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NEXGARD PLUS is an oral combination antiparasitic drug for dogs containing three active ingredients: afoxolaner (an isoxazoline), moxidectin (a macrocyclic lactone), and pyrantel (a tetrahydropyrimidine). It is indicated for the prevention of heartworm disease caused by Dirofilaria immitis; treatment and control of adult hookworm (Ancylostoma caninum, Ancylostoma braziliense, Uncinaria stenocephala) and roundworm (Toxocara canis, Toxascaris leonina) infections; killing adult fleas (Ctenocephalides felis); treatment and prevention of flea infestations; and treatment/control of tick infestations including Ixodes scapularis, Rhipicephalus sanguineus, Dermacentor variabilis, Amblyomma americanum, and Haemaphysalis longicornis. - **Afoxolaner** acts by inhibiting insect/acarine ligand-gated chloride channels—especially those gated by GABA—causing hyperexcitation in parasites' nervous systems leading to death. - **Moxidectin** interferes with chloride channel-mediated neurotransmission in susceptible parasites resulting in paralysis/death. - **Pyrantel** acts as a depolarizing neuromuscular-blocking agent causing paralysis/expulsion or death of nematode parasites[1][4][6][9].
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