Vethical ComboGuard® is a monthly, flavored chewable tablet for dogs that prevents heartworm disease, kills fleas and treats and controls adult hookworm, roundworm and whipworm infections.
About Vethical ComboGuard (spinosad + milbemycin oxime) for Dogs

Convenience. Proven effectiveness. All in one chewable tablet.

Benefits of Vethical ComboGuard:
  • Prevents heartworm disease
  • Kills fleas and prevents infestations. Treats and controls intestinal parasite infections (hookworm, roundworm, whipworm)
  • One easy-to-administer chewable tablet
With Vethical ComboGuard, you can play with your dog immediately after treatment. There is no need to isolate your pet. Just treat and play!

Vethical ComboGuard is an ideal choice for:
  • Families with children or other pets, since there is no transfer of product through contact
  • Anyone worried about staining carpeting, clothing or furniture
  • Dogs that swim or are bathed frequently
  • Dogs with dermatological (skin) conditions requiring topical therapy
Author and celebrity veterinarian Dr. Ernie Ward, along with Elanco's own Dr. Lisa Young, recently appeared on Lifetime's morning show to discuss overall health and parasite protection for dogs.
» Watch the interview
Controlling Internal and External Parasites in U.S. Dogs1

Primary Recommendations

Administer year-round broad-spectrum parasite control with efficacy against heartworm, intestinal parasites, and fleas, particularly those with zoonotic potential.

Administer preventive flea products year-round.
  • Conduct annual physical examination with complete history.
  • Conduct annual heartworm testing in dogs.
  • Feed pets cooked or prepared food (not raw meat) and provide fresh, potable water.
  • Conduct fecal examinations two to four times during the first year of life and one to two times per year in adults, depending on patient health and lifestyle factors.
  • Administer anthelmintic treatment to puppies at 2, 4, 6 and 8 weeks of age, followed by administration of a monthly preventive.
  • Treat nursing bitches and queens along with their offspring.
If optimal year-round heartworm preventive/intestinal parasite products are not used:
  • Deworm puppies at 2, 4, 6 and 8 weeks of age.2
  • Conduct fecal examinations two to four times a year in adult pets, depending on patient health and lifestyle factors, and treat with appropriate parasiticides.
  • Test for heartworm status yearly in dogs and/or before starting preventive medications.
  • Tailor parasite prevention programs to parasite prevalence and pet lifestyle factors.
1 Companion Animal Parasite Council at http://www.petsandparasites.org/resources/capc-guidelines, accessed December 2, 2012
2 ComboGuard is approved for dogs and puppies 8 weeks of age and older and 5 lbs or greater.
Green Chemistry
The introduction of spinosad for use in agriculture resulted in the receipt of a Presidential Green Chemistry Challenge Award3 in 1999 from the U.S. Environmental Protection Agency. The award was presented to Dow Agro Sciences LLC in the category of Designing Safer Chemicals for the introduction of spinosad as an insect control product for use on crops. This award demonstrates that spinosad, as a technology for insect control, has a favorable environmental profile. This award is not relevant to the safety and efficacy of Vethical ComboGuard, nor does it confer any environmental benefit to Vethical ComboGuard.

3 The Presidential Green Chemistry Challenge Awards Program, Summary of 1999 Award Entries and Recipients
Your veterinarian will know

Your veterinarian is your best source of advice about your dog's healthcare.

Your dog should be tested for heartworm infection before starting Vethical ComboGuard.

To minimize the likelihood of fleas continuing to jump onto your dog, it is important to treat all household pets with an approved flea protection product.

If a dose is missed and a monthly interval between doses is exceeded, then immediately give Vethical ComboGuard with food and resume monthly dosing. This will minimize the opportunity for heartworm infection. Also, continuing normal monthly dosing will allow you to gain control of any flea infestation or intestinal parasite infection that might have affected your dog. Vethical ComboGuard should be administered at monthly intervals beginning within 1 month of the dog's first seasonal exposure.

Vethical ComboGuard is not for use in humans. Like all medications, keep Vethical ComboGuard out of reach of children.

Heartworm Disease is a serious and potentially deadly disease.

Heartworm disease is caused by the growth of worms that are transmitted to dogs by mosquitoes. Although heartworms can live for as long as 7 years in an infected pet1, they often cause no visible symptoms — which is one reason they can potentially be so deadly. And it's also one of the reasons the Companion Animal Parasite Council recommends year-round heartworm protection.

