In this article we take an in depth and impartial look at the anti-itching drug Apoquel. Let’s find out who is using Apoquel for dogs, and what they are using it for.
We’ll pick apart the facts from the hyperbole, see how it’s been received by vets and dog owners since it hit the market just a few years ago, and hopefully help you if you’re deciding whether to give Apoquel to your dog.
What is Apoquel for dogs?
Apoquel is the commercial name for oclacitinib maleate, a drug which suppresses the itching sensation caused by dermatitis.
When our dogs feel an itch, they tackle it in exact the same way we do – by giving it a good scratch.
They do this using their feet, by rubbing against a satisfying-looking surface in your house, or even by chewing the niggly area with their teeth.
Unfortunately when dermatitis causes an itch that just won’t go away, repeating these behaviors over and over eventually damages the skin, causing painful lesions and setting up a vicious cycle of irritation which is hard to break.
What conditions is Apoquel for dogs used to treat?
Apoquel is prescribed to control the itching associated with allergic dermatitis and atopic dermatitis.
Allergic dermatitis is inflammation and itchiness of the skin caused by hives or hypersensitivity to any of the following:
- something touching their skin
- flea, tick, mosquito or other insect bites
- ear mites
- intestinal parasites
- or bacterial infections.
Atopic dermatitis is hypersensitivity to something in the environment which is either inhaled or absorbed through the skin, other than one of the things already listed above.
Sometimes the cause of atopic dermatitis is never identified.
Atopic dermatitis has a genetic component and is inheritable, and unfortunately Labradors are particular predisposed to it
Apoquel dog allergy medicine
An allergy is an extreme overreaction by our immune system to an everyday substance (the allergen).
When a dog suffers from allergies which cause dermatitis, there are two parts to treating them:
- identifying the allergen so they can be protected from it in future, and
- relieving the discomfort of their symptoms in the mean time.
Apoquel is used for the second part – relieving the discomfort of itching.
Since scratching the area frequently makes dermatitis exponentially worse, suppressing the need to scratch gives the skin a chance to heal.
But Apoquel does not by itself cure allergies or dermatitis.
Apoquel is usually prescribed to:
- treat the discomfort of itching while the cause of allergic dermatitis is identified and eliminated
- protect a dogs skin during summer if they get seasonal allergies
- or treat chronic atopic dermatitis over the long term if the cause is never identified.
How does Apoquel work?
Apoquel works by interrupting the signal pathway in our dogs’ cells which ultimately leads to inflammation and itching.
It manages that by blocking the activity of chemical signallers called janus kinases.
Where does Apoquel come from?
Apoquel is the latest in a line of drugs used to help dogs with itchy skin caused by allergic or atopic dermatitis.
It was released by Zoetis – the animal medicine arm of pharmaceutical giant Pfizer – in 2013.
So far no anti-itching drug (including Apoquel) has been created which is completely effective or completely free from side effects.
Apoquel was developed as an alternative for dogs who didn’t benefit from earlier drug therapies or who couldn’t tolerate their side effects.
Has Apoquel been tested?
Because Apoquel is relatively new, there hasn’t been much opportunity yet for tests to be carried out by scientists unaffiliated with Zoetis (that is, without any conflict of interest).
In Zoetis’ own tests, 186 out of 216 dogs with allergic or atopic dermatitis (86%) showed an improvement in symptoms within 30 days of taking Apoquel in a blind trial.
In a much smaller study at Montgomery Animal Hospital in 2017, vets reported promising evidence that Apoquel can help to treat dogs with outer ear infections caused by allergic skin disease.
Apoquel side effects in dogs
Following the first clinical trials of Apoquel, 279 dogs who had benefited from receiving it were permitted to continue receiving it directly from the manufacturer until it became commercially available, under the FDA’s Long Term Compassionate Use rules.
In 2015, Zoetis published the long term experiences of these dogs, some of whom had been using Apoquel for nearly two years by that point.
The most commonly described “adverse events” among those dogs were:
• urinary tract infections
• pyoderma (a bacterial skin infection)
• otitis (ear infections)
• weight gain
• vomiting and diarrhea
Less common adverse events included:
• cysts between the toes
• demodex mange
• blood abnormalities
Wait, “adverse events”, does that still mean side effects?
When a drug is as new as Apoquel, it takes time and carefully controlled trials to work out whether the health problems dogs experience whilst taking the drug are because of it, or whether they would have suffered them anyway.
So the term “adverse events” was used instead of side effects because it was difficult to say whether their frequency in dogs taking Apoquel was significantly higher than in the ordinary dog population.
That is to say, they may have had the same problems whether they received Apoquel or not.
In a review of her experiences with Apoquel for Pet Dermatology Clinic website, vet Melissa Eisenschenk agrees that incidences of ear infections, weight gain and urinary tract infections are higher in dogs on Apoquel. However, she notes that dogs with allergies tend to be more prone to urinary tract infections anyway, and the weight gain was less than usually seen with other anti-itching drugs).
Eisenschenk also reported bone marrow suppression in 1% of dogs taking Apoquel and recommended monitoring to identify these patients.
Veterinary feedback on Apoquel
In her review, Eisenschenk’s experience of prescribing Apoquel to over 1000 dogs was overall a positive one.
Which is mirrored by vet Nicole Heinrich’s description of giving Apoquel to 250 dogs on the VetGirl blog. Heinrich concludes that it is a promising replacement to steroids, but also stresses the importance of monitoring patients for the emergence of blood abnormalities.
