The document discusses combination dewormer treatments for small ruminants. A combination treatment involves administering more than one dewormer drug simultaneously to kill worms that may have developed resistance to individual drugs. Each drug in the combination should reduce fecal egg counts by at least 60% for it to be effective. Common drugs used in combination are albendazole, moxidectin, and levamisole, but they must be administered separately as combination dewormers are not available in the US. Combination treatments should only be used on clinically parasitized animals.

1. OM BIN AT ION T R E AT MENT S
The American Consortium for Small Ruminant Parasite Control
(ACSRPC; wormx.info) recommends that clinically-
parasitized small ruminants be given combination treatments.
A combination treatment is when you give more than one drug (dewormer) at the same time to kill the same worms.
Combination treatments have an additive effect on the worm population. The purpose is to kill as many worms as
possible. Worms which survive one drug can be killed by the second (or third) drug. To be beneficial, each drug in the
combination should reduce fecal egg count by at least 60 percent. A combination treatment with copper oxide wire
particles (COWP) may also be effective (dewormer + COWP).
Combination treatments should only be given to clinically-
parasitized animals, as evidenced by FAMACHA© score,
body condition score, the Five Point Check®, or other
targeted selective treatment (TST) criteria. Treating all
animals in a flock or herd will result in accelerated
resistance to all dewormers in the combination. Veterinary
approval (Rx) is required to give combination treatments to
goats and camelids, as non-FDA-approved drugs are
usually recommended.
ALBENDAZOLE (VALBAZEN®) + MOXIDECTIN (CYDECTIN®) + LEVAMISOLE (PROHIBIT®, LEVAMED®)
Combination dewormers are not available in the US. Each
drug in the combination must be administered separately,
ideally in a separate syringe. Dewormers should not be
mixed because they are not chemically-compatible. The
most effective drug from each class should be given. A full
dose of each drug should be administered, based on an
accurate weight. Only oral (drench) formulations should be
used. The withdrawal period of the drug with the longest
withdrawal should be observed (usually Cydectin®)