A yearly blood test, performed by your dog's veterinarian, is the only accurate way to detect heartworm infection.

There are four main phases in the lifecycle of a heartworm: microfilaria, larva, juvenile worm and adult worm.



Heartworms—long, spaghetti-like worms that can grow 10-inches in length—live in the hearts, lungs and bloodstreams of infected dogs. Heartworm disease is spread when a mosquito bites an infected dog. Microfilariae in the dog's blood mature into infective larvae in the mosquito, which are transferred to another dog by the mosquito's bite. In approximately six months, the larvae mature into adult heartworms.

Untreated, heartworms can lead to death in dogs. These are undoubtedly among the most devastating of canine parasites. Fortunately, needless pain and suffering can be prevented with an annual heartworm test and the medicine provided by VCA veterinarians.
Signs of Heartworm Disease:
  • Coughing
  • Lethargy
  • Exercise intolerance
  • Weight Loss
  • Heavy Breathing
References
  1. Heartworm Society at http://www.heartwormsociety.org/pet-owner-resources/heartworm.html accessed Oct 29, 2012
What Are Fleas?
Adult fleas are reddish-brown insects with bodies that are compressed, or flattened, from side to side. While visible to the naked eye, they are so small you could line up about eight adult fleas, end-to-end, in one inch. Because fleas are so small, they can be difficult to detect, much less eliminate from your home.

Fleas are wingless, but possess incredible jumping ability. This enables them to jump easily from ground level to “ambush” a pet.

Fleas feed on blood, and female fleas consume about 15 times their body weight each day1. Incompletely digested blood is excreted from the flea and dries to form what is commonly referred to as “flea dirt.” This serves as food for developing flea larvae and is one way veterinarians and pet owners can identify an infestation.
Why worry about fleas?

Fleas can pose a serious problem for your dog’s health.
Not only can fleas make your dog miserable, but depending on his age and overall physical condition, fleas can pose a serious threat to his health.
  • Fleas can cause severe discomfort for dogs, including scratching, chewing, biting and restlessness.
  • Fleas are the source of flea allergy dermatitis (FAD), the most common veterinary dermatological condition2.
  • Severe flea infestations can cause anemia, especially in puppies or debilitated adult dogs.
  • Ingested fleas also can transmit tapeworm infection to dogs.

Fleas also raise human public health concerns3.
Your dog isn't the only household resident that can suffer from flea bites. Flea infestations in homes and areas around a home often result in humans being bitten by newly-emerging fleas. You, too, are at risk for health issues, some of which can be serious.
  • Allergic reaction: Usually in the form of small, raised lesions, called papules, that can be red to purple in color. Severity will vary, depending on the severity of the allergy to the flea bite.
  • Tapeworm: Tapeworm (Dipylidium caninum) is generally spread through infected fleas found on both cats and dogs. Ingestion of infected fleas by children can result in tapeworm infection.
  • Typhus: A group of infectious diseases usually resulting in a sustained high fever (typhus fever), headache, delirium and sometimes red rashes. Two kinds are most commonly contracted from flea bites:
    • Flea Typhus. A type of typhus caused by Rickettsia felis, a bacteria first identified in cat fleas.
    • Murine typhus. Another bacterial form of typhus transmitted most commonly by rodent fleas but also by fleas found on dogs.
  • Plague: Rodent fleas that can be acquired by dogs and cats in some areas might be vectors for (carriers of) bubonic plague, Yersinia pestis. These fleas might leave the host to bite humans.
Controlling Fleas in Your Home

Fleas can be a major problem for dogs and their owners. Even if they never leave the house, dogs can be exposed to these blood-sucking parasites. Preventing flea infestations is the best protection against them. ComboGuard (spinosad + milbemycin oxime) for dogs starts killing fleas within 30 minutes, before they can lay eggs. And ComboGuard lasts a whole month — it can’t be rubbed, washed or shaken off.

Why are fleas so hard to control?
Once in your home, a female flea can produce 40–50 eggs per day4, so even a few fleas can quickly turn into a major infestation. Flea larvae turn into pupae, which are generally more impervious to flea control products applied to the animal or its environment. Adult fleas erupt out of their pupal stage, or cocoon, and quickly find a host, such as your dog. Because these cocoons can be found almost anywhere, including your own living room, it seems to pet owners that fleas appear out of nowhere.

