Should My Itchy Dog Get Apoquel?

Updated November 29, 2020

I have never seen a drug either so hyped or so demonised as Apoquel®.  If you have a dog that lives with itchy skin and allergies you’ve probably already heard of it. You might have heard of miraculous cures of long-suffering dogs. You might instead have heard of a drug too dangerous to trust.

I’m not here to defend Apoquel, and I’m not going to sell it to you. While it’s a good option for one cause of itching in dogs, it’s not a magic bullet. It’s not for every owner or every dog.

bravecto safety
Similar issues exist with all new drugs

Like all new drugs, it gets a hammering online for safety concerns. Some would say, “if you throw enough mud, some of it sticks.” Others would say, “where there’s smoke there’s fire.” The truth lies somewhere in the middle.

What Apoquel Is For

Apoquel has been specifically developed to treat atopic dermatitis. That’s the common skin allergy of dogs in Adelaide. While Apoquel may work for other causes of itching in dogs, in my opinion it shouldn’t be used for them.

Conditions, such as fleas, mites, or food allergy should all get specific treatment. In our rush to treat dogs for dermatitis, we are in danger of forgetting this. If your dog is scratching, you need a diagnosis first.

How Apoquel Works

Apoquel is the brand name of oclacitinib, a drug that inhibits enzymes which make inflammatory cytokines. These are some of the body’s messenger proteins that trigger the itching and inflammation of allergy.

Apoquel is extremely fast. I find that no matter how long a dog has suffered, the drug appears to have an effect as soon as it reaches the bloodstream. Let me tell you one outstanding story.

I saw patient X last year for a second opinion on her severe, long-term atopic dermatitis, the name we give to most skin allergies of dogs. I told her owners the vets had done everything that I would have done. The problem was, it wasn’t working.

This poor dog’s life had been one of constant itch, no matter what treatments were tried. The soundtrack to her owners’ lives was of constant scratching and nibbling, day and night. I said it was time for an Apoquel trial.

Her owners had read some of the horror stories, but everyone was desperate enough to try anything. With some trepidation, they gave the first dose with her dinner and sat down to watch TV.

An hour later they suddenly realised they hadn’t heard a thing from X, and turned to see her lying perfectly still. “She’s dead!” they cried and ran over to her in a panic. She looked up sleepily as if to say, “what’s all the fuss about?” Since then she’s barely itched again.

Is Apoquel a Wonder Drug???

Despite early success, Apoquel is no wonder drug:

  • It’s only been in use since 2013
  • It’s only one of many good skin treatments
  • It’s not free of side effects
  • It’s not cheap

Starting new drugs can be a bit like any new relationship. We tend to remember the positives and overlook the negatives. Only later do we look back with clearer eyes.

oclacitinib molecular structure
Useless chemical diagram By Vaccinationist (Own work, based on ChemSpider) [Public domain], via Wikimedia Commons

It sometimes takes time to learn about all the long-term consequences of any medication. So far, our experience has been generally positive. Of the 200+ dogs we have started on Apoquel, approximately two out of three had an excellent response, and of the other third, maybe half have had enough of an effect to make it worthwhile. One dog developed diarrhoea that required stopping the medication.

Loki’s Story

One of the excellent responders was my own dog, Loki. His skin had got bad enough that he often walked three-legged so he could scratch with the fourth. Evenings were spent nibbling at his legs. It’s tough to watch and he needed a radical change for the sake of his quality of life.

We called Apoquel his ‘itchy pill’. Like many other owners, we noticed that the effect wore off a few hours before the next dose was due. He would line up for it every morning, and within 30 minutes he wouldn’t scratch again until the following morning.

It was so effective that occasionally when he’d not stopped itching we discovered that he’d spat the tiny pill out on the floor. He had no visible adverse effects, and the only problem was the less than 24 hours of relief.

That’s why he’s now on a newer treatment called Cytopoint that you can read about here.

Reported Side Effects of Apoquel

Side effects that may occur are vomiting, diarrhoea, not eating, excessive thirst or appetite, or lethargy. Adverse skin changes may be itchiness, ear infections, skin infections or papillomas (warts). In particular, some dogs during drug trials developed deep skin infections on the feet.

Apoquel is, by design, immunosuppressive so we need to be careful that it doesn’t make infections worse. Similarly, some people suspect that it may lead to an increased rate of cancer, but there’s no evidence for this yet.

In fact, in 2020 a paper was published looking specifically at skin tumours in dogs on Apoquel. No difference was found between the 339 dogs being treated with oclacitinib and the 321 who weren’t.

You will also read online of many other adverse reactions that are reported to the FDA or APVMA. These should be interpreted with caution as they are illnesses that happened while the dogs were on Apoquel, not necessarily caused by it. It’s the old problem of correlation versus causation.

