clavamox also kill. I know--my pom died because two stupid Georgia vets were so 'bought-into" these drugs. The results are in a little cedar box on my chest-of-drawers along with a paw print after he died. Don't believe what vets tell you; they will lie in a minute to cover their you know what!

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  8. Jacquelyn, I'm very sorry what happened to your dogs. But I can assure you that we have absolutely no "buy in" when prescribing these drugs. We get no kickbacks or any other support for using these drugs. I'm also curious as to why you are singling out Georgia veterinarians, as all of the drugs you mentioned are used across the US and even across the world, including by world-renowned specialists. Why do you think that vets in Georgia are so much worse than vets in the other 49 states or in other countries who are using these drugs at equal rates? And do you realize that many vets in Georgia received their training in other states and move from there to Georgia (as I did)? If you're discounting ALL vets in this state, you are also discounting the training and experience of hundreds of vets who came from outside Georgia. Do you think there is something special about being in this state that makes vets in competent?

    Neither Vetoryl or Clavamox "kills". I've used Clavamox for my entire career of 17 years, and the worst side effect has been diarrhea and vomiting. Can a pet have an adverse reaction to either one? Yes, absolutely. But as I stated above (if you read the whole thing) there is no type of pharmaceutical on the market that has a 0% chance of an adverse reaction. Clavamox is one of the most widely used antibiotics in veterinary medicine and has been for decades. The equivalent drug, Augmentin, is also extensively used in humans. If this drug was so deadly, we wouldn't be using it.

    Believe me, we have NO incentive for using a dangerous drug. We get no payment from the companies and in fact could lose our licenses by knowingly using a deadly drug or misusing an approved one. We are also in this profession because the huge majority of us have a great passion for caring for animals. We hate seeing bad things happen, and we also hate having to see grieving pet owners.

    I do agree that if anyone thinks their pet is having a bad reaction to a medicine, the owner should stop giving it and call their vet. Many drugs have known side-effects that go away after stopping the medicine, but the vet will want to document this in the medical records. Pets CAN have unwanted effects, and in rare cases they can be serious.

    But I'm sure you won't be convinced of anything I say, as you've made up your mind on this issue, and I do practice in Georgia so I am already incompetent by your standards based only on my geography.

    And I have to say that I was expecting a response like Jacquelyn's (read my first paragraph above), but it took a lot longer than I thought.

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  9. I posted once already but included a link and now realize you may have deleted the post because of the link. So here goes again...

    Do you recommend trifexis for pets with compromised immune systems - diabetes or hypothyroidism, for example? Do you recommend to customers that their pets have a full diagnostic work up done prior to starting trifexis?

    I have a comparison question - what is your recommendation on pet treats from China - ok to feed or should avoid? Do you see any connection between the trifexis debate and the China treat claims? I ask because I have not been able to find anything definitively proving that the treats from China are killing pets either. I searched on the FDA site for information and found that there seems to be a whole lot of claims and a lot of coincidences, but no solid facts pointing to the deaths being related to the treats. From the FDA site regarding the testing of pets suspected to have died from the China treats:

    "What were the findings of the 26 necropsies that were performed?

    We are exceptionally grateful to the owners who consented to allow FDA to perform post-mortem examinations of their beloved pets. We understand this is a difficult decision to make and appreciate the opportunity to learn more about the potential cause of death.
    In half of the cases, we found evidence of several diseases, including widespread cancer, Cushing’s disease, mushroom toxicity, abscess, or internal bleeding secondary to trauma. We do not believe that these deaths are related to consumption of jerky pet treats.

    In the remaining 13 dogs, a relationship to jerky pet treats could not be ruled out, although we are still not able to identify an exact cause-and-effect nature of that relationship. Of these 13 dogs, 11 had indications of kidney disease and two had gastrointestinal disease.

    We still have necropsy cases pending and will provide updates in future reports."

    Thank you for your time and consideration of my questions.

