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It's Not About the Drug, Silly

December 4, 2012

It's Not About the Drug, Silly

December 4, 2012
Posted in: Dogs | Reading Time: 9 minutes

It's hard to believe a dog who exhibits such strength and confidence, ok, over confidence, can suddenly turn into a ball of mush, eyes filled with fear and looking to me make him feel better.

Last weekend we had a big scare. Normally, the dogs have taken Interceptor for their heartworm medication. When we moved to Switzerland, we learned there was no heartworm there so they did not take it the first year there. The second year, I put them on a European heartworm prevention simply because we were traveling south more often with the dogs where heartworm was prevalent. They took it with no problems.

I scheduled a check up with their vet a few weeks after coming back to California and to get them back on their normal heartworm medicine here, since we were out of it. Only there's a shortage of Interceptor, so our vet, like many out there, recommended Trifexis, which is the same ingredient as Interceptor, plus a "green/natural" flea prevention called Comfortis. My vet has had excellent experience with Comfortis in the past, but we never took it. In fact, I never put them on flea medicine and just used a tic collar because we never had issues with fleas. So when she suggested using Trifexis, I didn't question it (my mistake) since Comfortis is marketed as a"natural" flea repellant and not chemical.

Directions said to feed with a meal since it could cause nausea. I fed them their dinner at 8 pm with their dose of Trifexis. By 11:30 PM, Loki started becoming a bit needy, glassy-eyed and oddly affectionate. I sat with him and scratched his back as he normally loves but it wasn't long before he started becoming more agitated. Neediness turned into fear. Soon he looked like  he was on a bad acid trip. I'd seen that look before. The first time I'd ever given him Acepromazin for car anxiety, he had that look. But this time, it was worse. He staggered, paced and stumbled and looked like he was on the verge of vomiting. My poor boy leaned into me hard and looked to me to fix it and yet I had no idea what even caused it until I remembered giving him the Trifexis. While I do dose ACE occasionally for long car trips, I only give a mild dose and he usually just relaxes. His symptoms on Trifexis were so much more frightening. Loki's crackery may sometimes get on my last nerve, but nothing frightens me more than seeing him cracker-less and afraid.

I quickly called the ER and talked to the tech. After discussing the options, we opted to monitor his breathing and if it became labored, to bring him in. She told me that they had seen dogs with similar reactions who "weren't themselves" after taking Trifexis and that it should pass. I stayed up with Loki until 3:00 AM monitoring him as he finally  settled into his bed and went to sleep. To pass the time, I googled side effects of Trifexis.

From the Trifexis site:

 Like all medications, sometimes side effects may occur. In some cases, dogs vomited after receiving Trifexis. If vomiting occurs within an hour of administration, redose with another full dose. During field studies, no severe or prolonged vomiting occurred. Additional adverse reactions observed in the clinical studies were itching, decreased activity, diarrhea, inflammation of the skin, redness of the skin, decreased appetite and redness of the ear. All reactions were regarded as mild."

WTF? Redose something that just caused a dog to vomit? What kind of advice is that? Moving on...

Ask A Vet a Question posted an article about the topic.  The vet/author reached out to readers to share any stories on reactions they've had because she had only good experiences with it and was just starting to hear about negative effects rumored on the Internet. As of Sunday, she had 230+ commenters. As of today, she has 318 commenters and she is quickly editing her article and changing her own opinion. Some had dogs with symptoms that were genuinely related to Trifexis and some were inconclusive. Some dogs exhibit vomiting after dosing, in which case the recommendation by vets is to dose them again and stay on their regularly monthly dosing.  Some dogs exhibited exactly what Loki's symptoms were, neurological impairment. Some dogs had seizures. Those seem to be dogs prone to seizures. Some dogs showed extreme fear by hiding under furniture and other unusual behaviors. Some dogs have died after showing symptoms and receiving monthly doses. I have no real conclusive research on the drug, just a few stories (of the hundreds) that I read on the Internet.

It's not my place to condone this drug, because I'm not a vet, nor have I done real research. Also, there are many dogs on it who do very well and show no symptoms. My biggest concern are vets who overlook severe symptoms such as vomiting and neurological issues and advise to keep dosing the dog month after month, as some of the commenters relay. Afterall, Comfortis is supposed to be a "natural" flea remedy.  But arsenic is natural. And it doesn't take a scientist to know that small doses of it make us sick and large doses can kill us. Further research into Comfortis' ingredient, spinosad, shows that while it is a "green" pesiticide that comes from bacterial fermentation, it is by no means organic because it uses a chemical method to slow down spoilage.

