afoxolaner

According to clinical studies performed prior to marketing:

• The oral toxicity profile of afoxolaner consists of a diuretic effect (rats only), effects secondary to a reduction in food consumption (rats and rabbits only) and occasional vomiting and/or diarrhea (dogs, 120 and 200 mg/kg bodyweight (bw)) following high oral doses. No treatment-related effects on vomiting or diarrhea were noted following oral doses of up to 31.5 mg/kg bw in the pivotal target animal safety study, nor in the EU field trial.
• mild gastrointestinal effects (vomiting, diarrhea), pruritus, lethargy, anorexia, and neurological signs (convulsions, ataxia and muscle tremors) have been reported in less than 0.1% of 10,000 animals treated, including isolated reports, most reported adverse reactions being self-limiting and of short duration,{{Cite web|url=https://www.ema.europa.eu/en/documents/product-information/nexgard-epar-product-information_en.pdf|title=Nexgard product information - Annex I "Summary of product characteristics"|website=European Medicines Angency|access-date=14 November 2019}}
• (in combination with milbemycin oxime): vomiting, diarrhea, lethargy, anorexia, and pruritus were observed in 0.2 to 1% of 10,000 animals treated and were generally self-limiting and of short duration,
• In vitro studies reported that afoxolaner can bind to dopamine and norepinephrine cellular transport receptor systems and the CB1 receptor; inhibition of these catecholaminergic systems and certain types of competitive binding at CB1 receptors may mediate pharmacodynamic effects of diuresis, decreased food consumption, and decreased body weight in animals.

According to post-marketing safety experience:

• (in combination with milbemycin oxime): erythema and neurological signs (convulsions, ataxia and muscle tremors) have been reported in less than 0.1% of 10,000 animals treated, including isolated reports,
• The US Food and Drug Administration FDA reports{{Cite web |url= https://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm620934.htm |archive-url= https://web.archive.org/web/20180927214126/https://www.fda.gov/AnimalVeterinary/NewsEvents/CVMUpdates/ucm620934.htm |url-status= dead |archive-date= September 27, 2018 |title=CVM Updates - Animal Drug Safety Communication: FDA Alerts Pet Owners and Veterinarians About Potential for Neurologic Adverse Events Associated with Certain Flea and Tick Products| work = Center for Veterinary Medicine | publisher = U.S. Food and Drug Administration |access-date=2018-09-22}} that some drugs in this class (isoxazolines), including afoxolaner, can have adverse neurologic effects on some dogs, such as muscle tremors, ataxia, and convulsions.
• Extralabel use of afoxolaner in a pet pig has been described without any adverse effects.{{cite journal | vauthors = Smith JS, Berger DJ, Hoff SE, Jesudoss Chelladurai JR, Martin KA, Brewer MT | title = Afoxolaner as a Treatment for a Novel Sarcoptes scabiei Infestation in a Juvenile Potbelly Pig | journal = Frontiers in Veterinary Science | volume = 7 | pages = 473 | year = 2020 | pmid = 33102538 | pmc = 7505946 | doi = 10.3389/fvets.2020.00473 | doi-access = free }} Experimental use in commercial pigs also did not result in any adverse effects.{{cite journal | vauthors = Bernigaud C, Fang F, Fischer K, Lespine A, Aho LS, Mullins AJ, Tecle B, Kelly A, Sutra JF, Moreau F, Lilin T, Beugnet F, Botterel F, Chosidow O, Guillot J | display-authors = 6 | title = Efficacy and Pharmacokinetics Evaluation of a Single Oral Dose of Afoxolaner against Sarcoptes scabiei in the Porcine Scabies Model for Human Infestation | journal = Antimicrobial Agents and Chemotherapy | volume = 62 | issue = 9 | date = September 2018 | pmid = 29914951 | pmc = 6125498 | doi = 10.1128/AAC.02334-17 }}

In vivo studies (repeat-dose toxicology in laboratory animals, target animal safety, field studies) provided by MERIAL, the company that produces afoxolaner-derivative medicines, did not show evidence of neurological or behavioural effects suggestive of GABA-mediated perturbations in mammals. The Committee for Medicinal Products for Veterinary Use (CVMP) therefore concluded that binding to dog, rat or human GABA receptors is expected to be low for afoxolaner.