Alternatives to Apoquel

In our rush to use a novel therapy, we should never forget the things that have worked before. You can read about all the treatments for atopic dermatitis here. Even if your dog is being treated with prednisolone, I would not advise a change if it is working well without excessive side effects.

It’s even more important to remember that itching does not equal allergy. Atopy is only diagnosed after all the other causes of itch have been eliminated.

Cost of Apoquel

Personally, I think Apoquel is reasonably priced when compared with other costs of keeping atopic dogs comfortable. The three tablet sizes, 3.6mg, 5.4mg and 16mg are all similarly priced meaning bigger dogs are not greatly disadvantaged. I am told that my prices for Apoquel are comparable or slightly better than online prices.

I don’t think I’m allowed to state pharmaceutical prices online so let me just say that a whole tablet costs about the same as a bottle of spring water. Those owners whose dogs can fit into a half-tablet dose are the big winners. For these, I advise having a second bottle to fill with 10 or 20 tablets so that you don’t open the original bottle so often and let in airborne moisture.

Apoquel Dose Chart in kg: Number of Tablets

To finish, here’s an idea of what dose of Apoquel your dog would need. It comes in three tablet sizes. Dogs start on a dose twice a day for two weeks, then once daily for the long term.

Weight Range
of Dog (kg)
3.0 – 4.40.5 
4.5 – 5.9 0.5 
6.0 – 8.91  
9.0 – 13.4 1 
13.5 – 19.9  0.5
20.0 – 26.9 2 
27.0 – 39.9  1
40.0 – 54.9  1.5
55.0 – 80.0  2

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

36 Replies to “Should My Itchy Dog Get Apoquel?”

  1. So informative! Our 17yr old Jack Russell has been on Apoquel for about 18months now and its been fantastic for him; he did have papiloma’s before we started Apoquel, all over his body & 2 on his head, but they have increased since then – hard to tell whether thats age or because of the medication really. He does get itchy about an hour before his next dose like mentioned above so interesting to see others noted the same. Right now i’m battling him being constantly hungry. He’s also taking Cardisure so I had kind of hoped maybe that would reduce his appetite and balance it out a bit but I think age may also be getting to the old guy, he really only gets grumpy about food in the warmer months (We’re west of Sydney) so it might just be that he’s being more grumpy as he ages in general. Very interesting read though, thank you!

  2. Hi Susan, I have a 4 year old pug who has seasonal allergies and they just seem to get worse every year. He is on 5.4mg once a day but he wakes up at 3 or 4am and is just so so itchy he keeps everyone awake and you can tell he is distressed. Should I try giving him 1/2 in the am and 1/2 in the pm or just give him a whole pills 2x a day? He weighs about 23lbs so it looks by the chart he should get 2 a day but my prescription says 1 a day.

    1. Hi Liz. My advice would be to ask your vet about the dose. There may be a good reason why it’s the way it is, and now you’ve seen the dose chart you can have an informed discussion.

  3. I have a 2yr old Pug. She has been prescribed Apoquel 5.4, but will not take it. I have tried mixing it in her food, treats, cheese, etc. giving her half so she cannot detect it. Nothing so far has worked. So she keeps on itching. She was diagnoised with dermitis I would love to help her, but have had no success. Help!

    1. Hi Juanita. I have never heard of a dog refusing Apoquel. Normally I would teach you how to give a pill without food but Pugs are very hard. I can’t suggest anything except to ask your vet about Cytopoint instead.

    2. Hi I have some great news for you. I feel your pain with trying to give your pug tablets. We had this issue for some timeBUT something made me try Liverwurst paste and low and behold no more issues. It’s cheap and we just make sure it is well buried in the Liverwurst (Hans). Good luck!!!

  4. My dog 2yr 3month old border collie (22kg) has just been recently prescribed 3/4 tablet twice daily of Apoquel for the treatment of Discoid lupus erythematosus just wondering if you have had any experience in using the drug for this condition?
    We were prescribed Apoquel in addition to our ongoing treatment which hasn’t been effective to date of vit B3 twice daily, fish oil and Vit E daily along with 100mg Doxycycline twice daily.

    1. Hi Sharlene. That sounds like good thinking on your veterinarians part, but I have a few other suggestions. Firstly, if you live in the southern hemisphere your dog has just experienced a period of high ultraviolet radiation. This should always be prevented in dogs with discoid lupus via the use of sunscreens or exclusion from sunny areas. Secondly, if the Apoquel is unsuccessful, it could be reasonable to try tacrolimus or Atopica. However, you seem to be on the right track.

  5. My westie has been on apoquel for the last 6 years. It worked fine at first but nowadays he is still itchy, has itchy ears and his skin feels a bit greasy. I don’t think it’s really working for him anymore. Wondering if something else might work better

    1. Hi Hayley. Most people find that Cytopoint works a little better, but with Westies it’s also very important to pay close attention to secondary infections such as ear infections and yeast skin infection. These create more symptoms than the underlying allergy and will continue to occur even on Apoquel or Cytopoint.

