For most stages of HW dz, I'm treating with doxycycline (10 mg/kg BID) for one month before the 1st melarsomine (we use Diroban) injection. If microfilaria is found on the initial diagnosis, I'm pre-treating with diphenhydramine/dexamethasone before the first HW preventative and then monitoring the day for ~5 hours. Dog's stay current on HW preventatives throughout treatment. I really like Proheart 12 for this since it "batters" the worms better.
Each injection goes deep in the epaxial muscles between L4 and L5.
I have the assistant place pressure on the injection site for 5 minutes.
If it's stage 3, I'm treating for 2 months with doxy before the first melarsomine inj
Injections 2 and 3 of melarsomine occur one month after the first melarsomine inj over 24 hours.
I prescribed 0.3 mg/kg of prednisone BID for 5, SID for 5 days, and then EOD thereafter for one month after each injection series. I prescribe gabapentin for the first 7 days after each injection series.