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Ashley Etue, DVM, is a staff veterinarian with the Humane Rescue Alliance in Washington, DC, and the Pet Pantry of Lancaster County in Lancaster, PA. She is a resident with the American College of Animal Welfare. Her interests include community medicine, access to care, geriatric medicine and end-of-life care, and companion animal welfare.

The FDA has approved fluralaner for extended-release injectable suspension (Bravecto Quantum; Merck Animal Health), for protection against fleas and ticks in dogs. The drug is indicated for canines ages 6 months and older, and is the first product approved by the agency for flea and tick protection in dogs for 8 to 12 months.

Fluralaner is an isoxazoline antiparasitic drug. Several products containing isoxazolines are approved for the treatment and control of fleas and certain ticks in dogs and cats, according to the FDA. However, these products generally provide protection against fleas and ticks for 1 month.

Fluralaner for extended-release injectable suspension is indicated for treatment and prevention of flea infestations as well as black-legged tick, American dog tick and brown dog tick infestations for 12 months in canines aged 6 months and older. The product is also FDA-approved for the treatment and control of lone star tick infestations for 8 months in canines ages 6 months and older.

The product is approved in more than 50 other countries. It was first approved in Australia and New Zealand in 2023 and in the European Union the following year.

Christine Royal, DVM, vice president, companion animal and equine business unit, Merck Animal Health, said the company takes pride in its leadership with long-acting preventive parasiticides. “[We] are excited to offer a convenient option that gives dogs year-round

 comprehensive protection from fleas and ticks in one easy injection they can receive from their veterinarian,” Royal said in a news release.

 “The approval of Bravetco Quantum sets a new standard in pet care by providing veterinarians and pet parents with a safe and effective option when it comes to flea and tick protection for dogs.”

Pet owners are encouraged to consult with a veterinarian to determine whether a product in the isoxazoline class is appropriate for their pet. Veterinarians should review a patient’s medical history before deciding on a drug therapy. 

Isoxazoline products have been associated with neurologic adverse reactions, including muscle tremors, ataxia, and seizures in some dogs and cats, according to the FDA. Other adverse reactions observed in dogs and cats include lethargy, decreased appetite, vomiting, diarrhea, elevated liver enzymes, pruritus, lumps or swelling at the injection site, and a hypersensitivity reaction. However, these products are commonly used, and the agency has determined they are safe for most dogs and cats.

Veterinary teams should also advise dog owners about using fluralaner for extended-release injectable suspension in breeding dogs and define the appropriate treatment interval (8 vs 12 months) based on the species of ticks the dog is likely to encounter.

“Though people often think of flea and tick season during the summer months, studies have shown that while fleas and ticks are most active from early spring through the fall, they can be a threat year-round, especially knowing it only takes a few warm days for ticks to become active,” Frank Guerino, PhD, associate vice president of global pharmaceutical development, Merck Animal Health, said in a news release.

 “With Bravetco Quantum, a single dose provides year-long, continuous protection, simplifying care for both pet owners and veterinarians, and promoting compliance.”

Fluralaner for extended-release injectable suspension is available by prescription from a licensed veterinarian, who then administers the drug.

 Merck Animal Health expects the therapy to become available on the veterinary market by August 2025, through clinics and hospitals.

FDA approves first long-acting flea and tick treatment for dogs. FDA. July 10, 2025. Accessed July 10, 2025. https://www.fda.gov/animal-veterinary/cvm-updates/fda-approves-first-long-acting-flea-and-tick-treatment-dogs?utm_medium=email&utm_source=govdelivery

Freedom of Information Summary: New Animal Drug Application. FDA. July 10, 2025.

FDA approves Bravetco Quantum (fluralaner for extended-release injectable suspension) from Merck Animal Health. News release. Merck Animal Health. July 10, 2025. Accessed July 11, 2025. https://www.merck.com/news/fda-approves-bravecto-quantum-fluralaner-for-extended-release-injectable-suspension-from-merck-animal-health/

Fluralaner for extended-release injectable suspension (Bravecto Quantum) is also indicated for treatment of lone star tick in dogs.

