Apoquel: Helpful or Harmful to Your Dog?
It seems with every passing year, there is an increasing number of pets diagnosed with allergies or allergy-related skin conditions. And now there’s a new (less than 10 years old) drug on the market that claims to relieve all those itchy symptoms.
It’s called Apoquel (oclacitinib maleate).
Now, before we go any further, let’s be clear -- we are not promoting nor are we discounting Apoquel as an effective medication for the treatment of allergies and skin conditions. Every pet is different, and we firmly believe that the decision to medicate (or not) should come down to the risk/reward factors of each unique case.
We won’t be sharing our opinion about Apoquel. We encourage you to form your own conclusions about the drug based on the information available.
So let’s get to the facts about Apoquel. Here’s what we’ll cover:
- What is Apoquel & how does it work?
- Does Apoquel cure allergies and skin conditions?
- What are the side effects of Apoquel?
- Does Apoquel cause cancer?
- Is Apoquel safe for all dogs?
- What are the long-term effects of Apoquel?
- Are there alternatives to Apoquel?
Get quick answers
- I double-dosed my dog, will they be ok?
- Does Apoquel create seizures in dogs?
- Is Apoquel safe for long-term use?
- Will Apoquel treat a skin infection or just the irritation associated with it?
- My dog has a history of cancer; can he take Apoquel?
- Will my dog gain weight on Apoquel?
- What happens if I take my dog off Apoquel?
- Does Apoquel cause bloating?
What is Apoquel & how does it work?
Oclacitinib (Apoquel) is an FDA-approved immune suppressant drug. It is used to control pruritus (that’s medical jargon for ‘itchy skin’) in dogs that have allergic or atopic dermatitis. In plain english, itchiness is an immune response -- the body’s reaction to things like allergies, insect bites or skin conditions. Apoquel shuts down this immune response, which relieves your dog’s itch.
At the same time, however, Apoquel also prevents your dog from completing other important immune tasks, like fighting infection. More on that shortly ...
Apoquel tablets are available by prescription only. They come in three doses: 3.6mg, 5.4mg and 16mg. Recommended dosing is based on your pet’s weight.
According to sciencedirect.com, “In studies of dogs with atopic dermatitis, the efficacy was 66% and 49% as assessed by pet owners and veterinarians, respectively, and 67% in a study with allergic dermatitis.” Apoquel was also shown to have the same effect as prednisolone in dogs.
UW Veterinary Care, University of Wisconsin-Madison stated: “Our experience suggests that it [Apoquel] works great in around 50%, partially in around 30%, and poorly in 20% of dogs.”
In a 2013 information sheet, Zoetis, the pet-specific subsidiary of Pfizer and the makers of Apoquel, stated:
“Apoquel provides fast, long-term relief from itch and inflammation without many of the side effects associated with some other treatments.”
“Apoquel allows your veterinarian to continue to diagnose the underlying cause of itch while providing your dog with relief.”
“Apoquel targets a key itch signal in the nervous system and has minimal negative impact on the immune system.”
Does Apoquel cure allergies and skin conditions?
No. Apoquel does not cure any underlying causes of allergic or atopic dermatitis. Apoquel may minimize the symptoms associated with allergic or atopic dermatitis.
If Apoquel works for your dog, symptoms should subside as long as he’s on the drug. Unfortunately, if and when you stop giving Apoquel to your dog, his itchiness and inflammation will return.
What are the side effects of Apoquel?
The information sheet inside the Apoquel box lists the following potential side effects (in no particular order):
- SQ or dermal masses (unspecified)
- decreased leukocytes and/or globulins
- increased cholesterol and lipase
- May exacerbate neoplastic conditions (conditions that cause tumor growth, benign or malignant)
Some studies show that while on Apoquel, a low number of dogs have developed:
- bloody diarrhea
- skin and ear infections
- UTIs (urinary tract infections)
- histiocytomas (and other tumors)
- pyoderma (bacterial skin infection)
- demodex mange
- reduced white blood cell count
In early studies, some dogs developed side effects similar to those seen in dogs taking steroids:
- increased appetite (and weight gain)
Apoquel is a novel Janus kinase (JAK) inhibitor. According to Dr. Melissa Eisenschenk, DVM, DACVD, “JAK signaling is important to the function of the bone marrow … bone marrow suppression is the most concerning side effect.
Eisenschenk goes on to say that she has only seen this in about 1% of pets on Apoquel.
Does Apoquel cause cancer?
There is no evidence to suggest that Apoquel causes cancer. However, the drug does interfere with the body’s immune response, which can make pre-existing cancers worse.
Is Apoquel safe for all dogs?
Apoquel is not approved for dogs under 12 months of age.
Apoquel is not safe for dogs with serious infections.
Zoetispetcare.com offers the following safety information:
- Apoquel may increase the chances of developing serious infections
- Apoquel may worsen existing parasitic skin infestations or pre-existing cancers
- Apoquel has not been tested in dogs receiving some medications, including some commonly used to treat skin conditions, such as corticosteroids and cyclosporine
- Do not use Apoquel in breeding, pregnant or lactating dogs
What are the long-term effects of Apoquel?
