Is Convenience the Enemy of Dog Health?

In a word, YES!

Today, I learned about not one but two products likely coming on to the US dog pharmaceutical market. Two pharmaceutical giants, Merck and Boehringer Ingleheim are close to announcing injectable forms of their current oral products, Nexgard and Bravecto. (Bravecto already has an injectable product available in England). I’ve written about these products before, their lack of effectiveness in preventing tick bites and tick-borne disease transmission, as well as the seizure warnings they carry. (Hey, veterinarians, don’t prescribe these products to dogs that have had seizures, even ones on anticonvulsants! And boarded veterinary neurologists, please don’t overlook these products as possible causes for seizures, as was done in a case referred to me.)

So why am I even more worried about the new products’ imminent release? Take a look at the preliminary info being shared with veterinarians:

The obvious answer is that once injected, these products can not be removed from the body. And these products are labeled for use every 8 or 6 months respectively, rather than the one and three months for the oral products. It seems reasonable to infer that they will be active or circulating in the body for that duration of time. Will these products have more of an impact with regard to seizures? What will happen in a dog that has seizures already if they get the product? What about the breeds such as Collies, Shetland Sheepdogs, Australian Shepherds, and mixes of these breeds that carry a gene mutation making them more sensitive to certain drugs, with reactions often including seizures or other neurological problems?

Both products specify the size of needle that must be used to administer the product. An 18 gauge needle, as required by the Bravecto product, is 1.27 mm in diameter, or 0.05 inches – just 0.01 less than one 16th of an inch! The 22 gauge needle used by most veterinarians to administer vaccines is 0.718 mm in diameter. The Nexgard product is labeled for use with an 18 or slightly smaller 20 gauge needle.

This raises the question of what happens if a smaller diameter needle is used? Is the product too thick to pass through the needle? Does the product get damaged if a smaller needle is used, and if so, what impact does that have? And what about the Chihuahua that weighs six pounds when his owner sees a needle that might be used to inject a cow, and then sees the typical reaction of a toy breed to a painful injection?

One of my most common client complaints about the oral forms of these products (as well as other brands’ versions, such as Simparica, Credileo, etc.) is that they still find attached ticks and their dogs are newly testing positive for tick-borne diseases after switching from other non-oral tick preventatives. You do not want to experience the wrath of a dog owner whose dog now has clinical Lyme disease after they have been told that the oral products are more effective in preventing tick-borne diseases. And that is exactly what the Bravecto sales representative told my hospital team members when the product first came out. The real world experience has proven this statement to be untrue. Of course this is not surprising, given the limited number of dogs that received the oral products in pre-approval testing, compared to the 250 – 300 million doses that have been sold of Bravecto and Nexgard since their release, according to recent web search data. (At an average cost of $29 a month for a dog weighing about 20 pounds, consumers would have spent over. $1.6 billion dollars per year on these products. The amount is likely much higher given the number of dogs of larger size treated.) These products clearly are a large part of their respective companies’ financial portfolios.

Finally, I question the need for this level of parasite control in the average family dog. Living in cities and suburban areas, where the dog changes out I the chemically treated back yard, and walks in the pesticide laden public park or gold course, what is the risk? Are tapeworms (spread by fleas and the ingestion of rodents) so rampant that dogs require constant prevention? When is the last time your adult dog tested positive for roundworms or hookworms? It seems inappropriate and financially wasteful to treat for conditions that do not exist. We know human medicine practitioners constantly warn about the overuse of antibiotics, for fear of fostering bacterial resistance. Is no one concerned that use of these injectables, providing constant exposure to anti-parasite drugs to any parasites the dog may encounter can do the same thing?

It would not surprise me to see other companies that already have an oral product coming out with an injectable one. The technology seems to be becoming mainstream in today’s marketplace. It’s the nature of a competitive market, so please understand I am in no way singling out any particular company or product. Bravecto and Nexgard just appear to be the closest to being released at this point in time. Will pet owners soon be inundated with advertising for a slew of injectables to “protect” their dogs for months or year(s) against all sorts of internal and external parasites? How will they be able to tell the differences between the products to make an informed decision with regard to effectiveness, safety, cost, or other factors?

Obviously I am very concerned about the safety and effectiveness of these products. We have already seen what happened with ProHeart, the first injectable heartworm preventative. For those that may not remember, it took the dog world by storm when released, only to be pulled from the market for adverse reaction issues. It later returned, but vets have to undergo special training to administer it. It is available in both 6 and 12 month duration formulas, and contains moxidectin, the same heartworm preventative component used in the Bravecto and Nexgard injectable products, as well as some similar oral forms.

So where do you stand on these sort of products? Is the convenience worth the risk? Is there any group of dogs that would benefit from the products to justify the risk? I look forward to reading your comments on social media.