Simparica TRIO: Product Information (Page 2 of 3)

ADVERSE REACTIONS

In a field safety and effectiveness study, SIMPARICA TRIO was administered to dogs for the prevention of heartworm disease. The study included a total of 410 dogs treated once monthly for 11 treatments (272 treated with SIMPARICA TRIO and 138 treated with an active control). Over the 330-day study period, all observations of potential adverse reactions were recorded. The most frequent reactions reported in the SIMPARICA TRIO group are presented in the following table.

Table 1. Dogs with Adverse Reactions

Clinical Sign SIMPARICA TRIOn = 272 Active Controln = 138
Vomiting 14.3% 10.9%
Diarrhea 13.2% 8.0%
Lethargy 8.5% 6.5%
Anorexia 5.1% 5.8%
Polyuria 3.7% 3.6%
Hyperactivity 2.2% 0.7%
Polydipsia 2.2% 2.9%

In a second field safety and effectiveness study, SIMPARICA TRIO was administered to 278 dogs with fleas. Adverse reactions in dogs treated with SIMPARICA TRIO included diarrhea.
In a third field safety and effectiveness study, SIMPARICA TRIO was administered to 120 dogs with roundworms. Adverse reactions in dogs treated with SIMPARICA TRIO included diarrhea and vomiting.
For a copy of the Safety Data Sheet or to report adverse reactions, call Zoetis Inc. at 1-888-963-8471. For additional information about adverse drug experience reporting for animal drugs, contact FDA at 1-888-FDA-VETS or www.fda.gov/reportanimalae.

CLINICAL PHARMACOLOGY

Following oral administration of SIMPARICA TRIO in Beagle dogs (13 to 15 months of age at the time of initial dosing), sarolaner and moxidectin were rapidly and well-absorbed. Following a single oral dose of SIMPARICA TRIO (sarolaner dose of 1.2 mg/kg), the sarolaner mean maximum plasma concentration (Cmax ) was 523 ng/mL with a mean time to maximum concentration (Tmax ) of 3.5 hours and an absolute bioavailability of 88%. At a moxidectin dose of 0.024 mg/kg, the moxidectin mean Cmax was 13.1 ng/mL with a mean Tmax of 2.4 hours and an absolute bioavailability of 67%.

Following intravenous (IV) dosing of a combination solution of sarolaner and moxidectin, the sarolaner volume of distribution (Vss ) was 2.4 L/kg and systemic clearance (CL) was 6.0 mL/kg/hr. For moxidectin the Vss was 7.65 L/kg and CL was 26.6 mL/kg/hr. The terminal half‑lives were similar after oral and IV dosing for both sarolaner (12 days) and moxidectin (11 days). The primary route of elimination of both sarolaner and moxidectin is biliary excretion with minimal metabolism.

Following an oral dose of SIMPARICA TRIO containing 5 mg/kg pyrantel (as pamoate salt), pyrantel has measurable plasma concentrations, but they are low and highly variable. Pyrantel pamoate is intended to remain in the gastrointestinal tract allowing for delivery of effective concentrations to gastrointestinal nematodes.

MODE OF ACTION

SIMPARICA TRIO contains three active pharmaceutical ingredients, sarolaner, moxidectin, and pyrantel pamoate.

Sarolaner is an acaricide and insecticide belonging to the isoxazoline group. Sarolaner inhibits the function of the neurotransmitter gamma aminobutyric acid (GABA) receptor and glutamate receptor, and works at the neuromuscular junction in insects. This results in uncontrolled neuromuscular activity leading to death in insects or acarines.

Moxidectin is an endectocide in the macrocyclic lactone class. Moxidectin acts by interfering with the chloride channel‑mediated neurotransmission in the parasite. This results in paralysis and death of the parasite.

Pyrantel pamoate is a nematocide belonging to the tetrahydropyrimidine class. Pyrantel acts as a depolarizing, neuromuscular‑blocking agent in susceptible parasites, which causes paralysis and death or expulsion of the organism.

