# Heart-worm and Flea-Tick medications



## AKD (Jul 18, 2020)

At what age does a dog need to start taking these medications.

Also Simparica Trio is pushed a lot by vets where we live.
I have read mixed reviews on this forum and other places online about it. What is the latest on this ?

What are folks on this forum using for heart worm and flea-tick ?
Simparica Trio
Heardgard
Interceptor Plus
Bravecta 
are some of the ones that I see been used.


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## LuvShepherds (May 27, 2012)

My dog had a bad allergic skin reaction to Bravecto. It worked, but I had to stop using it. I’m not familiar with the others.


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## dogfaeries (Feb 22, 2010)

Scarlet takes Sentinel for heartworms, roundworms, hookworms, whipworms, and wears a Seresto collar for fleas and ticks.


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## Magwart (Jul 8, 2012)

First things first: what state do you live in? It matters in terms of your options, as northern states have a different approach to this than southern states.

Second, those are all really different products, that cover different things. I think you need to figure out first what you want the product to cover, and then you can back into what your options are. (E.g, Heartgard only covers HW, but not fleas; Bravecto is for fleas/ticks but not HW; Trio covers HW, fleas, and ticks). I don't know whether you're looking for HW protection, flea-tick protection, or all-in-one protection from your post.

In our breed rescue in the Deep South, for HW and fleas, we start pups on Advantage Multi no later than 12 weeks. I think it's labeled as early as 9 weeks. Heartgard can be started even earlier, I think. Nobody knows exactly when the pups become vulnerable to HW disease, so the later you push it, the more of a risk you are taking, if you are in an area with a lot of heartworms.

If your pup is older than 12 weeks and hasn't gotten started on HW prevention, AND if you also live in in a high-HW zone, then I would ONLY use Advantage Multi (or Coraxis) for the next 6-12 months, as it's the only one that kills juvenile-adult worms that escape other prevention products. You'll kill them slowly and end up with a negative test in a year, when you might not otherwise. (Coraxis is the same HW med without the flea component that is in Advantage Multi.)

Simparica Trio is quite new. There's not been much said about it on this forum, and reviews are still super-early elsewhere. Regular Simparica is different than Trio (regular Simparica is not for HW, only for fleas/ticks), but it has been out several years, and it seems to have a pretty good user experience. I've used it for my own dogs -- I think it's interchangeable with Nexgard in terms of effectiveness, and I've never had a dog have problems with either one, including many breed rescue dogs whose care I oversee). Regular Simparica is a different product than Simparica Trio though, so be very careful about mixing up reviews for them.

The biggest benefit of Trio is simplicity: one product does it all, so it's super-convenient for those who need iron-clad tick protection. The drawbacks are: it's fairly new (so it has a short track-record), expensive, and not all dogs need year-round flea/tick protection. I have no idea how puppies tolerate it, as I've never used it.

My honest advice is to try to stop worrying about what your vet is "pushing" and instead have a real, honest conversation about what diseases your vet is seeing locally, and your range of recommended options. Sometimes vets will recommend a new product (like Simparica Trio) because they can get you really good discounted promotional pricing with coupons/rebates, etc. -- it's not always nefarious! Trio is also the only all-in-one that offers good protection against ticks, so it may save you money in the long run if you need tick protection in your area due to nasty tick-borne diseases. Zoetis Rewards is also offering a REALLY good rebate on a year supply of it right now ($110 back -- doubling their usual $55 rebate temporarily with code DOUBLE2020). 

Sometimes if you tell your vet that you'd rather use older tried-and-true products known to have a wide margin of safety and that are less costly, they'll appreciate that. Then they'll recommend something simple and inexpensive, like Heartgard Plus or its generic equivalent (Tri-heart Plus), and perhaps OTC Frontline (if it works in your area--that's quite variable). Or even something like Interceptor. The key is you're having a conversation about YOUR concerns and YOUR budget, so that the vet can tailor quality care to YOUR needs. 

One of my vet-friends literally sells the cheapest generic HW prevention she can source, one dose at a time, for some of her clients who are on disability or out of work -- they come on the first of the month when they get their benefits check and buy one just dose because it's all they can afford. She's cool with it--she just needs them to tell her they need that option, and sets it up at the front desk. Other clients buy annual supplies of costly all-in-one products and won't see her again for a year -- she serves their needs too!

If you cannot have that honest conversation with your vet without paranoia about them "pushing" products, then perhaps you might either need a new vet, or else need to check-in with yourself about whether you are at risk of becoming the kind of client most vets wish they could fire (my vet friends talk a lot about this sort of client, and how hard it is to care for their pets because of the walls the humans throw up blocking good advice out of paranoia). Try not to become that client! I like having a care-partnership with vets where we are engaged in dialogue to reach good decisions together -- it works for my dogs, leaves me feeling "heard" after the appointment, and helps build a strong client-relationship that goes on for years and years.

