NexGard and NexGard Plus for Dogs, NexGard Combo for Cats

NexGard® products help protect dogs and cats from fleas, ticks, heartworms, and certain intestinal parasites, but each product is designed for different species and provides different levels of protection.

Whether your pet is prescribed NexGard®, NexGard® Plus, or NexGard® Combo, it’s important to understand what each medication treats, how to give it correctly, and the potential side effects.

Here’s what you need to know about how NexGard products work, dosing, safety considerations, and when to contact your veterinarian.

What Is NexGard® Used for in Dogs and Cats?

NexGard® products are prescription parasite preventives that help protect dogs and cats against certain external and internal parasites, including fleas, ticks, heartworms, and intestinal worms, depending on the product. 

Because pets can be exposed to parasites year-round, your veterinarian may recommend using these medications throughout the year.

NexGard® products are available in multiple formulations and strengths, including combination products that protect against additional parasites. Always use NexGard® products exactly as prescribed by your veterinarian.

These medications are dosed by species and body weight, so it's important to use the correct product and strength for your pet. Never use a cat medication on a dog or a dog medication on a cat, as this can lead to ineffective parasite control or an overdose.

NexGard® for Dogs

NexGard® is a monthly prescription chewable tablet for dogs that treats and prevents fleas and kills four common tick species.

Approved uses: NexGard® treats and prevents fleas and kills the following ticks:

• American dog tick
• Black-legged tick
• Lone Star tick
• Brown dog tick

It is approved for dogs and puppies 8 weeks of age and older that weigh more than 4 pounds.

Extra-label uses: Veterinarians may also prescribe NexGard® extra-label to treat demodectic mange, sarcoptic mange, and ear mites in dogs. Extra-label use means a veterinarian is prescribing a medication in a way that isn't included on the FDA-approved label when they determine it's appropriate for your dog.

NexGard® Plus for Dogs

NexGard® Plus is a monthly prescription chew for dogs that helps prevent heartworm disease while treating and preventing fleas, ticks, and certain intestinal worms.

Approved uses: NexGard® Plus:

• Helps prevent heartworm disease
• Treats and controls hookworms
• Treats and controls roundworms
• Treats and prevents fleas
• Kills the following tick species:
  • American dog tick
  • Black-legged tick
  • Lone Star tick
  • Brown dog tick

It is approved for dogs and puppies 8 weeks of age and older that weigh more than 4 pounds.

Extra-label uses: Because NexGard® Plus contains afoxolaner, veterinarians may also prescribe it extra-label to treat demodectic mange, sarcoptic mange, and ear mites in dogs.

NexGard® Combo for Cats

Approved uses: NexGard® Combo:

• Helps prevent heartworm disease
• Treats and controls roundworms
• Treats and controls hookworms
• Treats and controls tapeworms
• Treats fleas
• Kills the following tick species:
  • Black-legged tick
  • Lone Star tick

It is approved for cats and kittens 8 weeks of age and older that weigh more than 1.8 pounds.

Extra-label uses: Veterinarians may also prescribe NexGard® Combo extra-label to treat ear mites, notoedric mange, and cat lice when they determine it's appropriate.

Safety Considerations for NexGard® Products

Most dogs and cats tolerate NexGard® products well, but they should be used with caution in pets with certain medical conditions. Your veterinarian will determine whether NexGard® is appropriate based on your pet's health history.

NexGard® for Dogs: Use NexGard® with caution in dogs with a history of seizures or other neurologic disorders. At the time of publication, safety studies had not been performed in breeding, pregnant, or nursing dogs.

NexGard® Plus for Dogs: Use NexGard® Plus with caution in dogs with a history of seizures or other neurologic disorders. At the time of publication, safety studies had not been performed in breeding, pregnant, or nursing dogs.

The manufacturer has evaluated NexGard® Plus in dogs with the MDR1 mutation, and no adverse effects were observed. Dogs with the MDR1 mutation are not considered to have an increased risk of side effects from NexGard® Plus.

NexGard® Combo for Cats: Use NexGard® Combo with caution in cats with a history of seizures or other neurologic disorders. At the time of publication, safety studies had not been performed in breeding, pregnant, or nursing cats.

How NexGard® Products Work

NexGard® products work by using one or more active ingredients to kill fleas, ticks, heartworms, and intestinal parasites, depending on the product.

NexGard® for Dogs: The active ingredient in NexGard® is afoxolaner, an isoxazoline that kills fleas and ticks by overstimulating their nervous system, causing paralysis and death.

NexGard® Plus for Dogs: NexGard® Plus contains afoxolaner plus two additional antiparasitic medications:

• Moxidectin: A macrocyclic lactone that helps prevent heartworm disease and treats certain intestinal parasites by disrupting nerve signaling, leading to paralysis and death.
• Pyrantel: A dewormer that treats hookworms and roundworms by paralyzing the worms so they can be passed in the stool.

NexGard® Combo for Cats: NexGard® Combo contains esafoxolaner, eprinomectin, and praziquantel:

• Esafoxolaner: An isoxazoline that kills fleas and ticks by overstimulating their nervous system, causing paralysis and death.
• Eprinomectin: A macrocyclic lactone that helps prevent heartworm disease and treats certain intestinal parasites by disrupting nerve signaling, leading to paralysis and death.
• Praziquantel: Treats tapeworms by damaging the worm's outer surface, causing it to die and then be digested or passed in the stool.