  6. Hi Andrew my dog is on half anapoquel 5.4 mg a day and i have recently changed myvet as we moved homes and went to a closer vet however i have been paying 63 dollars for21 tablets at the new vet i payed 100 dollars for 21 tablets my dog has askin condition but doesent scratch to much however i live in queensland and a 100 dollars isalot ofmoney whenyour on a pension so I know you can g giveme a price but can i buy some from you

    1. Hi Nick. I’m unable to sell prescription medicines without either seeing the animal or being supplied with a valid prescription. If I were you I’d ring all the vets that you can drive to and see if any will supply it cheaper. Our prices in 2019 as a guide are around $250 for 100 tablets but I know we’re rather (too) cheap. Also, I’d look into Cytopoint injections– it can work out well if they end up lasting for longer than they should.

    2. Hi Nick
      I know where you are coming from I am also on pension Have 2 senior rescue pooches that I Love dearly My Vet has just put one on Apoquel He charges me $113 for 20 3.5 dosage
      I asked him and out giving me a script HE REFUSED
      I have been with him for 17 yrs & spent thousands of dollars with him I had 2 other fur babies that both passed last year Not happy
      but nothing I can do other than see if there are vets in my area who would write ne a script & I would go with them It’s sad because I really like the vet I have but I think he could have given me a script

    3. I buy mine from chewy, they fax the vet and get the ok then ship it to me and I only pay 51.00 for 21 16mg tablets that I then cut into quarters and give my dogs.. I have it on auto ship so I don’t run out and when I have enough all I have to do is skip a shipment and since my order is over 49.00 I get free shipping
      Not sure if you can get a site like this over where you’re at..

      1. Hi Lisa. In Australia at least, we have clear prescribing rules that prevent the use of the 16mg tablet below 13.5kg. Our tablet also does not have a score line to divide it 4 ways. It’s also worth pointing out that the prices you mention per tablet are not especially low, possibly because you are buying small quantities.

  7. Our Labradoodle was born in the summer and arrived itching and within a month she had a skin infection from itching so much. That first year we had to give her some steroids to manage her skin allergy, coupled with all the usual soothing balms and extra bathing. When winter arrived her skin settled down with no redness or itching. As it settled we guessed it indicated a grass allergy ( we live in the country). In Her second summer the same symptoms presented and again and we managed it the same way. Her skin settled down over the winter for the second year in a row. Going into her third spring the vet offered as Apoquel as an alternative to steroids being very safe they told us. We had to use quite a high dose she weighs 24kg and has been on – 10-16 mg since October last year. Ok so that brings us to now I am trying to stop the Apoquel as she should be better the paddocks are green and winter is upon us….. BUT she is worse and can’t sleep at night due to itching the only way I could get her to sleep last night was to pat her to sleep and stop her from scratching. We have been watching her diet closely and have removed all grains and feeding her single protein even though I think her allergy was initially grasses. I feel in my heart and observations that the Apoquel has made her so much worse and that her body has no defence.

    1. Hi Kath. I perfectly understand your point of view and it’s possible given that Apoquel is a newish drug. However, your experiences sound very similar to mine with my Jack Russell Terrier. Like many atopic dogs, his allergy became less seasonal and more severe over the first four years. He started only being affected for a month or two but by his fourth year it was year round. That’s when I started his Apoquel. It’s worth knowing as well that these days he is on Cytopoint.

      1. Thanks for your reply I appreciate it. I am taking her to our local vet tomorrow and I will be asking for Cytopoint. I’ve been reading as much as I can find and it sounds like the safer alternative. It’s heart breaking seeing her itch and biting herself raw. Fingers crossed

  8. Apoquel killed my dog. Never knew she had cancer until the day before she died. 3 years on the drug. Had no idea that it caused cancers to worsen. I suspect it may have caused it to begin with, but I can’t prove it. When she died, her stomach was massive, there was a mass on her liver that was bigger than the liver it self and one of her kidneys was more than double the size. I have her xrays to prove it. If I had known I would be trading her itching for her life, I would never have used the drug. On top if that, Apoquel becomes les and less potent over time, so it didn’t even work very well long term. Plus it’s expensive. Please do not use. Save your best friend even though I couldn’t save mine. Please run bloodwork to be sure. My dog died a couple days ago. I though Apoquel was great too. She had horrible skin problems. It wasn’t worth her life though. Look into washing with apple cider vinegar. It does help.

    1. Hi Terri. Very sorry. We generally run bloods on dogs on Apoquel (including mine above) and are thankfully problem-free up to now. There’s always a chance the drug caused the tumour or accelerated its growth of course. The advent of Cytopoint now also gives us an option that carries a lower rate of adverse effects, but the risk to dogs on Apoquel seems acceptably low if present.

