# Heartworm Prevention - Advantage Multi OK?



## Kojack (Nov 17, 2013)

Hello,

I have searched the forum and read about 150 pages of posts, but haven't found a clear answer.

We are considering Advantage Plus for our 6 month old GSD. Thoughts?

We live in Indiana, and we have mosquitos about 10 months out of the year. I like the idea the Advantage Plus also controls other pests.

Our vet recommended Trifexis, but after reading all the death stories, I wouldn't give it to a stray dog if it was all I had....

We have also read about certain Heartworms becoming resistant to Ivermectin, so we planned to stay away from those medications.

All the reviews we have read about Advantage Plus seem to be positive, but I wanted to hear it on here from people with specific knowledge of GSD's.

Thanks!


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## LifeofRiley (Oct 20, 2011)

I live in Illinois (your neighbor state) and I use HeartGuard. My current dog was HW+ when he arrived in rescue and we fostered him through his post-treatment recovery period... yes, we wound up adopting him! 

I have talked at length with vets about the various options out there and have decided to stick with HeartGuard. Of course, the stakes are higher with my dog because he was once HW+ and it is not recommended for dogs to undergo multiple treatments... it is very hard on them. My take-away from these discussions is that the vets think that HeartGuard is the best preventative out there.


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## LifeofRiley (Oct 20, 2011)

I should add that it is less about the brand and more about the formulation. For dogs who have once been treated for HW, it is recommended that they use an Ivermectin-based HW preventative. I honestly don't know what Advantage Multi uses.


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## Magwart (Jul 8, 2012)

This year, I shifted mine to Advantage Multi after doing a lot of research. I literally have a spreadsheet regarding the various products. I'm in South Louisiana -- major HW area, where dogs not on year-round prevention are virtually guaranteed to become infected.

I believe Multi is a very good product. The major downside is it's inconvenient, as compared to a flavored chew or flavored tab. It is it stinks when you apply it, and you have to remember not to pet your dog in that area on the back of the neck/shoulders. They have a greasy spot for a few days. You also have to be very careful that all of the product goes on the SKIN and not on the hair -- it's wasted if it's on the hair and your dog may not get enough of the active ingredient.

Here's why I switched to Advantage Multi from Iverhart Max (a Heartguard clone):

1. In the Auburn study, it's the ONLY product they tested that was 100% effective against the "resistant" strain of heartworm emerging in the Mississippi delta. 
Heartworm preventive efficacy study results revealed at NAVC - DVM

Also: 
DogAware.com News Archive: Heartworm Preventive Effectiveness

Where you are, resistance likely isn't a big deal (yet). Where I am, I keep hearing of people who had dogs on ivermectin (Heartgard, Tri-Heart Plus Iverhart, etc.) who claim they never missed a dose and their dogs tested HW +. Resistance has been rumored for years here, but it was typically explained away as owner compliance error (too late one month, missed a month, etc.). The Auburn study proved it's real. 

I decided to switch from Iverhart Max to Advantage Multi because I want to be using the most effective product that exists: 2 of my 3 have already gone through HW treatment upon rescue. If I lived in California or the Northeast, where resistance hasn't been found yet, I'd likely still use a less expensive, ivermectin-based product. 

2. Adv. Multi is one of only a few preventatives that protects against whipworms. Again, that's not a problem for most people as whips are rare. The shelter I pull many of my fosters from is infested with them though, so nearly everything comes out of there with whips (or hooks). Keeping my personal dogs on a product that protects against whips and hooks is thus important to me.

3. The flea protection is a bonus. It's been effective for me--we never see fleas. It gets rid of them on the foster dogs too.

4. The cost is better than Trifexis (I pay $14/mo. at KVsupply.com for Advantage Multi; Trifexis is $19/mo. With 3 dogs x 12 months, that $5 difference turns into $180/year saved).


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## Magwart (Jul 8, 2012)

LifeofRiley said:


> I should add that it is less about the brand and more about the formulation. For dogs who have once been treated for HW, it is recommended that they use an Ivermectin-based HW preventative. I honestly don't know what Advantage Multi uses.


Do you by chance have any links regarding that recommendation? I'm curious what the documentation is on it. I know a lot of treated dogs who are currently on Trifexis and Multi (neither is ivermectin-based). 

Advantage Multi uses moxidectin, which is the same class as ivermectin, but formulated differently. Down here, many vets actually are putting HW+ dogs on Multi instead of ivermectin-based products. Our rescue's vet wants all the HW+ dogs on Multi, not ivermectin.


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## LifeofRiley (Oct 20, 2011)

Magwart said:


> Do you by chance have any links regarding that recommendation? I'm curious what the documentation is on it. I know a lot of treated dogs who are currently on Trifexis and Multi (neither is ivermectin-based).
> 
> Advantage Multi uses moxidectin, which is the same class as ivermectin, but formulated differently. Down here, many vets actually are putting HW+ dogs on Multi instead of ivermectin-based products. Our rescue's vet wants all the HW+ dogs on Multi, not ivermectin.


Hi Magwart,

That is really interesting to hear. I will see if I can find some info, but primarily this is what I have heard from veterinarians in my area. I know that my vet special orders HeartGuard for me because the product they sell is not Ivermectin-based and they recommended that I use an Ivermectin-based product. 

It seems that I may have some more research to do on this topic as I bet the vets in your area have a lot more experience dealing with dogs that have been treated for HW than my vet.


