Bravecto Quantum: Insight from a dermatologist

With the news of the recent FDA approval of Bravecto Quantum (Fluralaner, Merck Animal Health), the first injectable long-acting flea and tick preventative for use in dogs, veterinary professionals have a new option to consider for their patients.  

Andrew Simpson, DVM, MS, DACVD, a board-certified dermatologist and task force member for the 2023 AAHA Management of Allergic Skin Diseases in Dogs and Cats Guidelines, took some time to answer commonly asked questions based on his experience and research. “Overall, I think the longer-acting preventatives offer a clinical advantage to the patient by providing consistent prevention of external parasites,” he said. 

The benefits of long-acting prevention 

Simpson explained that he considers the biggest argument for a long-acting injectable flea and tick preventative to be long-term ectoparasite control that doesn’t rely on pet owners remembering to give their pet’s preventative at home. He added that his experience in general practice was that many owners preferred long-acting treatments that could be given in the hospital; they appreciated not having to remember or struggle to administer at home.  

Offering an injectable product also helps the practice retain more of the revenue associated with flea and tick prevention when compared to prescribing oral products that clients may choose to purchase elsewhere, he said.  

Additionally, long-acting, non-oral flea and tick prevention can aid in the management of allergic skin disease, Simpson explained. 

“From a dermatologist’s perspective,” he said, “having a treatment option for continuous protection against fleas (and off-label protection against pruritic mites) helps eliminate one of the major ‘flare-factors’ in allergy management.” He added that the injectable formulation is also helpful for pets suspected of having food allergies, especially while they are on an elimination diet trial and need to avoid food ingredients that are sometimes used to flavor oral preventatives. 

Safety questions 

Because the drug is so long-acting, questions have been raised about the risk of adverse effects that have been associated with the isoxazoline class of drugs. When asked about his concern for adverse reactions, Simpson said that the incidence of seizures with fluralaner is “relatively uncommon.” However, he added that both seizures and allergic reactions, some of which required medical intervention, were reported in the Bravecto Quantum safety studies conducted prior to FDA approval.  

From his review of the safety data, Simpson concluded that most adverse effects are likely to be self-limiting and/or of short duration. However, he added, because this formulation of the drug is so long-acting, the potential for perpetuating seizures as the drug is continually released is “definitely a concern.”  

“Although there is not an official recommendation provided by the manufacturer,” he said. “it would seem clinically prudent to first give a shorter-acting oral dose of Bravecto (the 30-day course) to observe any neurologic abnormalities prior to committing to the injectable formulation for long-term use,” he said. However, he added, “one could not guarantee that a dog would not have any side effects from the injectable if the oral formulation was given without complications.” 

Client education 

Simpson said he believes that, when given the option, many dog owners would likely elect this type of flea and tick prevention because it would give them peace of mind and simplify their responsibilities in caring for their dogs.  

As with any new medication, however, Simpson advised of the importance of proper client education as to the benefits and potential risks associated with both the drug and long-acting formulation so that dog owners can make an informed decision. 

“It would be imperative for the veterinarian to warn of the potential for seizures when discussing the risks and benefits of Bravecto Quantum,” he said, “as well as the inability to eliminate the active drug faster than its natural duration of action if chronic adverse events do occur.” 

Further reading: 

FDA Fact sheet for pet owners and veterinarians about potential adverse events associated with isoxazoline flea and tick products 

 

Photo credit: Sladic/iStock via Getty Images 

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