One point on which there seems to be a lot of veterinary consensus: Apoquel is most suited to being used alongside carefully planned immunotherapy to isolate the cause of the itching and build up an appropriate immune response instead of an allergic one.
If you have the time and the inclination, you can read even more feedback from vets at a workshop on the pros and cons of Apoquel therapy (including side effects) in 2017.
Dog owner’s feedback on Apoquel
It’s human nature to compare notes with friends when we’re faced with trying something new.
Which can be tricky when something is so new it might not be on your friends’ radar yet either.
If you’d like, you can also read a compilation of dog owners’ experiences of Apoquel collected by vet Ron Hines on his website.
Remember that all cases are unique, and your Lab’s experience will not be the same ass another’s just because they are the same breed, age, or have the same allergy.
Detractors of Apoquel for dogs
Not everyone has been convinced by Apoquel, and since everything is online these days, there’s no point pretending the skeptics aren’t there.
Many ‘holistic’ vets, pretty much by definition, do not believe that Apoquel has a role in treating dermatitis.
Deva Khalsa and Will Falconer are among those who have written extensively against Apoquel.
Their main concerns are that suppressing any naturally occurring part of the body’s immune response is inherently wrong; that Apoquel also suppresses other important janus kinase functions (which include maintaining healthy bone marrow and intestines); and that Apoquel potentially increases the risk of cancerous tumors, which is unacceptable.
Using Apoquel dog medicine
If you’re preparing to take the plunge with Apoquel, what practicalities do you need to know about?
Apoquel is regulated by the Food and Drug Administration in the United States and the Veterinary Medicines Directorate in the United Kingdom.
It’s only obtainable with a vet’s prescription, so a trip to their surgery is a must.
In fact, if your Lab has dermatitis, visiting the vet isn’t just a bureaucratic exercise, they will be vital to improving your Lab’s well being in two other ways.
Apoquel for dog allergies
First, they’ll investigate the underlying cause of the dermatitis.
This might involve taking swabs to check for bacterial infection, using a special elimination diet to check for food allergies, and testing for parasites.
A great advantage of Apoquel is that it can be used concurrently with anti-parasitic drugs or topical ointments for bacterial and fungal skin infections, and it doesn’t interfere with allergy testing.
Secondly, your vet will monitor your dog while he’s taking Apoquel for any sign that he’s not responding well to it.
This should include taking blood samples to check bone marrow function.
Thirdly, your vet will help plan a long term strategy for managing your pet’s allergies.
Apoquel tablets for dogs
Apoquel comes in tablet form only. The tablets come in three doses: 3.6mg, 5.4mg and 16mg.
Dogs precribed Apoquel start by taking two doses a day for the first fourteen days.
Apoquel usually begins to work within a couple of days, and the consensus among vets who have used it is that if it isn’t working within two weeks, then it isn’t going to work at all.
After the first two weeks, the treatment is reduced to one dose a day. This is described as “maintenance therapy”.
Because Apoquel is eliminated by dogs’ bodies very quickly, some dogs owners have reported that the single dose works better if it is administered across two doses at the beginning and end of the day.
Apoquel dosage for dogs
The starting dose of Apoquel is determined by your Lab’s weight.
The data sheet provided by Zoetis gives the following doses:
If your Labrador weighs…
- 45 – 59.9lb, a single dose is two 5.4mg tablets
- 60 – 89.9lb, a single dose is one 16mg tablet
For the complete dosing chart you can consult the data sheet.
Needless to say, every dog is different. Whilst the doses listed there may be the best place to start, your vet might recommend tweaking the dose for reasons specific to your dog.
So, if your vet advises a different dose to that data sheet, always follow their advice.
They should be happy to discuss their reasoning with you!
Is Apoquel safe for dogs?
Apoquel is NOT safe or suitable for your Labrador if:
- they’re less than a year old
- they have a serious infections
- they’re being used for breeding, are pregnant or nursing puppies
In safety studies before Apoquel was released onto the market, puppies under one year old experienced an increased rate of bacterial pneumonia and demodex mange.
Your vet might also advise against using Apoquel if you Labrador has certain infections, since it works by suppressing part of the immune system.
Your vet might also advise against using Apoquel if your dog has had any kind of tumors in the past.
Apoquel for dogs cost
Finally, we come to the price of Apoquel of dogs.
In the US, Apoquel costs around $2.50 a tablet, which is pretty competitive with other anti-itching therapies.
If your Lab is unlucky enough to suffer allergic or atopic dermatitis, it’s likely to take several consultations with your vet and a small battery of tests to find out why.
And there’s a chance that the treatment could be lifelong.
So it’s a good idea to check whether these costs are covered by your pet insurance.
Should I give my dog Apoquel?
Always consult your vet if your dog has skin problems or is scratching.
Helping dogs with dermatitis is often a lengthy process of trial and error to find and eliminate the cause(s).
Anti-itching drugs can give your dog relief from the misery of dermatitis while that process takes place.
If your Lab has reacted badly to corticosteroids or other anti-itching drugs in the past, Apoquel might be the alternative they need.
Like virtually all effective drugs, Apoquel is not without side effects, and because it’s so new to the market there may be long term side effects which we don’t fully understand yet.
Like all medications, choosing to use Apoquel is a matter of weighing up your dog’s quality of life in the short term and the long term, and trying to make the best choice for your own pet.
Don’t forget, Apoquel is a prescription only drug and should only be given to your dog on the advice of a qualified veterinarian, and with strict attention to their instructions.
Have you tried Apoquel for your Labrador?
Please share your experience with us in the comments section below.