Clinical

First long-acting flea and tick treatment is FDA-approved for dogs

Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM), discusses how RECOVER is helping to standarize how CPR is performed around the world.

Standardizing CPR in veterinary medicine

Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM), chief nursing officer for Veterinary Emergency Group and program director for the RECOVER Initiative, explains the importance of CPR certification in veterinary medicine and why it is important to standardize this type of training with evidence-based guidelines, in a 

 interview. Yagi is leading a RECOVER workshop May 28-29, 2025, hosted by North American Veterinary Community (NAVC) during the NAVC SkillShop event in Orlando, Florida. The workshop aims to have attendees earn CPR certification and CPR instructor certification.

The following is a transcript of the video:

Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM):

 If you think about the human medicine field, it's actually a legal requirement for medical professionals to go through CPR training. And there are certification processes out there that [are] based off of evidence-based guidelines. Even nonmedical professionals that [work] with the public a bit, like teachers, would need to be certified in performing CPR. There's no such regulation or standard in veterinary medicine yet, and should there be? It is a really good question, but the RECOVER guidelines and the certification process is really an attempt to standardize how we perform CPR, based on an evidence-based guideline, which should improve the outcomes and spread that globally.

Kenichiro Yagi, MS, RVT, VTS (ECC) (SAIM), discusses how RECOVER is helping to standardize how CPR is performed around the world.

Conference

Veterinary care is financially out of reach for many pet owners, a recent survey exploring pet owners’ experiences with veterinary care found. The same study found that more than half (52%) of US pet owners have skipped or declined necessary veterinary care for their pets despite 97% of pet parents considering their pets family.

PetSmart Charities-Gallup State of Pet Care Study: Pet Parents’ Assessment of American Veterinary Care

, conducted by PetSmart Charities and Gallup, interviewed 2498 cat and dog owners across the US between November 13, 2024 and January 9, 2025, on topics that included how often they take their pets to the veterinarian, where they obtain pet health information, and how well veterinarians offer services that meet the needs of themselves and their pets. Both web-based and mailed surveys were used to ensure representation from a broad range of pet owners, including those without internet access. Gallup also weighted the sample to reflect national demographics of US dog and cat owners, including gender, age, race, Hispanic ethnicity, education, and region, according to PetSmart Charities.

Veterinary care costs pose a concern for high- and low- income pet owners

In pet owners across different income levels, financial barriers were reported as a reason to forgo or decline veterinary care. The survey found pet owners in households with an income of less than $60,000 were most likely to avoid care due to affordability. Higher income earners, meanwhile, had a greater tendency of declining services they did not believe justified the cost. Still, in those earning $90,000 or more, a third reported skipping veterinary care due to financial constraints.

At the time of the survey, 52% of pet parents reported having not taken their pets to the veterinarian within the past year, even when they felt their pet needed veterinary care, or declined care recommended by a veterinarian.

 The percentage of these pet owners were particularly high among

Pet owners living in households earning less than $60,000 annually (55%)

Additionally, 57% of veterinarians said they were unable to provide patients with desired care due to client economic limitations, according to a 2017 survey on small animal veterinarians’ opinions and actions regarding costs of care, effects of economic limitations on patient care and outcome, and more.

According to the State of Pet Care Study survey, the most declined veterinary services were diagnostic procedures, including blood tests (22%) and preventive care, such as yearly examinations and vaccinations (18%).

Pet owners are aware of the risks of skipping veterinary care

Fourteen percent of pet owners who skipped veterinary care said their pet’s condition worsened, or their pet died. Only a third of those who declined veterinary care saw an improvement in their pet’s condition after skipping care.

According to the survey’s findings, 30% of pet owners said they knew a friend or family member whose pet passed away because the owner could not afford the necessary veterinary care. Seven percent of survey participants reported declining lifesaving surgeries for their pet. Additionally, 11% reported knowing someone who had to surrender a pet because veterinary care was too expensive.