This is why it's important to treat fleas as quickly as possible and to make sure your dog is protected, even before she encounters fleas.

What you can do to control flea infestations
Even with flea protection for your dog, you still want to be sure your household is rid of fleas that were hidden in egg, larva or pupa stages when you treated your dog. The most effective means of controlling severe environmental flea infestations is the use of a pest management specialist (exterminator).

If you discover fleas in your home:
  • Consult your veterinarian. Your veterinarian is your best source of information about flea control for your dog. Depending on your individual situation, your veterinarian might make specific recommendations.
  • Eliminate fleas on your dog. ComboGuard kills fleas quickly, providing fast relief.
  • Eliminate fleas in your home. While treating your dog is an important step, you should also kill fleas in your home to prevent family members and any unprotected pets that visit your home from becoming infested.
  • Prevent future infestations. Once-monthly ComboGuard for dogs kills fleas before they can lay eggs. A key to preventing infestations is making sure other pets in the household are protected too.
References
  1. Dryden, M.W., 2005 Flea Guidelines, Flea control for dogs and cats, Advanstar Veterinary Healthcare Communications, sponsored by an educational grant from Merial
  2. Sousa, C.A., DVM, “Fleas, flea allergy, and flea control, a review,” Dermatology Online Journal 3(2):7, dermatology.cdlib.org
  3. Companion Animal Parasite Council at http://www.capcvet.org/recommendations/fleas.html, retrieved March 14, 2011
  4. Dryden, M.W., 2005 Flea Guidelines, Flea control for dogs and cats, Advanstar Veterinary Healthcare Communications, sponsored by an educational grant from Merial
Intestinal Parasite Lifecycle: Worms Within

ComboGuard (spinosad + milbemycin oxime) chewable tablet for dogs provides protection from three intestinal parasites.

Roundworm, hookworm, and whipworm are generally contracted either through ingesting the eggs or larvae, in the case of hookworm, by coming into direct contact with infected soil. In each case, the larval form of the worm migrates to the intestinal tract, where they mature into adults. The following descriptions are brief but provide a general idea of each worm's lifecycle1.
Roundworm

Roundworm eggs are deposited into the environment in animal feces and remains. Dogs ingest infective eggs from a contaminated environment. The larvae released from the eggs mature to adult worms which cause infection in your dog.



Roundworm larval migration is complex, but generally, once inside the dog, roundworm larvae migrate through the liver and lungs. The infected dog coughs them up into her mouth from the lungs and swallows them, which allows them to move into the small intestine. (In unborn puppies, the migration from the liver to the intestines is delayed until the pups are born.)

The larvae mature into adults in the intestines, laying eggs there, which are passed through the infected dog’s waste back into the environment.



Hookworm

Hookworm eggs are passed into the environment in animal feces, where they hatch and develop until they reach the infective larval stage. This phase takes from 2 to 9 days, depending on temperature and humidity.



When a dog eats these infective larvae or comes into direct contact with infected soil or animal remains, the larvae penetrate the skin and migrate to the small intestine. (As with roundworm, the larvae can migrate to the lungs, where they burrow into the tissue and go dormant. Some hookworm larvae can remain dormant until other adult worms die or the dog becomes pregnant or infected puppies are born.)

Once in the small intestine, the larvae mature into adult worms and feed on the walls of the intestine as well as on blood sucked from them. Adult worms can live for 4 to 24 months in the small intestine1.

Whipworm

Whipworm eggs pass into the environment through feces of infected hosts. Once deposited in the soil, they are highly resistant to destruction by environmental factors, such as temperature extremes and sunlight.



Infection occurs when a dog ingests the infective eggs. The larvae generally hatch in the small intestine and penetrate the mucous layer, where they develop for another 2 to 10 days before moving to the large intestine.

Larvae mature into adult worms in the large intestine. Signs of infection can begin appearing between 74 and 90 days from the time of infection.

ComboGuard makes controlling intestinal parasites easy, with one monthly, chewable tablet.