Personally, I have a list of "candidate products" that I made in advance of a vet visit to talk about HW and flea products -- what each med covered, pros/cons, and then we talked about it, and my vet added some thoughts. My vet was willing to write me a script for whatever product I preferred, as long as we kept the dogs protected from HW and fleas -- so it was just a matter of getting his insight into which products he knew to be working best for his clients (there were some older flea products that he did NOT think worked at all in our area due to resistance).

In many areas, simple Heartgard or one of its cheaper generic-equivalents like Tri-Heart Plus will be sufficient HW protection, and then you can layer on flea/tick protection for the months that you need it -- in Northern climates, the pests disappear when snow and ice arrive. OTOH, in warmer southern areas, they may not disappear at all during the winter, so it's a different thought process for year-round protection.

If you are in the Deep South or Mississippi Valley, I think Advantage Multi (or Coraxis) is in a league of its own because its the only one documented to have zero resistance for the emerging strain of ivermectin-resistant HW. If you aren't in the small region where resistance is emerging, then you can use whatever works best for your dog and your budget -- it's only a concern in this small area right now.

Cost matters too, as everyone has different budgetary concerns -- Triheart-Plus is about $5/mo. ($30/6 pack) from a legitimate online pharmacy. Then you have to add in the cost of whatever flea/tick product you choose for the months that you need it (typically another $15, for the oral meds). Some of the all-in-ones are well over $20/mo. (Advantage Multi is around $13/mo, but it doesn't have tick protection.)

See why a good vet helps to talk all of this through? There are a lot of variables!


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## AKD (Jul 18, 2020)

Magwart said:


> First things first: what state do you live in? It matters in terms of your options, as northern states have a different approach to this than southern states.
> 
> Second, those are all really different products, that cover different things. I think you need to figure out first what you want the product to cover, and then you can back into what your options are. (E.g, Heartgard only covers HW, but not fleas; Bravecto is for fleas/ticks but not HW; Trio covers HW, fleas, and ticks). I don't know whether you're looking for HW protection, flea-tick protection, or all-in-one protection from your post.
> 
> ...


Thank you .. really appreciate all the details. I will have a talk with my vet and see what options he recommends if any outside of Simparica Trio which I am a bit concerned about due to its newness.


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## crittersitter (Mar 31, 2011)

Less is more. I've always tried to do the bare minimum and safest proven products I could find. Where I currently live I don't use any chemicals in or on my dogs. We have virtually no mosquitoes or fleas here.


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## Sabis mom (Mar 20, 2014)

AKD said:


> Thank you .. really appreciate all the details. I will have a talk with my vet and see what options he recommends if any outside of Simparica Trio which I am a bit concerned about due to its newness.


It isn't really a new product, it's two of their very popular products finally combined into one. It was to replace the Simparica/Revolution combo.
I am using Simparica/Revolution on my dog and I am happy with it so far. The combo was not available in my area until June of this year so I won't be able to get it until next year.


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## Quixotic (Apr 30, 2020)

I've used Nexgard for fleas/ticks and Heartgard for heartworms since getting Freya five months ago. Lots of ticks in my area, but since starting the monthly treatment, she's never had one attached. Given my location (northern-ish Virginia), she'll have both year round.


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## Catrinka (Aug 6, 2020)

Quixotic said:


> I've used Nexgard for fleas/ticks and Heartgard for heartworms since getting Freya five months ago. Lots of ticks in my area, but since starting the monthly treatment, she's never had one attached. Given my location (northern-ish Virginia), she'll have both year round.


The fleas and ticks in the mountains here in NC are a big problem, so Nexgard is what my vet started my almost 10 week old Luca on. I just bought the first month for starters because I wanted to do some checking here on what is the safest (yet effective) choice for flea/tick control especially for while he's so young. I used to have my adult dogs on Frontline Plus but it didn't seem as effective anymore. My last GSD was on Bravecto which worked well but caused skin problems so we had to stop using it. With where we live, it has to work well but I'd like the safest option.

Until life returns to some degree of normal COVID-wise, I'm using a regional 24 hr emergency vet office about 45 minutes away for all these frequent early puppyhood vaccination visits because they're the only ones around us who will allow one masked dog owner in with their dog as opposed to drop-off curbside. Maybe it wouldn't have made a difference to my pup, but I feel more comfortable being right there with him and it feels like there's more opportunity for asking questions. But it was a busy day when we were there so the vet, while gentle and friendly with Luca, didn't have time for much discussion on flea/tick treatment. So I'm reading through the threads here on the subject and welcome any advice.


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## Dunkirk (May 7, 2015)

I'm in a similar climate with fleas and ticks a problem. My dog is on NexGard and Sentinel. It would be cheaper putting him on NexGard Spectra, but I prefer to spread out and separate by approximately a week, the chemical load I put on Nitro.


