Is Apoquel as good as it sounds?
10 facts about this new “anti-itch drug” for dogs!
Karen Helton Rhodes, DVM, DACVD
Terri Bonenberger, DVM, DACVD
Canine Skin Solutions, Inc.
There has been an incredible amount of hype and internet discussion about this new drug for allergy dogs. Unfortunately, part of the discussion has been the immediate lack of availability directly after launch. The carrot was dangled and then taken away!
We, as dermatologists, have now had the opportunity to use this new “allergy tool” in our “therapeutic toolbox” since October 2013. Hundreds of patients later, that duration of clinical experience has revealed several key pieces of information regarding the use of Apoquel. Unlike some well-circulated internet reports that my clients often bring to an office visit, the information in this report is based on direct clinical experience with the drug. Let’s explore what we “know to date”.
Apoquel = oclacitinib (company= Zoetis of Florham Park, NJ; previously the animal division of Pfizer)
1. What is Apoquel?
*First, it is NOT a steroid (cortisone), antihistamine or cyclosporine.
*Apoquel is an immunomodulatory drug (modulates the immune system)
*It is a unique class of medication that specifically targets the activity of cytokines that are involved in the stimulation of itch and inflammation.
*Cytokines are chemicals that the body produces when exposed to an allergen (among other things!)
* Apoquel blocks the cycle of inflammation and itch that these cytokines trigger
2. How does Apoquel work?
*Apoquel inhibits the activity of inflammatory cytokines (example: interleukin 31) by inhibiting JAKs (janus kinase) enzyme activity in the body. These JAK messenger/signaling compounds act as triggers for the neurostimulation that creates itch. If you can block the trigger…you can block the itch.
3. How is Apoquel dosed?
*twice daily pill for the first 2 weeks and then the dose is lowered to once daily
*It is REALLY FAST…….most dogs respond within 24 hours!
*the drug is out of your dog’s system in 24 hours ……so it must be given daily to be effective
* some dogs will see an increase in itching when the dose is lowered but it is important to try to stay with a once daily dose for safety (your veterinarian will discuss and monitor any alternative dosing)
4. Does it work for every itchy dog?
* It does NOT seem to help with itchy ears or recurrent ear infections from allergy
5. Do I have to taper Apoquel if I decide to stop the drug?
*No, it can be stopped abruptly
*remember, it is out of your dog’s system in 24hours after the last dose
6. Is Apoquel safe?
*Apoquel is NOT for dogs less than 1 year of age!
*the most common side effect is vomiting and diarrhea…..but, typically, mild
*At a very high dose (5-6 times recommended dose) studies showed that Apoquel MAY increase the chance for demodicosis, infection, or may cause an increase in skin lumps or tumors- we are not sure if these observations are related to Apoquel use or would have occurred even without the medication…we are still collecting data!
*some dermatologists have seen the above complications with Apoquel at even the recommended dosages ( I have not seen an increase in infections in ANY of my patients nor have I seen a problem with demodex mites)
*some people report weight gain
7. Do I need to monitor my dog’s blood work?
*YES! Any long-term drug can pose a problem!
*Apoquel is a new drug and we are still collecting data on safety.
*I have seen lowered white blood cell counts and anemia in some of my patients taking Apoquel
* rarely, liver enzymes can be elevated
*If you see a problem in the blood work…stop the drug (or lower the dose) and all goes back to normal
*Remember, if you don’t look…..you will never see a problem!
8. Can my dog receive regular vaccines while taking Apoquel?
*Yes, there is no problem
9. Can my dog be allergy tested (intradermal skin testing) while taking Apoquel?
*Yes! Excellent tests results have been found while on Apoquel. There is no need for withdrawal prior to testing
10. Will Apoquel treat ALL causes of Itching?
* Apoquel has been shown to decrease itching in all forms of hypersensitivity: Atopic dermatitis (environmental allergy), CARF (cutaneous adverse reaction to food), contact allergy, and even hypersensitivity to scabies mites (mange)
*DON’T forget to look for an underlying cause! Don’t let Apoquel mask a problem such as scabies mites, which are easily treated and do not require long –term therapy
*DON’T use Apoquel as a BandAid
For more information on allergies and therapeutic options visit www.HealthySkin4Dogs.com