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|Amounts to be administered and administration route For oral use. Dose: The product should be administered at a dose of 2.50–5.36 mg/kg bodyweight of afoxolaner and 0.50–1.07 mg/kg bodyweight of milbemycin oxime in accordance with the following table: Weight (kg) Dosage 2 - 3.5 1 x NexGard Spectra (XS) 9 mg/2 mg tablet > 3.5 - 7.5 1 x NexGard Spectra (S) 19 mg/4 mg tablet >7.5 - 15 1 x NexGard Spectra (M) 38 mg/8 mg tablet >15 - 30 1 x NexGard Spectra (L) 75 mg/15 mg tablet >30 - 60 1 x NexGard Spectra (XL) 150 mg/30 mg tablet For dogs above 60 kg appropriate combinations of chewable tablets should be used. Method of administration: The tablets are chewable and palatable to most dogs. If the dog does not accept the tablets directly they may be administered with food. Treatment schedule: The treatment schedule should be based on veterinary diagnosis and on the local epidemiological situation. Treatment of flea and tick infestations and gastrointestinal nematodes: NexGard Spectra can be used as part of the seasonal treatment of fleas and ticks (replacing treatment with a monovalent flea and tick product) in dogs with diagnosed concurrent gastrointestinal nematode infestations. A single treatment is effective for the treatment of gastrointestinal nematodes. After treatment of the nematode infestations, further flea and tick treatment should be continued with a monovalent product. Treatment of demodicosis (caused by Demodex canis): Monthly administration of the product until two negative skin scrapings are obtained one month apart. Severe cases may require prolonged monthly treatments. As demodicosis is a multi-factorial disease, where possible, it is advisable to also treat any underlying disease appropriately. Treatment of sarcoptic mange (caused by Sarcoptes scabiei var. canis): Monthly administration of the product for two consecutive months. Further monthly administration of the product may be required based on clinical assessment and skin scrapings. Prevention of heartworm disease: NexGard Spectra kills Dirofilaria immitis larvae up to one month after their transmission by mosquitoes therefore the product should be administered at regular monthly intervals during the time of the year when vectors are present, starting in the month after the first expected exposure to mosquitoes. Treatment should continue until 1 month after the last exposure to mosquitoes. To establish a treatment routine, it is recommended that the same day or date be used each month. When replacing another heartworm preventative product in a heartworm prevention programme, the first treatment with NexGard Spectra should start on the date when the former medication was due to have been administered. Dogs living in heartworm endemic areas, or those which have travelled to endemic areas, may be infested with adult heartworms. No therapeutic effect against adult Dirofilaria immitis has been established. It is therefore recommended that all dogs 8 months of age or more, living in heartworm endemic areas, should be tested for existing adult heartworm infestation before being treated with the product for heartworm prevention. Prevention of angiostrongylosis: In endemic areas, monthly administration of the product will reduce the level of infection with immature adults (L5) and adults of Angiostrongylus vasorum in the heart and lungs. Prevention of thelaziosis: Monthly administration of the product prevents establishment of infection with adult Thelazia callipaeda eyeworm. Overdose No adverse reactions were observed in eight-week old healthy puppies after 6 treatments at up to 5 times the maximum dose.