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  10. Great questions, Holli! Let me try to address them. And keep in mind that I do NOT work for Elanco or receive any money or support from them. I'm just an average small animal vet with a blog and an opinion. ;)

    Trifexis and Comfortis both carry cautions when using them in dogs with known seizure disorders. But as far as I'm aware there are no concerns when the immune system is abnormal. Certainly dogs with diabetes or hypothyroidism shouldn't be at an increased risk using Trifexis compared to other heartworm preventatives. Remember that milbemycin and siponsad are in other products on the market for which there have been no safety concerns. I don't recommend running lab tests prior to ANY heartworm preventative, including Trifexis. I've seen no evidence that this would help, or that mild underlying health problems related to the liver or kidneys would prevent using this product.

    Now let's say that the pet is showing serious signs of illness or organ dysfunction. In those cases I put the hold on ANY preventative care (vaccines, heartworm preventative, etc.). Prevention is for healthy pets, not sick ones, and if there are major problems we need to be focusing on figuring them out and treating them rather than ignoring them and pushing preventative medicines.

    I'll admit that I haven't looked into the China issue as deeply. I do know that back in 2007 there were many deaths that were attributed to dog food with contaminated gluten from China. This was well documented and investigated. Since then there have been many food and treat recalls for various reasons, but most of those happened because the manufacturer noticed a problem or potential problem and voluntarily recalled the product before health concerns were reported.

    Looking at the data you quoted (and thanks for actually reading my comment rules! But your link was ok. http://www.fda.gov/animalveterinary/safetyhealth/productsafetyinformation/ucm295445.htm) I can't see overwhelming evidence that the treats were a primary cause. In fact, the report highlights my point that there are often underlying health problems that may not have been diagnosed, or may not have been considered by the owner.

    Am I cautious about food and other products made in China? Yep. But I don't think that means that we should eliminate any and all Chinese products. I also know that Elanco has specifically investigated this possibility and has ruled it out as a factor. There are different processes and safety precautions when you're making foods rather than pharmaceuticals, and I'm sure that plays a part in the differences between food recalls compared to drugs.

    Holli, I hope that answers your questions.

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  11. Here's a strange one. Kirby's been taking Iverhart his whole life. He was on Comfortis about a year when we tried Trifexis. His eyes, skin, and a large portion of his coat started getting very dark. His vet couldn't find anything wrong with him and a family vet said it was just hormones. The only change was these meds so I stopped the Trifexis and went back to comfortis and iverhart. His eyes are now their normal chocolate brown and his skin is lightening up. No other changes happened in his diet or activities. Hence I feel it had to be something different in the trifexus so even though I'm not warning against, I don't recommend it.

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  12. That's very interesting, Kirby. Those kind of skin and eye changes are not reported side-effects or concerns with Trifexis. Also, by giving Comfortis you're still giving one of the ingredients found in Trifexis (spinosad). The other ingredient, milbemycin, is also found in Interceptor and Sentinel. No skin, coat, or eye color changes have been noted with Comfortis, Interceptor, or Sentinel, and they've been used longer than Trifexis. Even though the timing is suggestive, I can't see how it would be related to Trifexis. This also illustrates the differences between caustaion and correlation. The color changes are correlated with Trifexis (meaning they happened about the same time), but are probably not caused by the product. Remember that correlation does not automatically mean causation.

    However, if it concerns you, definitely don't use it. Comfortis and Iverhart are both good products and will achieve the same goal.

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  13. Yes, they go after these companies for a story. But where is the outrage over the Chinese Dog Treats that really are killing dogs? I know that my dog was killed by the treats and had the vet confirm that he was otherwise healthy prior to the treat ingestion and I filed a report with the Government with the Vet statement etc. Over 600 had filed similar reports at the time of my filing. The SAME TREATS are still for sale at Costco. I guess an "American Threat" is bigger news.

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  14. Stay away from mixed compounds. My dog was poisoned by Merial Frontline Certifect which is Frontline plus with the addition of amitraz. Little testing was done because all 3 ingredients were already approved for Vet use.
    I would never use Trifexis simply because it is a multi pesticide mix and after my experience I would be very leery of using it. I will stick with older HW stuff like Ivermectin or Heartguard . If trifexis is still out a few years from now I might use it but after the terrible experience with Certifect I am suspect of all untested mixtures.

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  15. Jeff, did you realize that Heartgard is a mixed compound? It's ivermectin plus pyrantel palmoate. And it's not true that little testing is done if the ingredients are already previously approved. The FDA requires that mixed compounds undergo all new testing. Trifexis had to undergo the same trials and tests that had previously occurred with Comfortis and Interceptor. Just because it uses previously known compounds doesn't mean that a company can just put them together and sell a product.

    The USDA governs topical antiparasitics, NOT the FDA, so the rules are a bit different there. But still they have to go through testing, and no company wants to willingly put out a deadly product, especially a large, well-known company such as Merial.

    Remember that ANY compound has the potential to be dangerous to a sensitive individual. Make sure you read my details on that. Just because an individual had a reaction doesn't mean that the product itself is always bad.

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  16. After reading this blog and all of the comments in it's entirety along with the opinions of countless beloved pet owners from other sources, why risk it? Give your pets an alternative natural treatment instead of poisons. May not be as handy but would certainly rid your mind of any guilt connected to poisoning your pet!

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    1. Unfortunately there are no natural preventatives that have been confirmed to prevent heartworms. Yes, I've looked at the sources and various articles written by pro-natural veterinarians. Every single one of them relies on anecdotal evidence rather than real scientific evidence. Saying "I haven't seen X disease in dozens of cases of giving Z treatment" does not constitute real evidence. I even found an article from one a vet who prefers natural therapies who had to admit that there wasn't any real evidence for such preventatives actually working.

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  17. Good, go from toxin overmedicating to no medication with Woo Woo natural garbage.
    Do your homework, use science and not natural garbage promoted by hucksters.Also don't fall for the vet sympathy trolling to make a fee and at the same time poison your dog.You DO NOT need flea poison unless you have flea infestation. You DO NOT need heartworm meds year round except in very select areas. You DO NOT need any vaccines except for rabies after age two if you got puppy shots and a couple boosters, distemper and parvo immunity is LIFELONG after age 2. Use your head and science. DON't be fooled by natural garbage OR YOUR VET trying to upsell you.

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    1. Jeff, I agree with using science. Try doing it for both sides of the issue. Flea medications are used to PREVENT flea infestations. If you wait until you have a lot of fleas you will then have to treat extensively for several months on your pets, home and yard. Prevention is better. Your claim that heartworm prevention is not needed year-round in most areas is completely untrue, and is completely against what the parasitologists and cardiologists recommend. Science supports year-round prevention in most areas. There is absolutely NO proof of lifelong immunity after an initial set of vaccines when a dog is young. I anticipate that the distance between SOME vaccines will continue to increase over the next years, but there is no evidence that these vaccines give immunity for life. Again, the science holds up in the facts I present.

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  18. Just an update almost a year and half later after stopping trifexis. Kirby's eyes have not gotten dark again and his groin area has remained a normal color. This may not be a known side effect but since nothing else was changed I must conclude something in the drug was affecting him internally which, if continued, could have resulted in devastating terms. Today, at age 7, he is a healthy active pup.

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  19. Sorry, not true at all. The leading vet info blogs all say vaccines good for at least 7 years, science my friend, not upselling.I will give my dog another set of boosters at age 8 or nine.
    Science says the heartworm cycle In The Mosquito is broken any time the temp dips below 55 degrees and must start anew, and ivormectin only needed every other month, April through November north of the Mason Dixon line and many other areas. SOME areas in the south need year round.
    You DO NOT need to give flea meds as a preventitive, that is pure bunk and upselling the patient. You have plenty of time if you notice a flea or two to begin treatment with a topical like Frontline.IF you live in the south or have always had a flea problem,then go ahead and treat all the time. Remember all these products are PESTICIDES and be conservative! ANY FLEA AND TICK PILL should be avoided if possible.
    My pomeranian killed by a topical that has as a third ingredient,amitraz,in addition to regular frontline mix ,so even topicals can kill or injure. BETTER to Wait till you see fleas in my book.

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    1. Yes, there is some evidence that SOME vaccines MAY be valid for 7 years, but even the immunology specialists don't agree on this issue. Even if the 7 year duration of immunity turns out to be true that is certainly NOT the lifetime immunity that you stated.
      Every cardiology and parasitology specialist I've ever heard lecture and every single report I've ever read in the veterinary journals advocates year-round heartworm prevention in every part of the country. Are there parts of the country where heartworm isn't a risk in the winter? Absolutely. But when do you start giving it? When do you stop? It is hard enough to get pet owners to to give prevention consistently without them trying to remember when to start and stop. If everyone followed your advice we would see many more cases of heartworm disease.
      I will vehemently disagree with you on not using flea medications as a preventative! That is NOT upselling, that is good prevention. By the time you see a flea or two you already have many more on your pet. And most clients will NOT notice a single flea. Trust me on this with 32 years experience in the field. I've had many, many clients that insist their pets don't have fleas until I show them the dozen or so running around on the skin. Some areas of the country don't need it year round, and I'll agree with that. But I've seen far too many cases of people who waited until they saw fleas before treating and then found themselves with difficulty getting rid of the parasites and having to use more expensive treatments including professional exterminators.
      Can flea preventatives cause harm? In rare cases, yes. But overall these products are safe in the vast majority of pets when used appropriately.
      Obviously, Jeff, we're going to disagree on these issues. I do base my opinions on scientific papers and lectures at professional conferences in combination with personal experience having seen thousands of patients over nearly two decades of practice.

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  20. Approx 60 hours ago we have our 4 year old Boston French Bulldog cross a prescribed single dose of Comfortis. She ate it no problem with her morning meal but by noon that day all was not well. She was lethargic, wouldn't jump or climb stairs that she routinely flew up. We quite sure she had some minor tremors of the rear legs. She continued to eat and drink well but the following day she was unable to lower her head, she wanted her food but couldn't reach her dish. If we held it up she would eat. Walking was on a bit of an angle and slow. She did her business as usual which was a good sign. Called my vet clinic who said she must j=have injured herself and that no way Comfortis would cause these symptoms. Not satisfied with this explanation I phoned Elanco. The agent was sympathetic and friendly but said she wasn't aware of Confortis causing these symptoms. Suggested that I wait 48 hours as most side effects diminish within that period but also offered to pay for a Vet check at their cost if I wasn't satisfied. Said she would call me back today to ensure my dog was improving. Today was a little better but symptoms still persist so after waiting all day I called back. She couldn't offer an explanation but put me in contact with a staff Vet who was friend and very helpful. Said she was quite sure that our dog was suffering from Ataxia. Said generally symptoms would diminish within 48 hours but our dog might be taking a little longer to metabolize the DRUG. Suggested if we were worried (this is the understatement of the year - we haven't slept in 2 nights) that we take her to a local vet at their cost. Vets unfortunately are all closed for the weekend now. She continues to slowly improve but I must say that we have been terrified. We sit on pins and needles hoping that she fully recovers. Folks, don't use this product. A flea free pet is not worth the risk.

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  21. Well it took a full 4 days to get our loving pet back to her almost normal self. I don't care if Comfortis would kill every flee in the county, it is not worth it. I know that any medication may have side effects, but folks this is flee medication not life saving heart medication. If I were a VET (my childhood dream) I couldn't prescribe a medication that could have this type of side effect without making sure that the owner knows that they are potentially putting their pet at risk. I know my Vet and Elanco are going to get some serious negative feedback from me. SHAME ON THEM FOR SELLING THIS CRAP!!!!

