Heartworm Prevention for Dogs

Medications to Prevent Heartworm Disease

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Heartworm disease is a life-threatening parasitic infection that invades the hearts and lungs of dogs. Because heartworms are spread solely by the mosquito, any dog exposed to mosquitos is at risk. Heartworm disease is a relatively common disease in dogs that has been seen everywhere in the United States. Because of this, the American Heartworm Society currently recommends year-round treatment with a heartworm preventative for all dogs in the US regardless of climate. However, dogs in the Southeast are at the highest risk.

Though termed "prevention," heartworm preventatives are actually insecticides that work to kill heartworm larvae present in the bloodstream. These medications are given on a monthly basis to keep larval heartworm infections from developing into full-blown infestations. Because these medications destroy early heartworm infections, it is essential to administer them on a regular basis. If you occasionally miss a dose, it is recommended to give the missed dose immediately and continue to give the medication monthly. All dogs should have a heartworm test done by a veterinarian once per year. If you miss two or more months of heartworm prevention, contact your vet. Your dog may need to be tested for heartworms sooner (usually about six months after that point). It is important not to give heartworm prevention to a heartworm positive dog unless specifically instructed to do so by a veterinarian. Certain forms of heartworm prevention may be harmful to dogs that are heartworm positive.

Giving your dog heartworm prevention is an ESSENTIAL part of being a responsible dog owner. In addition, it is safer and less expensive to prevent heartworms than to put your dog through heartworm treatment for heartworm disease. Heartworm prevention costs about $35-$250 per year depending on the size of the dog and the brand of prevention chosen. Heartworm treatment can cost upwards of $1000!

Talk to your veterinarian about the ideal heartworm prevention for your dog. The following medications are used on a regular basis to prevent heartworm infestation:


Some Brand Names:
Heartgard, Heartgard Plus (by Merial)
Iverhart Plus, Iverhart Max (by Virbac)
Tri-Heart Plus (by Merck)

Ivermectin-based heartworm medications are given orally once per month. Ivermectin is a broad-spectrum anti-parasitic drug used in humans and animals. In monthly heartworm prevention, the dose of ivermectin is extremely low, making it effective at killing heartworm larvae but not other common parasites. In the above brands of heartworm prevention, the "plus" refers to the addition of pyrantel pamoate, which kills the common intestinal parasites hookworms and roundworms. The "max" indicates an additional of pyrantel pamoate as well as praziquantel, which kills tapeworms.

Side effects of ivermectin are usually neurological in nature (central nervous system depression, wobbly gait). Some dog breeds, such as the Collie and Shetland Sheepdog, are known to be sensitive to ivermectin. However, at such a low dose, the above heartworm prevention medications rarely cause side effects or reactions, even in sensitive breeds.

Milbemycin Oxime

Some Brand Names:
Trifexis (by Elanco)​
Sentinel (by Virbac)

Milbemycin-based heartworm medications are also given orally once per month. Like ivermectin, milbemycin oxime is a broad spectrum anti-parasitic drug. It is used in animals only (not in humans). Milbemycin also kills roundworms, hookworms, and whipworms. Both Trifexis and Sentinel include an additional drug to prevent flea infestation. However, the flea prevention offered by Trifexis is far superior to that in Sentinel.

There are generally no side effects of milbemycin if given as directed. Symptoms of milbemycin overdose tend to be neurological in nature (stupor, tremors, wobbly gait). No dog breeds are known to be sensitive to milbemycin.


One Brand Name:
Revolution (by Pfizer)

Selamectin is applied topically once per month. It is an anti-parasitic drug used in animals only that kills fleas, heartworm, hookworms, roundworms, and ear mites. The product comes in a small tube that is applied to the skin (not the hair) on the back, between the shoulder blades. Proper application is essential to ensure effectiveness.

Though rare, the side effects of selamectin may include loss of appetite, excessive drooling, vomiting, diarrhea, muscle tremors, fever, and rapid breathing. At the site of application, there may temporarily be stiff or clumped hair, hair discoloration, hair loss, skin irritation, or a powdery residue.


Brand Names:
Advantage Multi (by Bayer)
Proheart 6 (by Fort Dodge)

Moxidectin is an anti-parasitic drug used in animals only that kills heartworms, hookworms, roundworms and whipworms. Moxidectin is administered one of two ways: Advantage Multi is applied topically; Proheart 6 is an injectable.

Advantage Multi comes in a small tube that is applied once a month to the skin (not the hair) on the back, between the shoulder blades. Proper application is essential to ensure effectiveness. Advantage Multi contains moxidectin and imidacloprid, which kills fleas. Though rare, the side effects of Advantage Multi may include lethargy, itching, and hyperactivity. At the site of application, there may temporarily be stiff or clumped hair, hair discoloration, hair loss, skin irritation, or a powdery residue.

Proheart 6 is given as a subcutaneous (under-the-skin) injection once every six months. The moxidectin was developed into a sustained release form that allowed it to last for six months. This form of heartworm prevention became very popular because it eliminated the need for monthly treatments which could easily be forgotten. In 2004, Proheart 6 was voluntarily withdrawn from the market after a number of adverse reactions were reported. The drug became available again in 2008, but many restrictions apply so that the company may monitor reactions. Proheart 6 may only be given by a veterinarian who has completed the company's certification module. Dogs receiving the injection must meet certain age and health criteria. Pet owners must be advised of the risks and sign a consent form prior to treatment. Potential side effects include severe allergic reaction, lethargy, seizures, vomiting, diarrhea, weight loss, pale gums, increased thirst or urination, weakness, and bleeding/bruising.

Choosing the right heartworm prevention for your dog can be a tough decision. It is important to talk to your vet about the right options for you and your dog. No matter what you decide, make sure you keep your dog on heartworm prevention all year long. It can make the difference between life and death for your dog.

If you suspect your pet is sick, call your vet immediately. For health-related questions, always consult your veterinarian, as they have examined your pet, know the pet's health history, and can make the best recommendations for your pet.