  9. My dog has very bad skin condition . Has allergy tests and immunotherapy injections but still flare ups very allergic to yeast bacteria. One bad flare up started on apoquel . Miracle . 8 weeks in
    Restless at night Diarrhea unless given stool firmer and buscopan . Reduced apoquel to 4 mg rather than 8 . Ok in himself except seems uncomfortable at night . Up twice a night .
    Blood tests indicate slightly raised cholesterol. Vet wants to scope , I wonder though if I should stop apoquek first .
    He also has two weekly baths for yeast Bactria ,
    Wits end. Little skeep and worried

    1. Hi Chris. Instead of stopping Apoquel, have you thought of changing to Cytopoint? It usually works well for dogs that respond to Apoquel but has fewer side effects.

  10. hi my dog has been on Apoquel nearly a year her itch is under control she is on one and half a day she weighs 40 kilos sometime she vomits eats a lot of grass and does drink more i have notice some small lumps my vet says nothing to worry about but i have heard some people write that there dog was on this drug and there dog got cancer as it is suppressing the dogs immune system so now im scared do i take her off it regards adrieanna
    please advise

    1. Hi Adrieanna. Firstly, I would trust your vet as they we all see a lot of lumps, most of which are nothing to worry about. You can look at some pictures of lumps here. Secondly, you can consider changing to Cytopoint as a safer alternative. However, Apoquel is a very safe drug and true problems are actually quite rare. Of the 50 patients we’ve used it on, there has been just one dog who had gastrointestinal side effects.

  11. My dog has been itchy since we moved to acreage (1year) She had also had 3 or 4 ear infections which seem to come about when she gets particularly itchy. We just haven’t been able to stop her itching completely since we’ve lived here. Today our vet prescribed Apoquel. My biggest concern is the cost. Though I have found it significantly cheaper on line so hopefully they will let me have a prescription.

    1. Most vets are happy to write a prescription but you may also find it cheaper at different vets (our prices were cheaper than online last time I checked)

      1. Hi Andrew
        I wish my vet of 17 yrs would write a script for me for Apoquel
        After spending thousands of dollars with him He Refused to give me a script His nurse told me he gets cranky when people ask for scripts Maybe time to change vets
        Cheers Denise

  12. My 7 year old Stella the English Bull Terrier had constant skin allergy flare ups for years…including large red welts on her torso and legs, and severe itching and redness on her paws; she would chew them until the were raw and often infection would follow. We tried everything the vet suggested for years, including steroid medication and injections. She now has half to one apoquel a day. It has changed her life. Worth every penny, despite the expense. No apparent side-effects ( 2 years and counting) so far and just a happy, itch free, non-distressed dog and owner.

  13. I would like to share my approach in managing my boy’s seasonal Atopic Dermatitis ( AD) & Apoquel. A long post, however, my approach with Andrews support has helped immensely.

    Andrew has looked after all of my Akita’s and when my white boy presented with acute ‘hot spots’ and other unknown skin issues, during his 2nd flair up, Andrew recommended he would benefit by being on Apoquel. However, this required my dog being seen & assessed by a Dermatologist, to identify his underlying skin problem. Assessment outcome – allergy triggers to various seasonal grasses, weeds & tree pollen’s.

    Now, I ensure he has his therapeutic baths / grooming, his Allergen Specific Immunotherapy injections (ASI), supplements & in my case Apoquel only during our peck pollen season.
    Outside of the pollen season he does not require Apoquel.

    Firstly: the goal of the ASI is to slowly desensitise his own immune reaction to his known triggers ( pollen’s etc).
    Secondly, with regular therapy baths/ grooming the aim is to
    1. remove all allergen triggers off his skin &
    2. build up & moisturise his compromised skin barrier ( I only use
    Evening Primrose Oil 3 % Vet grade shampoo),
    Thirdly all my dogs are given supplements to naturally support their immune system ( EPO the food supplement, Vitamin C, Organic Spirulina, Probiotic’s w/- turmeric & coconut powder, Tripe powder, a quality grain fee kibble & my cooked food),
    Fourthly, I watch our pollen count during the high season and this is only when he is given Apoquel.
    Fifthly, I vacuum my home daily w/- the aim of keeping pollen’s to a minimum and,
    Lastly, I DE my carpets and the dogs bedding to kill the dust mites.
    Of course, he is monitored by Andrew who is astounded by his well hydrated soft fur and overall healthy condition.
    Thank you J.

  14. Thank you for writing this and other blog posts. It’s really appreciated by dog owners like me who need a professional view.

  15. After 5 years of itching scratching, couger is finally good. Apoquel is his miracle drug. Amazed how quick it works. Worth the money, for dogs sake.Off of it now for winter..until spring….

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