But none of that really matters. Because sometimes drugs or natural remedies help, and sometimes they hinder. And if it's one thing I've learned, it is to trust the body. This is not chemotherapy. It's a prevention. It shouldn't cause your dog to be sick. Common sense tells me this is not good for my specific dog. When I shared Loki's experience with my vet, who is a wonderfully balanced Western and holistic veterinarian, her immediate response was "do not give it to him again." Even if she didn't advise that, it wouldn't matter, because there's no way I'd ever give it to him or Juno again. Though, to be frank,  Juno had no reaction to the drug.

It's not about the drug. It's not even about the vet who advises taking it. It's about being completely aware and accountable for caring for your best friend. Yes, pharmaceutical industries and doctors make mistakes. And yes, both are driven by capitalism. But ultimately, the buck stops with us. We make the choice on our own healthcare and our dogs' health care. The only way to get better healthcare for dogs and for ourselves is to not be led blindly and not to give up accountability but to take an active role in your pet's (and your own) healthcare. Research, ask the important questions. Don't be complacent in believing that doctors, pharmaceuticals, or even holistic care providers are infallible. They're not.

Loki remained clingy the next day but was more alert. And by day three he was back to normal.

Interestingly enough,  makers of Interceptor list the same possible side effects from Interceptor that dogs who've taken Trifexis have had (but Trifexis doesn't actually list, yet):

 Side effects of Interceptor are rare, but some animals may show signs of depression, drowsiness, vomiting, loss of appetite, diarrhea, hypersalivation, seizures, and weakness."

And side effects from Comfortis:

The most common adverse reaction reported is vomiting. Other adverse reactions reported in decreasing order of frequency are: depression/lethargy, decreased appetite, incoordination, diarrhea, itching, trembling, excessive salivation and seizures. Following concomitant extra-label use of ivermectin with Comfortis, some dogs have experienced the following clinical signs: trembling/twitching, salivation/drooling, seizures, ataxia, mydriasis, blindness and disorientation.

Ever notice how most drug side effects cover the array of anything and everything?  Why can't they make a drug with side effects like cleaning the house or doing the laundry?  I digress. . .

Unlike Trifexis, I couldn't easily find any Google-researched stories related to serious dog illness or fatalities from Interceptor.  One site notes that Comfortis should not be used with Ivermectin, the active ingredient in the other heartworm drug, Heartguard. It states that it could result in Ivermectin toxicity, or increased sensativity to the drug. Heartguard, which prevents heartworm, roundworm and hookworm, lost its marketshare in recent years because it was shown to be toxic in collies or mix-breed collies. Hence Interceptor came on the market with its ingredient, milbemycin oxime, which added whipworm to the list of worm prevention in Heartguard. I always wondered why I didn't see Heartguard anymore.  Thank you Internet for enlightening me. I can now sleep at night, knowing the answer to that question that plagued me so.

I find it interesting that Comfortis can't be used with Heartguard (Ivermectin) but there's nothing yet on its use with Interceptor (milbemycin oxime). Maybe that will change. And maybe if I had done the research earlier, I would have caught that drug interaction and questioned it for the new compounded drug.

Did I lose you yet? If you're confused, don't be. Just ask your vet questions about side effects of every drug s/he recommends. Ask about interactions with other drugs or natural remedies you already administer to your pet. Ask your friends their experiences with the drug/remedy they use. And do the Internet research. Now more than ever, it's easier to become informed. Google researching may cause you to lose and hour or two but it will save you time, money and the health of your best friend in the long run.

In the mean time, if they ever make a drug with side effects that includes washing the windows, I'm totally going to continue dosing it. And stock up on Windex.

Ain't Too Proud to Beg

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13 comments on “It's Not About the Drug, Silly”

  1. Thank doG, Loki is okay and that you were able to see his distress. I feel sorry for the other dogs and owners who had experienced worse.

  2. We are on Trifexis, but only because Interceptor is not available. We will go back when - if - it is available again. While The Herd has had no adverse effects, I do not like giving them any medicine they do not need - which include flea medications in our part of the world (one of our blessings - no fleas and no ticks).

    The issue is that the manufacturing plant that makes Interceptor had quality control problems (putting the wrong meds in the wrong bottles) on HUMAN medicine. It has affected a number of medications (such as Excedrin, Gas-X, NoDoze, etc.

    The problem is Heartguard uses Ivermectin which has had adverse effects in some breeds, particularly herding breeds. I am NOT an expert in those breeds, but have certainly read of concerns to avoid ivermectin.

