Should My Itchy Dog Get Apoquel?

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 regret that we were so one-eyed.

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 50 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.

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)
3.6mg5.4mg16mg
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

By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These blogs are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story!
Have something to add? Comments are welcome below and will appear within 24 hours of lodging.

Andrew

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

  1. 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
    Thankyou
    Nick

    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. 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

  3. 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.

  4. 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

  5. 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.

  6. 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)

  7. 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.

  8. 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.

  9. Hi,
    Im stressing out, I have a 9 & 1/2 year old, 18kg English Staffy who has IBD, Environment Allergies & Food sensitivities, I have sorted his food allergies out & I have his IBD under control he takes Pantoprazole 20mg ant acid blocker for his bad acid reflux, he was taking Omeprazole 20mg for nilly 2 yrs but last Summer Nov 2017 I moved from Newcastle Beach to Lambton, where there’s more trees & bush, Patch started reacting really bad itching & scratching 2 weeks after we moved, then his stomach was playing up with bad acid reflux, I dont know if the Nutro Natural Choice Lamb & Rice dry kibble was too blame as he just started eating the Nutro after we move, Patches acid reflux became so bad it burnt his Esophagus went down & burnt his wind pipe, Patches vet said his allergies have put his immune system into over drive & he’s having an IBD flare he was that bad I asked vet to put Patch to sleep, then Jan 2018 I asked vet can we do Endoscope + Biopsies, I thought he had stomach cancer & I would feel better putting Patch to sleep, it was breaking my heart watching this 9yr old happy go lucky staffy cry & whinge when he wasnt sleeping, he had pain whenever he ate his Nutro lamb food, the Omeprazole wasnt working, the endoscope showed Patch has an inflammed esophagus & wind pipe, gastritis in stomach & spiral bacteria was starting up again, & Gingavtis left back molar,I finally changed Patches food I wish i did it earlier but the vets said it wouldnt be the Nutro, Nutro is a good food, I think it was HIGH in Toxins & its made by same makers as Advance, March 2018 Patch is put onto Wellness Core Large Breed cause it had the lowest fat-13% high in potein-34% low in Kcals 345 per cup within 1 month Patch started to get better I also changed from Omeprazole to Pantoprazole 20mg you can buy Pantoprazole from chemist but you only get 14 days tablets, so the vet said try the Pantoprazole if he gets better I’ll write a few repeat scripts & you can buy from Chemist Now its August & Patch is really bad with his itchy skin again cause of this wierd weather it feels like Summer hot & windy, on Friday Patch was suppose to have a Dexafort injection for his itchy skin but he doesnt do well when he has taken very low dose of Predisone for IBD pain, he gets vomiting & diarrhea so the vet said Apoquel has less side effects then the Dexafort injection & I bought 7 x 16mg Apoquel tablets, I have to wear gloves & 1/2 x 1 Apoquel tablet & give 1/2 x 16mg tablet twice a day with a meal & if by the 3rd day Patch has stopped itching I reduce the Apoquel to just 1 a day cause of his IBD.. Its Sunday & I have still not given Patch the Apoquel after seeing the vet Friday Patch stressed himself out & got bad acid reflux woke 3.30am Saturday vomited yellow acid, so Im glad I never started him on the Aopquel like the vet wanted Friday with his dinner I would have blamed his vomiting acid on the Apoquel..
    Im so worried he’ll get diarrhea or vomiting & the Aopquel will make Patch unwell, he had a bath on the Friday the Malaseb bath always reduces his itchy skin… Can the Apoquel make him have a IBD flareor does he have morechances reaction from his environment allergies again ??

    1. Hi Susan. Although diarrhoea and vomiting are possible side-effects on Apoquel, the risk seems very low and I can’t imagine it is substantially higher for your dog. We have now over 50 patients who take Apoquel and have only had one dog with gastrointestinal side-effects, which responded to stopping the drug. It’s a low risk thing to try and it sounds like it’s going to be much better than using the corticosteroids that your dog is on currently.
      On other subjects, have you seen our page on elimination diets and even though your vet sounds great, have you thought about seeing a specialist?

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

  11. 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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