Seventy-three percent of survey participants who declined care due to cost indicated not being offered a more cost-effective option. Of the pet owners who declined care that was not practical for them or their pet, 46% said they were not offered an option that better fit their needs.

“...While the most advanced care is an option that should be explored for pet parents, it should not be presented as the only option—or perhaps not even the first option—given the number of pet parents who have financial considerations and the robust research on first-recommendation bias,” wrote the authors of the State of Pet Care Study.

Sixty-four percent of pet owners said payment plans would make it possible for them to afford to pay at least twice the amount for lifesaving treatment for their pet. Still, less than 1 in 4 owners has ever been offered a payment plan, according to the survey’s findings.

Approximately 4 in 10 pet owners were interested in alternative veterinary care methods for their pets, such as community clinics (38%), home visits from a veterinarian (38%), or telemedicine (37%). Black pet owners (54%), 18- to 29-year-olds (48%), and those living in households earning less than $60,000 annually (47%) reported the highest interest in community clinics.

"The data show that many pet parents are not being presented with alternative care options that could make veterinary services more accessible, despite interest in such options," Zach Hrynowski, a senior researcher at Gallup, said in a news release.

 "Our analysis of the data points to a clear opportunity for the veterinary industry to expand affordable, flexible solutions that meet pet parents' needs."

Pet companionship offers extensive mental and physical health benefits, with the Human Animal Bond Research Institute estimating that pet ownership saves the US healthcare system nearly $23 billion annually.

Yet, approximately 50 million pets in the US lack access to appropriate veterinary care, ie., care that meets the basic standards, according to PetSmart Charities.

“The hope is the findings in [the]...State of Pet Care Study... will influence the evolution of veterinary care to include more affordable, flexible, and accessible models,” wrote Aimee Gilbreath, MBA, president of PetSmart Charities, in the study’s foreword.

 Robyn Jaynes, DVM, director of veterinary affairs at PetSmart Charities, stressed the urgent need for collaboration across the veterinary field to improve access to care, noting that change will require efforts from clinics, schools, and leaders alike. "The veterinary industry must unite to ensure every pet has access to care, as the magnitude of the problem is such that no one entity can solve this on their own," she said.

"Clinics should practice flexibility and focus on providing options that work for each pet family’s needs. Veterinary schools must train vets in spectrum-of-care practice and continue research supporting lower-cost models, and industry leaders need to drive innovation that also reduces costs. Together, we can build a system that meets families where they are, because access to veterinary care shouldn’t be a privilege," Jaynes continued.

According to PetSmart Charities, the organization has committed to $100 million to improving access to veterinary care. The charity is offering grant funding to expand affordable veterinary care clinics, support research on affordable payment options, investigate single-service models to help lower costs for pet owners, and more.

"We estimate the cost to ensure adequate care for all pets currently going without it is over $20 billion annually using traditional care delivery models," said Gilbreath.

 "Systematic solutions to this crisis go well beyond what 1 organization can provide—we need a united front from veterinary industry leaders, schools, practices and nonprofit animal welfare leaders to produce sustainable change."

PetSmart Charitites-Gallup State of Pet Care Study: Pet Parents’ Assessment of American Veterinary Care. Gallup, PetSmart Charities. Accessed April 17, 2025. 

https://www.gallup.com/analytics/659123/gallup-petsmart-charities.aspx

New study finds more than half of U.S. pet parents skip or decline needed veterinary care. News release. PetSmart Charities. April 16, 2025. Accessed April 17, 2025. 

https://prnmedia.prnewswire.com/news-releases/new-study-finds-more-than-half-of-us-pet-parents-skip-or-decline-needed-veterinary-care-302429953.html

Kipperman BS, Kass PH, Rishniw M. Factors that influence small animal veterinarians’ opinions and actions regarding cost of care and effects of economic limitations on patient care and outcome and professional career satisfaction and Burnout. 

Nearly 1 in 3 pet parents says they know someone whose pet passed away because the owner could not afford the necessary treatment.

Ashley Eute, DVM

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