How To Give NexGard® Products

NexGard® products should be given once a month, year-round exactly as directed by your veterinarian. Administration varies depending on which NexGard® product your pet has been prescribed.

NexGard® for Dogs:

• Follow the directions on the drug label or those provided by your veterinarian.
• Give by mouth once monthly, with or without food.
• If your dog vomits within two hours of receiving a dose, contact your veterinarian. Another full chew may be recommended.

NexGard® Plus for Dogs:

• Follow the directions on the drug label or those provided by your veterinarian.
• Give by mouth once monthly, with or without food.

NexGard® Combo for Cats:

• Follow the directions on the drug label or those provided by your veterinarian.
• Part the fur and apply the medication directly to the exposed skin on the midline of the neck, between the base of the head and the shoulder blades, where your cat cannot lick it.
• If your cat requires a second applicator based on body weight, apply it in the same manner and location.
• Apply once monthly, year-round.
• Avoid contact with the application site for four hours, or until it is dry. Do not allow your cat or other pets in the household to lick the application site.

What Happens If You Miss a Dose of NexGard®?

If you miss a dose of NexGard®, NexGard® Plus, or NexGard® Combo, give or apply it as soon as you remember, then resume your pet's regular monthly dosing schedule. If you're unsure what to do, contact your veterinarian for guidance.

It's important to give NexGard® products once a month, year-round to maintain continuous parasite protection.

Do not give extra or double doses.

NexGard® Side Effects

NexGard® products are well tolerated by most dogs and cats, but side effects can occur. Contact your veterinarian if your pet develops severe or concerning symptoms after receiving NexGard®.

NexGard® and NexGard® Plus for Dogs: Rare side effects may include:

• Gastrointestinal upset (vomiting, diarrhea, or loss of appetite)
• Dry or itchy skin
• Low energy (lethargy)
• Allergic reactions, such as hives or facial swelling

Neurologic side effects have been reported with medications in this drug class. Tell your veterinarian if your dog has a history of seizures or other neurologic disease.

Neurologic side effects may include:

• Muscle tremors
• Loss of balance or difficulty walking
• Seizures

Contact your veterinarian immediately if your dog develops any of these symptoms.

NexGard® Combo for Cats: Cats may drool excessively if NexGard® Combo is accidentally given by mouth or if they lick the application site before it has dried.

Uncommon side effects may include:

• Vomiting
• Hair changes at the application site
• Loss of appetite
• Low energy (lethargy)

Neurologic side effects have also been reported with this class of medications. Tell your veterinarian if your cat has a history of seizures or other neurologic disease.

Neurologic side effects may include:

• Muscle tremors
• Loss of balance or difficulty walking
• Seizures

Contact your veterinarian immediately if your cat develops any of these symptoms.

Human Side Effects

NexGard® products are not intended for use in humans.

When handling NexGard® Combo:

• Wash your hands with soap and water after application.
• Avoid contact with your eyes. If the medication gets into your eyes, rinse thoroughly with water. If you wear contact lenses, flush your eyes first, remove the lenses, then continue rinsing.

Humans should never take medications prescribed for pets, and pets should never receive medications intended for people.

If you accidentally ingest a pet medication, seek medical attention or call Poison Control at 800-222-1222.

Monitoring Your Pet

Dogs should be tested for heartworm infection before starting NexGard® Plus.

The manufacturer does not recommend routine monitoring for NexGard® or NexGard® Combo. However, your veterinarian may recommend additional testing based on your pet's health, other medications, or the condition being treated.

When Should You Call Your Veterinarian?

Contact your veterinarian if:

• Your pet develops severe side effects.
• Your pet's condition worsens or does not improve.
• You suspect your pet has received an overdose.
• You have additional questions or concerns about using NexGard® products.

NexGard® Overdose

An overdose of NexGard® products is uncommon, but if you suspect your pet has received too much medication, seek veterinary care immediately.

NexGard® and NexGard® Plus: These medications have a wide margin of safety. Vomiting may be the only sign of an overdose.

NexGard® Combo: This medication also has a wide margin of safety. In rare cases, overdose symptoms may include:

• Loss of balance
• Muscle tremors
• Low body temperature
• Dilated pupils

If you suspect an overdose, seek emergency veterinary care or contact an animal poison control center. Consultation fees may apply.

• Pet Poison Helpline: (855) 764-7661
• ASPCA Animal Poison Control: (888) 426-4435

How To Store NexGard® Products

Store NexGard® products according to the manufacturer's instructions to help maintain their safety and effectiveness.

Storage guidelines:

• NexGard®: Store at controlled temperatures at or below 86 F (30 C). Brief exposure to temperatures up to 104 F (40 C) is acceptable.
• NexGard® Plus: Store at controlled temperatures at or below 77 F (25 C). Brief exposure to temperatures up to 104 F (40 C) is acceptable.
• NexGard® Combo: Store at 59–86 F (15–30 C). Brief exposure to temperatures up to 104 F (40 C) is acceptable.
• Keep the medication in its original blister pack until you're ready to use it to protect it from moisture and light.
• Keep out of reach of children and pets.