    Interceptor (and Trifexis) use Milbemycin Oxime which has generally been considered safer, but Trifexis adds Comfortis which has shown adverse effects (vomiting). Unfortunately, Inteceptor is generally unavailable in the U.S. (though I have heard of Canadians being able to get hold of it).

    A great article for reference - http://www.heartworm.com/prevention/dogs (hopefully, I do not spam out by adding a link to comments).

  3. Wow. I just gave my dogs Comfortis (not the first time) last night. When I went to pick it up at the vet, the receptionist wasn't aware that it shouldn't be taken on the same day as Heartguard. I'm waiting a couple of days for the Heartguard. I wasn't aware, really, of the issues. So thanks for doing the research on our behalf. My dogs seem to do fine with the Comfortis. I give them Frontline usually, because it wards against ticks which applies to one of my dogs that does trail runs), but when they actually get an infestation (I can feel the flea poop on the their skin), Comfortis knocks it (them) dead.

    My dog who passed away in 2003 was perfectly healthy until he received a multi-vaccination, common at the time. Then he contracted auto-immune hemolytic anemia and died within a few weeks. The symptoms were terrible. Can't be sure the vaccinations were the cause, but my internet research turned that up as the most likely culprit/cause.

    Just so scary when you think you're doing the right thing, taking the steps to care for your best friends, and it turns out to be harmful.

    Glad Loki is back to his old self.

  4. We got a sample of Triflexis when we brought Kuster home from the vet the first time, and my husband put it away because he was too young to have it. But the week he brought it home, I read about a dog having a pretty scary reaction to it, and I decided we'd be avoiding it. I am SO glad that the Cracker will be okay!

  5. Our vet uses Heartguard and has never said anything about problems with certain breeds. Since our new dog Millie is of unknown heritage that worries me. Fortunately she has had a couple of doses of Heartguard with no ill effects. Thanks for the information.

    Cindy

  6. A very scary time for you. We are so pleased Loki is back to his usual cracker self. Neither of these products, as far as we are aware, are available in the UK.

    Thank you for telling us about Trifexis. Should it ever be sold here we will know to stay well clear.

  7. I, too, learned about the collie breed disposition to have adverse reactions to common preventatives. That's pretty scary, but certainly no reason to pull Heartguard. The whole business is scary. I have no doubt that dog drugs are pushed to market (after what I can only imagine are horrific tests with overdosing) and then heavily advertised to vets and consumers as solving yet another problem.

    I cringe that I have to dose my dogs at all, but I do it (heartworm and topical flea and tick). Am I being rational? I wish somebody could give me a regional breakdown of the risk of infestation v. the risks of these chemicals.

    We didn't have heartworm medication when I was growing up and the flea collars we used were likely very toxic, but even still, the little corgi that my family had lived a full and long life.

    I concur that vets are often too dismissive about possible side effects. In their defense (out on a limb here) most clients likely couldn't process more information. But when they have clients (like me or you) who do know how to handle information, it should be made available. My example is phenobarbital. The vet totally understated the side effects and my less than statistically significant sampling of friends all had the same experiences with horrible phenobarbital side effects in their dogs.

    Uh oh, rambling. Anyway, thanks for the informative post.

    Mango Momma

  8. Wow, Thatnks for that information. We get heartguard from our vet and have never been told anything about adverse reactions. Luckily in the 3 years we have been giving it to Rocco he's shown no issues! He is a Sibe so not in the collie breed line, but still that is frightening especially if you don't know your dogs breed specifics.

  9. Poor Loki. It's awful to see a big strong happy dog with such terrible symptoms. Calhoun once got my green tea vitamins off the counter and proceeded to eat the entire contents of the packet. That resulted in his heart pounding a mile a minute. He was probably nauseas as well. He paced and circled. It was so bad and broke my heart. So glad Loki rebounded.

    Mamma Heartbeat

  10. Wow, that is so scary. I'm so glad Loki is okay. Steve and Kat are on Interceptor. I had heard about shortages, but I didn't realize it was basically unavailable. They go to the vet after Christmas. I have them on Advantix also. Ticks are horrible here and with their thick coats, I think I wouldn't find ticks until they were big. We pick up ticks just walking on the sidewalks. Hopefully it will get cold and stay cold this winter to help for next year. Steve and Kat used to take Heartguard, so I guess if we can't get Interceptor I'll ask to go back on that until Interceptor is available. I don't like the sound of everything I've heard about Triflexis.

  11. My Dog is having seizures after taking Trifexis. Also redness of ears. I will never use this drug again. We have put out hundreds of dollars due to this drug to save our dogs life.

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