As mentioned, Apoquel works by disrupting kinase pathways in dogs' immune systems. That disruption may stop (or at least minimize) itching, but it’s also stopping your dog’s ability to complete other important immune tasks.
Talk to your vet about regularly checking your dog’s blood count, kidney and liver function, and urine while he’s taking Apoquel.
Can you overdose on Apoquel?
To date, there isn’t a lot of literature about Apoquel overdose. In one study, dogs were given six times the normal dose of Apoquel for several weeks. The results mainly showed gastrointestinal issues, such as vomiting, diarrhea and decreased appetite.
Another overdose study was performed in 4- to 6-month old dogs—they were treated with multiple times the recommended dose twice a day for four months. The study was terminated early because, “some dogs receiving 3x and 5x overdose developed adverse events related to immune suppression including generalized demodicosis.”
If you accidentally give your dog too much Apoquel, keep a close eye on her for 24-48 hours. If she shows signs of any of the above-mentioned issues, take her to the vet to get checked out.
Are there alternatives to Apoquel?
There are always alternatives. It’s not for us to say whether they’re “better” or “worse” than Apoquel. That’s up to you. Still, we did some research and uncovered these alternatives to Apoquel:
A balanced supplement, with many vitamins and minerals, can address the underlying issues. Preferably containing a digestive enzyme to assist digestion and any allergies that may be known or unknown. Click here to see our recommendation.
Yucca is a natural alternative shown to have a similar effect to steroid drugs (but without the harmful side effects).
Quercetin, a plant derivative, acts as a natural antihistamine. It’s often used to help dogs who have responded well to Benadryl.
Atopica (cyclosporine) was the go-to choice before Apoquel was released. It, too, has its own list of dangerous side effects.
Prednisone is a steroid that’s been used to treat itch and inflammation for years. Unfortunately, steroid drugs have much stronger side effects than Apoquel, and they’re not recommended for long-term use.
Over the counter antihistamines, like Benadryl, are a fairly safe option to combat an acute allergic reaction in the short-term but the daily use of sweetener/sugar in Benadryl is not recommended.
If you want to avoid Apoquel, there are a few natural alternatives. The most common is holistic nutrition. Holistic nutrition focuses on whole foods and supplements that can help address your pet's needs, both physically and emotionally. It can also be used as an alternative to Apoquel if you're concerned about its side effects.
Another option is homeopathy or traditional Chinese medicine (TCM). These therapies use herbs or other natural ingredients to treat allergies in pets by strengthening their immune systems so they can fight off allergens without medication. TCM has been shown effective for treating allergies in dogs with fewer side effects than conventional medications like corticosteroids.
The benefits of holistic pet nutrition can help address the underlying needs of your pet, which may prevent symptoms and relieve symptoms of allergies.
If you're wondering whether or not holistic pet nutrition is right for your dog, here are a few things to consider.
Holistic pet nutrition can help address the underlying needs of your pet, which may prevent symptoms and relieve symptoms of allergies.
There are also many foods that contain ingredients that have been linked to allergies in humans as well as animals (e.g., meat or dairy products). These foods should be avoided whenever possible because they could make it easier for an animal to develop food sensitivities over time.
Natural (long-term) solutions for itchy, irritated skin
There are several alternatives to medication when it comes to treating allergic and atopic dermatitis:
- Identify & remove environmental allergens
- Check for dietary allergies, intolerances or sensitivities
- Rule out infections and parasites
- Feed supplements (digestive enzymes and omega 3s are great for dry, itchy skin)
Rob: My dog’s itching is a problem.
Lindsay: Hi Robert, sorry to hear.
Rob: Is Apoquel safe?
Lindsay: We recommend proactive supplements as opposed to reactive products. That's why we only use necessary, high quality ingredients to assist pet health long-term. Our Essentials formula works on this, as it contains digestive enzymes (to help assist allergies) and MSM (to strengthen the skin and coat). Alternatively, Omega3 is a good way to add healthy oils to problem skin.
Rob: How successful is Essentials at relieving itch?
Lindsay: Essentials is our full support supplement that contains necessary vitamins, minerals, amino acids, digestive enzymes, MSM, and glucosamine hydrochloride. Based on our 20 years experience, I’d say it’s very successful—but success will depend on the actual cause of the itching. Essentials is the best option if you don't know the cause, as it addresses multiple facets of the diet and helps to rebuild cellular structure. Results can be seen within 2 to 4 weeks.
Rob: Great, thanks so much for all the helpful info!
Get your pet on the fast track to recovery:
Apoquel is not for all pets. If your dog or cat has allergies and it's causing them to scratch, itch and bite themselves all day long and they're really uncomfortable, then Apoquel might be something to consider. But, if your pet is itching and scratching due to allergies or nutritional deficiencies, then it's best to try other methods first.
If you're looking for an alternative to Apoquel, we recommend trying Holistic Pet Nutrition. It's a great way to address the underlying needs of your pet, which may prevent symptoms and relieve symptoms of allergies.
Learn more about your pet’s itchy skin
We also have some other posts that dig a little deeper into the causes and treatment of allergies and skin conditions … check ‘em out here:
This was a very interesting article about how to use Apoquel and the holistic approach should you choose another path.