EFFECTIVENESS

Heartworm Prevention
In two well‑controlled laboratory studies, a single oral dose of SIMPARICA TRIO was 100% effective in preventing the development of adult D. immitis in dogs inoculated with infective larvae 30 days before treatment.
In a well-controlled US field study consisting of 246 dogs administered SIMPARICA TRIO and 119 administered an active control, no dogs treated with SIMPARICA TRIO tested positive for heartworm disease. All dogs treated with SIMPARICA TRIO were negative for D. immitis antigen and blood microfilariae at study completion on day 330.
Flea Treatment and Prevention
In a well‑controlled laboratory study, SIMPARICA TRIO began to kill fleas at 4 hours and demonstrated 100% effectiveness at 8 hours after initial administration. After weekly re‑infestations, SIMPARICA TRIO reduced the number of live fleas by ≥97.8% within 12 hours of infestation for 28 days.
In a separate well‑controlled laboratory study, SIMPARICA TRIO demonstrated 100% effectiveness against adult fleas within 24 hours following treatment and maintained ≥99.7% effectiveness against weekly re‑infestations for 35 days.
In a study to explore flea egg production and viability, SIMPARICA TRIO killed fleas before they could lay eggs for 35 days.
In a well‑controlled 60‑day US field study conducted in dogs with existing flea infestations of varying severity, the effectiveness of SIMPARICA TRIO against fleas on Day 30 and 60 visits was 99.0% and 99.7%, respectively, compared to baseline. Dogs with signs of flea allergy dermatitis showed improvement in erythema, papules, scaling, alopecia, dermatitis/pyodermatitis and pruritus as a direct result of eliminating fleas.
Tick Treatment and Control
In a well‑controlled laboratory study, SIMPARICA TRIO began to kill existing I. scapularis within 8 hours, SIMPARICA TRIO reduced the number of live ticks by ≥94.2% within 24 hours of infestation for 28 days.
In well‑controlled laboratory studies, SIMPARICA TRIO demonstrated ≥98.9% effectiveness against an existing infestation of Amblyomma maculatum, Ixodes scapularis, Rhipicephalus sanguineus , and Dermacentor variabilis 48 hours post‑administration and maintained ≥90.4% effectiveness 48 hours after re‑infestation for at least 28 days. Against Amblyomma americanum , SIMPARICA TRIO demonstrated ≥99.4% effectiveness 72 hours after treatment of existing infestations, and maintained ≥98.4% effectiveness 72 hours after re‑infestation for at least 28 days.
Intestinal Nematode Treatment and Control
Elimination of roundworms (immature adult and adult Toxocara canis and adult Toxascaris leonina) and adult hookworms (Ancylostoma caninum and Uncinaria stenocephala) was demonstrated in well‑controlled laboratory studies.
In a 10-day multi‑center field study, SIMPARICA TRIO was effective against Toxocara canis and reduced fecal egg counts 99.2%.

ANIMAL SAFETY

Margin of Safety: SIMPARICA TRIO was administered orally to 8‑week‑old Beagle puppies at doses of 1, 3, and 5X the maximum labeled dose (2.4 mg/kg sarolaner, 48 μg/kg moxidectin, and 10 mg/kg pyrantel) at 28 day intervals for 7 treatments. Dogs in the control group received placebo. There were no clinically‑relevant, treatment related effects on clinical observations, body weights, food consumption, clinical pathology (hematology, coagulation, serum chemistry, and urinalysis), gross pathology, histopathology, or organ weights. During the end-of-study ophthalmic examination, the following change was found: one 1X dog had retinal dysplasia (OS folds).

Ivermectin-sensitive Collie Safety:
SIMPARICA TRIO was administered orally once at 1, 3 and 5X the maximum labeled dose to Collies that had been pre‑screened for avermectin sensitivity. Dogs in the control group received placebo. Clinical signs (ataxia, muscle fasciculations, mydriasis) associated with avermectin sensitivity were observed in the 5X group. All dogs were completely recovered by the third day of the study.

Heartworm-Positive Safety:
SIMPARICA TRIO was administered orally at 1 and 3X the maximum labeled dose at 28 day intervals for 3 treatments to Beagle dogs with patent adult heartworm infections and circulating microfilariae. Dogs in the control group received placebo. Diarrhea occurred more commonly in the treated dogs and also more often in the 3X group compared with the 1X group. Two dogs (1 each in 1X and 3X) developed a fever less than 24 hours after the first dose. The fever may have been a transient reaction to a rapid microfilaria reduction. Both dogs recovered without treatment.

Field Safety: In three well‑controlled field studies, SIMPARICA TRIO was used concurrently with other medications such as vaccines, antimicrobials, anthelmintics, antiprotozoals, steroidal and non‑steroidal anti‑inflammatory agents, anesthetic agents and analgesics. No adverse reactions were associated with the concurrent use of SIMPARICA TRIO and other medications.

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