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## David Winners (Apr 30, 2012)

Interceptor Plus and a Sentinel collar for us. I talked to my vet about what works here (NW Ohio). I get them new Sentinel collars in April after the last frost and they wear them through November. 

I used to use garlic in Oklahoma, but it doesn't work here.


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## Magwart (Jul 8, 2012)

Sabis mom said:


> It isn't really a new product, it's two of their very popular products finally combined into one. It was to replace the Simparica/Revolution combo.
> I am using Simparica/Revolution on my dog and I am happy with it so far. The combo was not available in my area until June of this year so I won't be able to get it until next year.


Revolution is a topical in the U.S. The Trio is an oral product -- so it seems like they're changing it from a topical to an ingestible, from what little I know of Trio. That is a huge change.

Something similar happened with Proheart 6 - same active ingredient as a different topical product, with a long, safe history, but they made it into an injection. After a few months, it was withdrawn and then re-released with a black-box warning not to give it to puppies, seniors, or sick dogs. Changing the delivery system turned out to matter.


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## Sabis mom (Mar 20, 2014)

Magwart said:


> Revolution is a topical in the U.S. The Trio is an oral product -- so it seems like they're changing it from a topical to an ingestible, from what little I know of Trio. That is a huge change.
> 
> Something similar happened with Proheart 6 - same active ingredient as a different topical product, with a long, safe history, but they made it into an injection. After a few months, it was withdrawn and then re-released with a black-box warning not to give it to puppies, seniors, or sick dogs. Changing the delivery system turned out to matter.


I thought about the change, but it is also preventing the current double up on the chemical load. So hopefully it will balance out. I separate them by 7 days with Shadow, giving the Revolution first and then the Simparica a week later.


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## 4K9Mom (Jun 19, 2019)

I use Frontline Gold about every 3-weeks in the summer (4 weeks all winter), which Merial's vet has assured me that it's been tested for and is safe. I also vacuum a lot. 

And I use Heartgard.

I have a farm with woods where wildlife live and pass through regularly. I don't have a flea problem at all and as long as the grass is kept short, ticks aren't an issue. 

One of my beagles started having seizures two months after starting Bravecto. I can't prove causation, but I went back to the old stuff that was working fine anyhow.


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## SammyS778 (Oct 31, 2018)

I use Canada Drugs Advantix every four weeks and find it very effective. We have a very high density of ticks here. I used Bravecto a couple of years back and was appalled at how many ticks I found on them each day; those that had bitten were all dead, but they also brought live ticks into the house on their coats. I would estimate that I would remove ten to twenty ticks per day from the dogs. It is very effective at killing those that attach but has absolutely no repellent properties at all.
With Advantix and now four dogs, I have removed two ticks and have been in tick country for well over a month.
I use Drontal for worming every three months and Advocate every four weeks to complete the panel.

I don’t use either the Advocate or the Advantix in the winter months.


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## AKD (Jul 18, 2020)

Magwart said:


> First things first: what state do you live in? It matters in terms of your options, as northern states have a different approach to this than southern states.
> 
> Second, those are all really different products, that cover different things. I think you need to figure out first what you want the product to cover, and then you can back into what your options are. (E.g, Heartgard only covers HW, but not fleas; Bravecto is for fleas/ticks but not HW; Trio covers HW, fleas, and ticks). I don't know whether you're looking for HW protection, flea-tick protection, or all-in-one protection from your post.
> 
> ...


This was such a well thought out response, I read this once in a while just to keep things straight in my head. I did discuss this with my vet and he felt Simparica Trio was the way to go and we have been using it. Have given 2 doses thus far and seen no negative side effects yet. I do live in a area where both heart worms and fleas/ticks are rampant and year round. The worst thing is if you go searching internet for side effects you run across some terrible worst case scenarios which make your heart sink a little every time you give the dog one of these medications.


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## Sabis mom (Mar 20, 2014)

AKD said:


> The worst thing is if you go searching internet for side effects you run across some terrible worst case scenarios which make your heart sink a little every time you give the dog one of these medications.


I hate that! I lived in Alberta for 25 years. No fleas, few ticks, no heartworm. So when I moved and had to put my dog on preventatives AND start vaccinating I was in research overload! All I kept finding were these horror stories and I was freaking right out. It would be nice if instead of the 20 cases of issues you could read the 20,000 with no issues. Lol


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## Galathiel (Nov 30, 2012)

I live in Texas in one of those darker red areas on the above map. If you do not have your dog on preventative, or if you miss a dose, you can guarantee that your dog will have heartworms if they spend a good amount of time outdoors. Our mosquitoes are ridiculous! They loooooove me. 

We've done the HW shot for some time now and just a couple of weeks ago went to the newish once a year shot. Pray for us! (we use Bravecto for fleas/ticks).

ETA: the 6 mo. shot can be given starting as 6 months and the 12 month shot at 12 months I believe. I would probably not give it to mine until they were at least a year old, regardless.


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