Selectivity for insect over mammalian GABA-receptors has been demonstrated for other isoxazolines.{{cite journal | vauthors = Casida JE | title = Golden age of RyR and GABA-R diamide and isoxazoline insecticides: common genesis, serendipity, surprises, selectivity, and safety | journal = Chemical Research in Toxicology | volume = 28 | issue = 4 | pages = 560–566 | date = April 2015 | pmid = 25688713 | doi = 10.1021/tx500520w }} The selectivity might be explained by the number of pharmacological differences that exist between GABA-gated chloride channels of insects and vertebrates.{{cite journal | vauthors = Hosie AM, Aronstein K, Sattelle DB, ffrench-Constant RH | title = Molecular biology of insect neuronal GABA receptors | journal = Trends in Neurosciences | volume = 20 | issue = 12 | pages = 578–583 | date = December 1997 | pmid = 9416671 | doi = 10.1016/S0166-2236(97)01127-2 | s2cid = 5028039 }}

The marketing authorization was granted by the European Medicines Agency in February 2014, for Nexgard,{{Cite web|url=https://www.ema.europa.eu/en/documents/assessment-report/nexgard-epar-public-assessment-report_en.pdf|title=CVMP assessment report for Nexgard (EMEA/V/C/002729/0000)|website=European Medicines Agency|access-date=14 November 2019}} and in January 2015, for Nexgard Spectra.{{Cite web|url=https://www.ema.europa.eu/en/documents/assessment-report/nexgard-spectra-epar-public-assessment-report_en.pdf|title=CVMP Assessment Report for Nexgard Spectra (EMEA/V/C/003842/0000)|website=European Medicines Agency|access-date=14 November 2019}}

Afoxolaner is the active ingredient of the veterinary medicinal products Nexgard, Frontpro, and Nexgard Spectra (in combination with milbemycin oxime).{{cite journal | vauthors = Shoop WL, Hartline EJ, Gould BR, Waddell ME, McDowell RG, Kinney JB, Lahm GP, Long JK, Xu M, Wagerle T, Jones GS, Dietrich RF, Cordova D, Schroeder ME, Rhoades DF, Benner EA, Confalone PN | display-authors = 6 | title = Discovery and mode of action of afoxolaner, a new isoxazoline parasiticide for dogs | journal = Veterinary Parasitology | volume = 201 | issue = 3–4 | pages = 179–189 | date = April 2014 | pmid = 24631502 | doi = 10.1016/j.vetpar.2014.02.020 | doi-access = free }}{{cite journal | vauthors = Beugnet F, deVos C, Liebenberg J, Halos L, Fourie J | title = Afoxolaner against fleas: immediate efficacy and resultant mortality after short exposure on dogs | journal = Parasite | volume = 21 | pages = 42 | date = 25 August 2014 | pmid = 25148564 | pmc = 4141545 | doi = 10.1051/parasite/2014045 }}{{cite journal | vauthors = Beugnet F, Crafford D, de Vos C, Kok D, Larsen D, Fourie J | title = Evaluation of the efficacy of monthly oral administration of afoxolaner plus milbemycin oxime (Nexgard Spectra, Merial) in the prevention of adult Spirocerca lupi establishment in experimentally infected dogs | journal = Veterinary Parasitology | volume = 226 | pages = 150–161 | date = August 2016 | pmid = 27514901 | doi = 10.1016/j.vetpar.2016.07.002 | doi-access = free }} They are indicated for the treatment and prevention of flea infestations, and the treatment and control of tick infestations in dogs and puppies (8 weeks of age and older, weighing 4 pounds (~1.8 kilograms) of body weight or greater) for one month.{{cite web|url=https://www.boehringer-ingelheim.com/animal-health/companion-animals-products/nexgard?itid=NexGard%C2%AE|title=Boehringer-Ingelheim companion-animals-product Nexgard (afoxolaner).|publisher=Boehringer Ingelheim International GmbH|access-date=13 November 2019}}

{{reflist}}

{{insecticides}}

Category:Acaricides

Category:Chloroarenes

Category:Insecticides

Category:Isoxazolines

Category:Naphthalenes

Category:Trifluoromethyl compounds

Category:Carboxamides

Category:Dog medications