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Related FAQs: Flowerhorns, Flowerhorns 2, Flowerhorn Identification, Flowerhorn Behavior, Flowerhorn Compatibility, Flowerhorn Selection, Flowerhorn Systems, Flowerhorn Feeding, Flowerhorn Disease, Flowerhorn Disease 2, Flowerhorn Disease 3, Flowerhorn Disease 4, Flowerhorn Disease 5, FAQs on Flowerhorn Cichlid Disease by Category: Environmental, Nutritional (e.g. HLLE), Social, Infectious (Virus, Bacterial, Fungal), Parasitic (Ich, Velvet...), Genetic, Treatments, Flowerhorn Reproduction, Neotropical Cichlids, Cichlid Fishes in General, Cichlid Systems, Cichlid Identification, Cichlid Behavior, Cichlid Compatibility, Cichlid Selection, Cichlid Feeding, Cichlid DiseaseCichlid Reproduction,

Related Articles: Parrot ("Jelly Bean") Cichlids & Flowerhorn Cichlids: maintenance and healthcare of two popular hybrid cichlids by Neale Monks, Flowerhorns by Ong, What do you think of Flowerhorn Cichlids? By Neale Monks, Cichlids of the World

Why is your Flowerhorn or Parrot Cichlid Sick?



© Neale Monks 2012


Almost all the queries we get about sick Flowerhorn and Parrot Cichlids come down to the same set of problems. So to speed things up and make it easier for you to treat your pet fish, here are the important things you need to know. 

Aquarium Size

Keeping these big cichlids in a small aquarium is the NUMBER ONE reason why these fish get sick. Before you start spending money on medications, look critically at the aquarium. A single Flowerhorn cichlid needs a 75-gallon (280-litre) aquarium. A single Parrot Cichlid needs a 55-gallon (210-litre) aquarium. Yes, juvenile cichlids up to about 4 inches (10 cm) might be kept in slightly smaller tanks, but it isn't recommended. When you buy your cichlid, get the right size aquarium right from the start.

Why does aquarium size matter? There are several reasons. Good water quality is one, and stable water chemistry is another. Ammonia and nitrite levels need to be 0 mg/l and that the nitrate level below 20 mg/l. The water should be hard, slightly alkaline, and with a pH between 7 and 8. These cichlids are also very sensitive to low oxygen levels, and a big aquarium will minimise this problem. Water temperature can affect oxygen levels too, and needs to be middling, 77 degrees F (25 degrees C) being ideal. Weekly water changes of at least 25% are a good way to keep living conditions in the aquarium clean and healthy.

If you don't have space for a big aquarium, then don't buy a Flowerhorn or Parrot Cichlid. WWM can't offer any magic workarounds, and even the best medications will fail if the environment is wrong. Flowerhorns and Parrot Cichlid must have a clean, hygienic aquarium to do well.

Like most big cichlids these fish are best kept alone. They are aggressive, territorial, and don't need "friends".


Here's another common reason things go wrong. Don't use live feeder fish, ever! Live feeder fish are a sure-fire way to introduce parasites. Furthermore, some species (goldfish and minnows especially) contain dangerous quantities of fat and thiaminase that cause long-term health problems.

Tubifex worms are another food known to introduce parasites, and in recent years bloodworms (Chironomus larvae) have been suspected of being risky too. Avoid both, whether live or frozen.

The best foods for these cichlids are good quality pellets such as Hikari Cichlid Gold and Spectrum brand, together with brine shrimps and occasional offerings of green foods, particularly cooked peas and spinach. Green foods are an excellent way to ensure your fish doesn't suffer from constipation, a common problem. Feel free to starve your fish for a few days if it doesn't show much interest in peas, and it's a good idea to get them used to green foods right from the start, not when you start suspecting your fish is bloated or constipated. 

Digestive tract problems (such as a protruding anus)

We often get sent photos of cichlids with their anus protruding outwards. Often the fish is exhibiting other problems as well, such as loss of appetite. This problem is caused by bacteria and/or protozoans in the digestive tract. Medicating with Metronidazole and Nitrofurazone can help, assuming of course the underlying, mostly environmental problems are fixed as well. So alongside the Metronidazole and Nitrofurazone, check the size of the aquarium and perform water quality tests to make sure the ammonia and nitrite levels are zero and that the nitrate is below 20 mg/l. 

Hole-in-the-Head and Lateral Line Disease

Hole-in-the-head (or HITH) is where off-white pits appear on the head. It may be the same disease as the one that causes pits to appear along the lateral line of the fish, sometimes called Head-and-Lateral-Line Erosion, or HLLE.

The causes of these diseases are unclear, but several factors have been identified. A poor living environment is almost always a factor, so the size of the aquarium should be checked, as well as water quality and water chemistry. Warm, oxygen-poor water is another common factor. Infrequent water changes are yet another factor. Finally, diet is an important factor, in particular a lack of vitamins (perhaps from insufficient green foods) being particularly significant.

In short, the more you depart from proper care, the greater the risk of HITH and HLLE. 


Cichlids like the crosses that are Flowerhorns and Parrots can become constipated, in much the same way as goldfish. The article Floaty, Bloaty Goldfish covers this topic very well and the treatment (green foods and Epsom salt) works just as well with cichlids as it does with goldfish.

Do note the differences between constipation and the digestive tract infections described earlier. Constipated cichlids may have problems swimming but they will otherwise look active, healthy and normal. Fish with bacterial or protozoal infections will look much less healthy, and may be disinterested in food, exhibit weak colours, be gasping at the surface, and often produce copious amounts of slimy, pale faeces. 


Without question, the best medications for treating sick cichlids are Metronidazole and Nitrofurazone. When used together they're very good at eliminating most of the most common pathogens. You may be able to acquire these medications from your local aquarium store or online, but in many places they will need to be obtained from a vet.

Needless to say, prevention is better than cure!

Would addition of a few comments re maintenance be warranted?
Am a huge fan of weekly good-sized water changes w/ these fishes…

Perhaps a line or two re compatibility, good choices in tankmates?

Sick Flowerhorn article
> Hello Bob, Chuck,
> I threw this together in the hope than Chuck and I wouldn't need to keep saying the same things again and again. If the two of you would be so kind as to peruse and suggest changes, I'd be happy to then submit this as a freebie to WWM for its use as/when.
> Cheers, Neale

> Ahh, thank goodness (and you). Please see my notes in red on the attached copy. B

Hi Bob,

Please go ahead and make those changes.
Re: tankmates; I'd recommend none. Given most of these fish are kept in too-small tanks anyway, adding, say, a Plec, is only going to make things worse.
Cheers, Neale

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