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Heartworm Treatment: The Slow Kill Approach with Advantage Multi

Updated: Dec 27, 2023

Heartworm Treatment

Heartworm disease poses a serious threat to our beloved pets, particularly dogs, and can lead to severe health complications if left untreated. Fortunately, there are treatment options available to combat this potentially fatal condition. In this blog post, we will delve into heartworm treatment, with a specific focus on the slow kill approach using Advantage Multi, a widely used medication that offers an effective and convenient solution for managing heartworm infection.

Understanding Heartworm Disease:

Heartworm disease is caused by a parasitic worm called Dirofilaria immitis. These worms are transmitted through the bites of infected mosquitoes. Once inside the dog's body, the larvae develop and migrate through the bloodstream to the heart and lungs, where they mature into adult worms. Over time, these worms can cause significant damage to the cardiovascular system, leading to heart failure, lung disease, and eventually death.

Heartworm Treatment Guidelines

Thank you for choosing one of Shenandoah Shepherd Rescue's dogs. We appreciate your commitment to their care and well-being. If you've adopted a heartworm-positive dog, this guide will help you navigate the treatment process using the Slow Kill method with Advantage Multi.

Traditional Heartworm Treatment:

The traditional approach to heartworm treatment involves a three-pronged strategy: SSR no longer utilizes this protocol due to serious adverse reactions and/or death while undergoing treatment.

  1. Immiticide Injection: The first step is administering a series of injections containing melarsomine dihydrochloride, a medication that kills adult heartworms. This treatment is typically reserved for severe cases of heartworm disease.

  2. Antibiotics and Steroids: Prior to and following the immiticide injection, antibiotics may be prescribed to prevent secondary infections caused by the dying worms. Steroids may also be given to minimize inflammation and manage the immune response.

  3. Strict Exercise Restriction: Dogs undergoing treatment must undergo a period of restricted activity, as physical exertion can exacerbate the complications associated with the dying heartworms.

Heartworm Treatment

The Slow Kill Approach:

This Slow Kill approach is a safer alternative to fast-kill injections. Your commitment to this treatment plan contributes to your dog's gradual recovery. Regular testing and open communication with your vet are essential for the well-being of your pet. Shenandoah Shepherd Rescue is here to support you throughout the process.

Advantage Multi and Slow Kill Treatment:

Advantage Multi is a topical medication that offers broad-spectrum protection against heartworms, fleas, and various gastrointestinal parasites. While it is primarily marketed as a monthly preventive, it can also be utilized as part of a slow kill approach for heartworm treatment.

The slow kill method aims to gradually eliminate the heartworm population within the dog's body. Advantage Multi, containing the active ingredients imidacloprid and moxidectin, plays a crucial role in this approach by killing the microfilariae (immature heartworms) and preventing the development of new larvae into adult worms.

Advantages of Slow Kill Treatment with Advantage Multi:

  1. Minimally Invasive: Since slow kill treatment primarily relies on monthly preventive medication, it avoids the need for injections and the associated risks and discomfort for the dog.

  2. Easier on the Dog: Unlike the strict exercise restriction required during the traditional treatment, slow kill treatment with Advantage Multi allows dogs to maintain an activity level that more closely resembles normal, reducing stress and promoting overall well-being.

Heartworm Treatment

How to Treat:

Shenandoah Shepherd Rescue’s current covered Heartworm Treatment protocol is slow Kill with Advantage Multi.  Shenandoah Shepherd Rescue will cover the following expenses relating to Heartworm Treatment:

·        1 Month of Doxycycline and;

·        12 Months of Advantage Multi 

Step 1: Doxycycline for 30 days

  • Administer Doxycycline for 30 days as prescribed.

  • Give with food & avoid dairy during treatment, as it interferes with absorption.

  • Check your dog's medical records provided at adoption for confirmation, and consult with the foster parent if needed.

Step 2: Advantage Multi for 12 consecutive months

  • Apply Advantage Multi topically each month for 12 months.

  • Advantage Multi not only prevents heartworm disease and treats heartworm microfilaria but also combats fleas and controls various parasites.

  • No additional heartworm preventatives are needed during Advantage Multi treatment.

  • While strict confinement is not required, limit strenuous activities to ensure a gradual recovery.

Step 3: Testing after 12 consecutive months on Advantage Multi

  • After completing the 12-month regimen, have your dog retested by your vet to confirm heartworm negativity.

If still positive after 12 months:

  • Consult Blue Ridge Veterinary Associates (or SSR) for further guidance.

  • Consider One (1) Proheart 12 Injection.

  • Repeat One (1) Month of Doxycycline yearly until the dog tests negative.

Please click here to request heartworm treatment support for your SSR foster or adopted dog.


Heartworm disease requires prompt attention and effective treatment to protect our furry companions from its detrimental effects. While the traditional immiticide injection method remains the most recommended course of treatment in the veterinary community, the slow kill approach with Advantage Multi offers a more accessible, and in our opinion, a safer option for our dogs.

Remember, early detection, regular preventative measures, and open communication with your veterinarian are key to safeguarding your pet's health and ensuring a heartworm-free life full of joy and vitality.

Studies on Heartworm Treatment via Moxidectin can be found here and here.

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