References
  1. Information summarized from the Companion Animal Parasite Council site: http://www.petsandparasites.org/dog-owners/roundworms/ and http://www.petsandparasites.org/dog-owners/hookworms/ (Accessed October 22, 2012)
Vethical ComboGuard® (spinosad + milbemycin oxime) for Dogs:
Frequently Asked Questions

Q: What is Vethical ComboGuard?
Vethical ComboGuard is a monthly chewable tablet for dogs. Vethical ComboGuard kills fleas and prevents flea infestations, treats and controls hookworms, whipworms and roundworms, and prevents heartworm disease. Vethical ComboGuard is for use in dogs and puppies 8 weeks of age or older and 5 pounds of body weight or greater. If you do not administer Vethical ComboGuard monthly throughout the year, the final dose must be given no fewer than three months following the last exposure to mosquitoes.

Q: Why has my veterinarian prescribed Vethical ComboGuard?
Your veterinarian has prescribed Vethical ComboGuard as a way of preventing your dog from developing problems caused by infection with three commonly occurring parasite categories. Heartworm infection can make dogs very sick and can even be fatal. This parasite is spread to dogs by mosquitoes. Vethical ComboGuard can prevent flea infestations from becoming established, and can also remove any fleas that are on your dog at the time of treatment. Vethical ComboGuard will also treat and control common adult intestinal worm infections (roundworms, hookworms and whipworms).

Q: Should I give Vethical ComboGuard each month all year round?
Consult your veterinarian regarding the need for year-round use of Vethical ComboGuard. If you do not administer Vethical ComboGuard monthly throughout the year, the final dose must be given no fewer than three months following the last exposure to mosquitoes.

Q: Will Vethical ComboGuard kill heartworms?
Vethical ComboGuard prevents heartworm disease by killing certain stages that develop after an infected mosquito bites a dog. As with other heartworm preventives, Vethical ComboGuard does not kill adult heartworms. Speak to your veterinarian about treatment options if your dog is diagnosed with an adult heartworm infection.

Q: Will my dog still need to be tested for heartworm infection while taking Vethical ComboGuard?
You should speak to your veterinarian about the frequency of heartworm testing while your dog is taking Vethical ComboGuard.

Q: How do I switch to Vethical ComboGuard from another heartworm preventive?
Follow the advice of your veterinarian about switching heartworm preventives.

Q: What should I discuss with my veterinarian regarding Vethical ComboGuard for my dog?
Your veterinarian is your dog's healthcare expert and can make the best recommendation for medications for your dog. This includes the prevention, control and/or treatment of parasites such as fleas, heartworms and intestinal parasites that may cause conditions that include flea allergy dermatitis, anemia and heart disease. Key points of your discussion may include the following:
  • As with other heartworm preventatives, dogs should be tested for heartworm prior to beginning treatment with Vethical ComboGuard.
  • If a dose is missed and a monthly interval between doses is exceeded, then immediately give Vethical ComboGuard with food and resume monthly dosing. This practice will minimize the opportunity for heartworms to grow. Also, continuing normal monthly dosing will allow you to gain control of any flea or intestinal parasites that might have infected your dog.
  • To minimize the likelihood of fleas continuing to jump onto your dog, it is important to treat all household pets with an approved flea protection product.
  • Vethical ComboGuard is not for use in humans. Like all medications, keep Vethical ComboGuard out of reach of children.
Q: How should I give Vethical ComboGuard to my dog?
Give Vethical ComboGuard with food for maximum effectiveness. Vethical ComboGuard is a chewable tablet and may be offered as a treat. Consult your veterinarian regarding the need for year round administration of Vethical ComboGuard. To help you remember the monthly dosing schedule, stick-on labels are included for your calendar.

Q: What if I give more than the prescribed amount of Vethical ComboGuard to my dog?
Contact your veterinarian as soon as possible if you believe your dog has ingested more than the recommended dose of Vethical ComboGuard. In a study in which dogs were dosed at 1, 3, and 5 times the upper half of the recommended dose, dogs exhibited vomiting, tremors, decreased activity, salivation, coughing and vocalization.

Q: Should I restrict either my dog's activity or contact with my dog after the tablet is consumed?
Since Vethical ComboGuard is an oral formulation, you may maintain normal activities and interactions with your dog.

Q: How quickly will Vethical ComboGuard kill fleas?
In a laboratory study of spinosad alone, an active ingredient of Vethical ComboGuard, spinosad started to kill fleas within 30 minutes and killed 100% of the fleas within 4 hours. Vethical ComboGuard kills fleas before they can lay eggs.