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  22. If we avoided selling every medication with potential side effects, our pharmacy shelves would be empty. I'm very sorry that this happened to your dog, but millions (not an exaggeration) of dogs have taken this medication for nearly 10 years, and the vast majority have had no problems whatsoever (including my own dogs). Yes, it's tragic when a pet or person suffers a side effect to a medication, especially when it is serious. But we can't ignore the fact that millions upon millions of doses have been sold world-wide without any adverse effects whatsoever.

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  23. As long as Vets make people aware of how serious the side effects can be, including, Ataxia, seizures, blindness and death. Seems a little to drastic to me just to kill a few flees!!!

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  24. Unless you have historically had a flea problem in your area this or any ingestable preventative is not worth the risk.
    WAIT until you have evidence of fleas and stick with oldet preventative like Frontline plus. DO ABSOLUTELY EVERTHING FIRST before you resort to an ingestable preventative. CHECK THE RECORD as trials to get this approved showed a huge number ( statistically ) of neurological problems.

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    1. So why don't we see these symptoms with Comfortis, Interceptor, or Sentinel?

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  25. Well I've seen first hand the neurological effects of Comfortis. Company downplays the serious side effects and highlights the minor issues like vomiting, lethargy. How many tablets would they sell it they told owners that their dog could go blind or suffer serious neurological effects.

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  26. We have been giving our new puppy Trifexis for four months now. Every time we give it to her she is lethargic/sleeps the next day. She looks sick too having sad/bloodshot eyes. Eventually, she goes back being a normal happy healthy puppy. I am here now because I just gave her Trifexis again and she vomited an hour or so after consuming it with dinner. The pill was in her stomach for over an hour. I searched thru her vomit to look for the pill and could not find it. Did she absorb what she needed from it? I live in Florida and I am wondering if there is an alternative that will cover all her needs. Money is no object. We love our new Mini American Shepherd. She is part of our family. If you could please offer us any suggestions. We do not wish to see her suffer every month. She does not vomit or act this way any other time. It is only after taking Trifexis. If she continues to vomit from it I will always worry she is absorbing what she needs. I researched Trifexis and unfortunately I did read that the insecticide in it is manufactured in China. That is another concern I have about Trifexis.

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  27. Trifexis is as safe as Interceptor, Sentinel, and Comfortis, as it contains the same ingredients as these. Nausea and vomiting is a common side effect of Comfortis and Trifexis and does NOT indicate a toxic reaction. If it has been more than an hour since she took the pill she will have digested and absorbed the medication. If you have any concerns at all, contact your vet.

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  28. Terri Powell, RPh(30 yrs)
    Combining spinosad and milbemycin oxime into one "convenient" pill only increases the risk of doing more harm than good. It's common sense. There will be an increased risk of adverse events with this combination. I would say this combination can be described as toxic to some dogs. The convenience of this drug combination is not worth the potential harm to our dogs. Pointing out the safety record of each drug when used alone is a moot point. Again, common sense. Trifexis is another unfortunate example of a drug company's greed at the expense of patient safety. There are better, albeit inconvenient ways of keeping our pets free of parasites.

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    1. Terri, if you have that much experience in the pharmacy field, then I'm surprised at your comments. There is no reason to believe that combining drugs automatically makes them more dangerous than using them individually. In the human field we see combination products in most over-the-counter treatments for colds, allergies, and even headaches. Why would the combination of products in Trifexis be more dangerous than using the products individually? What evidence do you have that the combination is more toxic than single ingredients? And did you know that virtually every heartworm preventative is a combination product? Most of the common ones contain ivermectin and pyrantel, but you'll find other products with multiple ingredients.

      You should also know that a company cannot simply put two existing products together and then make it available to purchase. Trifexis had to undergo the same safety and efficacy trials that Comfortis and Interceptor did, even though it is just a blending of the two. So the FDA had to evaluate the combination as much as it did the individual ingredients when then first came onto the market.

      How is the company being greedy? They saw a need for convenience that virtually every dog owner wanted, and met that need in the market. How is that greed? And how did they do it at the expense of patient safety when the product was as thoroughly investigated as any other preventative on the market?

      I fail to see how any of your statements are "common sense".

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