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## LifeofRiley (Oct 20, 2011)

Magwart –I didn’t find any scientific data to support (or refute) what I have been told by my vets re: using an ivermectin-based preventive for dogs that have previously been treated for heartworm…. it is very possible that this information is simply not up-to-speed on the latest thinking because I did get the distinct impression that my vet doesn’t see dogs that have been treated for being HW+ that often. 

To be fair to my vet, I probably also dismissed Advantage Multi as an option for me as I really do dislike the topical application method and I do not live in an area where year round flea/tick treatment is necessary.

Anyway, I did find some interesting info on ML resistance that I thought I would post here for you. You have probably already read these, but just in case…

http://www.heartwormsociety.org/veterinary-resources/AMHS_Symposium.pdf

CAPC changes heartworm guidelines due to evidence of resistance - DVM


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## blackshep (Aug 3, 2012)

With horses, we rotate dewormers to help avoid a resistance issue. Would this be something that people should do with heartworm medication, rather than sticking with one brand/drug class?


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## Kojack (Nov 17, 2013)

So is Advantage Multi safe? This is a 6 month old with no history of hw.


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## LifeofRiley (Oct 20, 2011)

Kojack said:


> So is Advantage Multi safe? This is a 6 month old with no history of hw.


Moxidectin is an FDA-approved heartworm preventive for dogs – it is the active ingredient in Advantage Multi for heartworm prevention. As Magwart stated, it is in the same product class as Ivermectin. A lot of studies have been done on the safety of moxidectin. According to the studies I have read, Moxidectin is both safe and effective. In fact, it seems to be safer than ivermectin for dogs with the MDR1 gene mutation (primarily collies).

The question I would ask myself, if I were you, is whether or not you need the "Multi" side of "Advantage Multi" year-round given where you live. For example, are fleas a year round problem where you live? 

I would also consider what application/delivery method you prefer. The comments I made earlier about the topical application method were based on my personal preference, not safety issues. 

Anyway, I hope Magwart re-visits this thread to share more of her personal experiences with using Advantage Multi.


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## Magwart (Jul 8, 2012)

In non-MDR1 dogs, there's probably nothing more studied than ivermectin (the active ingredient in Heartguard, Tri-Heart, Iverheart, Pet Trust, etc.). It's been around forever, and the amount used in HW meds is super-low (it gets used (safely) in WAY higher doses to treat mange, for example). That said, I don't use it any more because of the resistance issues in _my_ region. Until I became concerned about this, I used ivermectin-based products because of the long, long history of safety.

We've put Multi on many, many dogs in rescue, and I know lots of people who use it on personal dogs. I know of no adverse reactions -- it doesn't mean they don't happen; I just haven't heard of any. The biggest risk to it is consumer application error (putting it on the hair instead of the skin, and the dog not getting enough of the medicine).

The only major down side is the smell and not being able to pet the dog on the back for a few days (which can be annoying). That said, I'm in an area where year-round flea prevention is useful. 

I also know lots and lots of people who use Trifexis without adverse reactions. Many find it far more convenient to just give a pill.

I think Riley's right--figure out what components you need year round, whether you need dewormer and if so what kind, and go from there to pick a suitable product. They're all approved by the FDA. 

I also am finding more and more people using the 6-month Proheart 6 injection (the dog gets a shot every six months, no monthly doses to remember), if all you want is heartworm protection. My vet has his personal dogs on Proheart 6, in fact. 

There's a ton of choices. It just all depends on your lifestyle and environmental needs, and what delivery method you find convenient. The main thing is pick a delivery method you'll use, consistently. If you're the kind of busy person who might forget to give a dose, the shot might be the way to go. If you are outdoorsy and need flea protection, or you need dewormer protection, Multi or Trifexis might be the way to go. If you want the most economical option, Iverheart or Pet Trust (ivermectin-based) would be the way to go.

Lots of variables here -- the important think is to keep the dog on _something_ to protect against heartworms!


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## LifeofRiley (Oct 20, 2011)

blackshep said:


> With horses, we rotate dewormers to help avoid a resistance issue. Would this be something that people should do with heartworm medication, rather than sticking with one brand/drug class?


I, honestly, don't know if that is a factor in the HW drug-resistance that has been documented with dogs. But, it is interesting to hear that changing up de-wormers is a common practice when it comes to de-worming horses. 

It seems to me that a lot of the current focus on the resistance issue is on the use of the "slow-kill" method to treat heartworm and on factors unique to the Mississippi Delta region due to studies that suggest that the "resistant" strain has not spread in ways scientists would expect based on other vector-borne diseases.


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## LifeofRiley (Oct 20, 2011)

Magwart said:


> *There's a ton of choices. It just all depends on your lifestyle and environmental needs, and what delivery method you find convenient. **The main thing is pick a delivery method you'll use, consistently.* If you're the kind of busy person who might forget to give a dose, the shot might be the way to go. If you are outdoorsy and need flea protection, or you need dewormer protection, Multi or Trifexis might be the way to go. If you want the most economical option, Iverheart or Pet Trust (ivermectin-based) would be the way to go.
> 
> *Lots of variables here -- the important think is to keep the dog on something to protect against heartworms!*


:thumbup: I completely agree!


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## Twink90 (May 21, 2014)

I live on a farm & always wondered if I should rotate wormer on dogs . We use ivermectin, Strongid, panacur & quest for my horses & goats. In fact I rotate my flea protection on dogs &. Cats. I will have to ask my vet his opinion on this .
I too have a rescue that had HW treatment over 7yrs ago. We use Iveheart Max year round. I know a lot of friends that are happy with the multi. I may try as fleas, mosquitoes & ticks are horrible! Frontline plus quit working for me & advantix isn't doing great with fleas for me right now.
Good luck


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