Q: Does seeing fleas on my dog mean that the treatment is not working?
Vethical ComboGuard kills fleas before they can lay eggs when used monthly according to the label directions. Remember that all animals in the household should be treated with an approved flea product to help control the flea population. Your dog can continue to be exposed to the fleas that live in the environment. When fleas jump onto your dog, they will be killed by Vethical ComboGuard. If within a month after your dog receives Vethical ComboGuard you see fleas on your dog, it is most likely that these are new fleas. These new fleas will be killed before they can produce eggs that contaminate the environment. Continued monthly use of Vethical ComboGuard can prevent any new infestations.

Q: What if I see worms in my dog's stool during the month after administration of Vethical ComboGuard?
Vethical ComboGuard is indicated to treat and control intestinal parasite infections of adult hookworms, roundworms and whipworms. In occasional cases, it is possible that the action of Vethical ComboGuard in killing the intestinal worms will lead to the dog expelling them in the stool. If you have questions, consult with your veterinarian for measures you can take to prevent a reinfection with intestinal parasites.

Q: Is it safe to give my dog Vethical ComboGuard?
Vethical ComboGuard has been demonstrated to be safe in pure and mixed breeds of healthy dogs when used according to label directions for dogs and puppies 8 weeks of age and older and five pounds of body weight or greater. You should discuss the use of Vethical ComboGuard with your veterinarian prior to use if your dog has a history of epilepsy (seizures). Puppies less than 14 weeks of age may experience a higher rate of vomiting.

Q: Is it safe to give my breeding dogs Vethical ComboGuard?
Ask your veterinarian about the use of Vethical ComboGuard prior to use in breeding females. The safe use of Vethical ComboGuard in male dogs intended for breeding has not been evaluated.

Q: What side effects might occur with Vethical ComboGuard?
Like all medications, sometimes side effects may occur. In some cases, dogs vomited after receiving Vethical ComboGuard. During field studies, no severe or prolonged vomiting occurred. To ensure heartworm prevention, observe your dog for 1 hour after administration. If vomiting occurs within an hour of administration, redose with another full dose. 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. The following adverse reactions are based on post-approval adverse drug event reporting. The adverse reactions are listed in decreasing order of frequency: vomiting, depression/lethargy, pruritus, anorexia, diarrhea,trembling/shaking, ataxia, seizures, hypersalivation, and skin reddening. For technical assistance or to report a suspected adverse drug reaction, contact Elanco Animal Health at 1-888-545-5973. Alternatively, suspected adverse drug reactions may be reported to FDA at 1-888-FDA-VETS or or http://www.fda.gov/AnimalVeterinary/SafetyHealth/ReportaProblem/ucm055305.htm

Q: Is Vethical ComboGuard FDA approved?
Yes, Vethical ComboGuard is a prescription product approved by the FDA and should only be obtained through a licensed veterinarian with whom you have a proper vet/client/patient relationship.

Q: Can other medications be given while my dog is taking Vethical ComboGuard?
Yes, Vethical ComboGuard has been given safely with a wide variety of products and medications. Your veterinarian should be made aware of all products that you administered and/or intend to administer to your dog.

Q: Can Vethical ComboGuard be given to cats?
No. Vethical ComboGuard is not labeled for use on cats. Vethical ComboGuard was developed exclusively for administration to dogs. If you also need flea control for your cat, Vethical offers SimpleGuard and AcuGuard for flea control for cats.

Print the client information sheet for Vethical ComboGuard

Important Safety Information

Serious adverse reactions have been reported following concomitant extra-label use of ivermectin with spinosad alone, one of the components of Vethical ComboGuard chewable tablets.

Treatment with fewer than three monthly doses after the last exposure to mosquitoes may not provide complete heartworm prevention. Prior to administration of Vethical ComboGuard, dogs should be tested for existing heartworm infection. Use with caution in breeding females. The safe use of Vethical ComboGuard in breeding males has not been evaluated. Use with caution in dogs with pre-existing epilepsy.

The most common adverse reactions recorded in clinical trials were vomiting, pruritus, lethargy and diarrhea. To ensure heartworm prevention observe your dog for 1 hour after administration. If vomiting occurs within an hour after administration, redose with another full dose. Puppies less than 14 weeks of age may experience a higher rate of vomiting.

View full product insert for complete safety information.