The combination milbemycin oxime/lufenuron (trade names Sentinel Flavor Tabs, by Novartis Animal Health

Novartis

Novartis International AG is a multinational pharmaceutical company based in Basel, Switzerland, ranking number three in sales among the world-wide industry...

, and Program plus) is a parasite control drug in which the active ingredient

Active ingredient

An active ingredient is the substance of a pharmaceutical drug or a pharmaceutical ingredient and bulk active in medicine; in pesticide formulations active substance may be used. Some medications and pesticide products may contain more than one active ingredient...

, milbemycin oxime

Milbemycin oxime

Milbemycin oxime is a veterinary drug from the group of milbemycins, used as a broad spectrum antiparasitic. It is active against worms , insects and mites ....

, eliminates flea

Flea

Flea is the common name for insects of the order Siphonaptera which are wingless insects with mouthparts adapted for piercing skin and sucking blood...

s and worms, while a second active ingredient, lufenuron

Lufenuron

Lufenuron is the active ingredient in the veterinary flea control medication Program, and one of the active ingredients in the veterinary flea control, heartworm prevention, and anthelmintic medicine milbemycin oxime/lufenuron .Lufenuron is stored in the animal's body fat and transferred to adult...

, arrests the development of eggs and larva

Larva

A larva is a distinct juvenile form many animals undergo before metamorphosis into adults. Animals with indirect development such as insects, amphibians, or cnidarians typically have a larval phase of their life cycle...

e, preventing them from maturing and continuing the infestation of an animal. This combination is registered for animal use only. To achieve efficacy, the treatment is administered once monthly, together with food, in a dosage suitable for the weight of the affected animal. The usual ratio is 500 µg milbemycin oxime and 10 mg lufenuron/kg body weight. Novartis indicates the proper dosage by color-coding the packages.

Several 2002 studies by Novartis demonstrate that milbemycin oxime/lufenuron compares favorably to some other treatments, such as the moxidectin

Moxidectin

Moxidectin is a parasiticide used for the prevention and control of heartworm and intestinal worms, and can be found in treatments prescribed for animals such as dogs, cats, horses, cattle and sheep. It is also used for the prevention of red mite in caged birds...

 injection. The combination is considered effective in the elimination of fleas, and the prevention of infection from hookworm

Hookworm

The hookworm is a parasitic nematode that lives in the small intestine of its host, which may be a mammal such as a dog, cat, or human. Two species of hookworms commonly infect humans, Ancylostoma duodenale and Necator americanus. A. duodenale predominates in the Middle East, North Africa, India...

 (Ancylostoma caninum), heartworm

Heartworm

Heartworm is a parasitic roundworm that is spread from host to host through the bites of mosquitoes. The heartworm is a type of filaria, a small thread-like worm. The definitive host is the dog but it can also infect cats, wolves, coyotes, foxes and other animals, such as ferrets, sea lions and...

 (Dirofilaria immitis), roundworms, whipworm

Whipworm

The human tapworm is a roundworm, which causes trichuriasis when it infects a human large intestine. The name whipworm refers to the shape of the worm; they look like whips with wider "handles" at the posterior end.-Life cycle:The female T. trichiura produces 2,000–10,000 single celled eggs per day...

s (Trichuris vulpis), and ascarids (Toxocara canis

Toxocara canis

Toxocara canis is worldwide distributed helminth parasite of dogs and other canids. T. canis are gonochorists, adult worms measure from 9 to 18 cm, are yellow-white in color, and occur in the intestine of the definitive host. In adult dogs, the infection is usually asymptomatic. By the...

and Toxascaris leonina

Toxascaris leonina

Toxascaris leonina is a common parasitic roundworm found in dogs, cats, foxes, and related host species. Toxascaris leonina, or T. leonina, is an ascarid nematode, a worldwide distributed helminth parasite which is in a division of eukaryotic parasites that, unlike external parasites such as lice...

). The USA FDA approval for Sentinel says "Concurrent use of insecticides may be necessary". It is the concurrent use of Sentinel and nitenpyram

Nitenpyram

Nitenpyram is an insecticide used in agriculture and veterinary medicine to kill insect external parasites of livestock and pets.In veterinary medicine, it is used orally with dogs and cats to control fleas . After ingestion, it begins killing fleas within 30 minutes and kills every adult flea on...

 (Capstar) that has an FDA-approved indication "to kill adult fleas".

Side effects

Milbemycin oxime/lufenuron can lead to a negative physical response

Adverse effect (medicine)

In medicine, an adverse effect is a harmful and undesired effect resulting from a medication or other intervention such as surgery.An adverse effect may be termed a "side effect", when judged to be secondary to a main or therapeutic effect. If it results from an unsuitable or incorrect dosage or...

in some animals, most dangerously those that test positively for heartworm disease before receiving the treatment. Less serious side effects are an upset stomach or loss of appetite, various skin irritations, and mood changes.