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?
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?
Unfortunately, it’s too soon to say. Zoetis released the drug in 2013, and there have yet to be any studies to reveal data on the long-term effects of Apoquel in dogs.
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.
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:
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.
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
- Try topical solutions, like balms and ointments (often used to treat hot spots)
- Feed supplements (digestive enzymes and Omega 3s are great for dry, 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: