Apoquel for dog allergies is a widely used medication that has been gaining more and more popularity, but how is Apoquel different from other allergy drugs for dogs? What's the difference between Apoquel and Atopica? What are the suggested doses and what are some side effects of Apoquel for dogs? What should dog owners do if they notice side effects? These are all important questions. Veterinarian Dr. Ivana Vukasinovic provides information about Apoquel for dog allergies, dosages, Apoquel side effects and other pertinent information.
Apoquel for Dog Allergies
Oclacitinib (brand name Apoquel by Zoetis) is a veterinary medication used in the control of pruritus associated with allergic dermatitis and the control of atopic dermatitis in dogs at least 12 months of age.
Allergic dermatitis, simply put, is inflammation of the skin caused by any type of allergic reaction. Most common allergic diseases in dogs that affects the skin are: urticaria, food hypersensitivity, flea, tick, mosquito or other insect bite hypersensitivity, intestinal parasite hypersensitivity, hormonal and bacterial hypersensitivity, malassezia hypersensitivity and atopic dermatitis (eczema) due to hypersensitivity to an inhaled or contact (on skin) allergen such as grass allergy or dust allergy (environmental allergy).
Apoquel, chemically speaking, is a janus kinase inhibitor (partially selective JAK1 inhibitor). Janus kinase represents a family of enzymes that are part of cell signalization protocols activated by cytokines during an allergic reaction. Actually, JAK enzymes enable cytokines to transmit signals and initiate the biological response. By inhibiting JAK, there is no cytokines to signal to the cells that something is going on, and therefore, there is no allergic response.
Cytokines are messengers responsible for many cell-to-cell communications and are responsible for different and important biological cell behaviors. Because they regulate many cellular functions, their dysregulation will lead to many changes at the cellular level that translate into different clinical signs and disease.
Medications for Allergies in Dogs
The itching-scratching (and biting) cycle is never ending. Dogs will scratch the affected area by reflex, seeking comfort and will, eventually, produce wounds and even worst problems.
The largest number of drugs made for allergies target that itching sensation, but, also, main cause of allergic reaction must be found and resolved. Veterinarians use different drugs for solving allergy-caused problems, following are some.
Antihistamines are used in dogs, but with lousy results. Some of them will show a good response, but the main group of treated dogs will have various results, with the main side effect being drowsiness.
Steroids are very popular in treating dogs with allergies; they are anti-inflammatory and relatively inexpensive. But, they often come with many undesirable side effects: hunger, increased drinking, increased urination, changes in mental status, and, over long periods, liver damage and Cushing’s disease. Corticosteroids are non-specific in their course of action since there are receptors for them in every cell.
Atopica is the next “big thing” when it comes to treating allergy symptoms in dogs when steroids for whatever reason are not an option. And then there is Apoquel for dog allergies. What's the difference between Atopica and Apoquel for dog allergies?
"In my experience, oclacitinib has been very helpful in my atopic patients that were nonresponsive or had a limited response to the previously available treatments for atopy—injectable immunotherapy, sublingual immunotherapy, modified cyclosporine or glucocorticoids."~ Alice M. Jeromin veterinary dermatologist.
Apoquel Versus Atopica
Atopica is cyclosporine, a metabolite from fungi. Cyclosporine works by stopping T-lymphocyte from transmitting the message that would result in histamine release from dog’s skin mast cells. Without histamine, there is no itching.
The biggest difference between Atopica and Apoquel is in the time needed to achieve the necessary effect; Atopica needs few days of daily dosing to achieve its maximum effect, while Apoquel shows reduction of itching sensation and other symptoms within the first day ( as fast as the first 24 hours).
While with Atopica, most concerning side effects are different gastrointestinal problems, with Apoquel we have bone marrow suppression as the most concerning side effect, but, with Atopica, we are talking about almost 40% of the treated dogs that will develop some GI tract problems, while with Atopica only 1% or less of the dogs will or will not develop serious side effects.
While the most significant and troublesome side effects observed with Atopica are gastrointestinal symptoms, with up to 40 percent of patients showing different kinds of GI problems, Apoquel does not affect GI tract in that way.
Apoquel Dose For Dogs
Apoquel comes in 3.6 mg, 5.4 mg and, 16 mg film tablets. The dose of Apoquel tablets (oclacitinib maleate) is 0.4 to 0.6 mg per kilogram of active substance (0.18 to 0.27 mg per pound) of body weight, orally, usually divided into two daily administrations for up to 14 days.
For more advanced cases, the administered dose should be at first 7 days - 0.4 to 0.6 mg/kilogram every 12 hours, then 0.4 - 0.6 mg/kilogram once a day for the next seven days. The drug should not be used for more than 14 days if not necessary.
It is not recommended to go above recommended dose or to use the drug in longer periods because, like every other itch-removing drug, Apoquel is also a potent immunosuppressive drug.
Apoquel Side Effects in Dogs
Apoquel is contraindicated for use in pregnant or lactating dogs, in cases of known or suspected immune suppression, or in dogs with neoplasia of any kind. Also, this drug is not indicated in dogs younger than 12 months of age.
During the first initial trials, the margin of safety study for young puppies was stopped due to the development of pneumonia and demodectic mange (generalized) in dogs who received a high experimental dose (3 to 5 times higher than treatment dose).
Apoquel side effects listed in the product sheet include normal range of common side effects: vomiting, diarrhea, lethargy, weight loss, with few side effects that are not usual, such as dermal masses, decreased leukocytes and increased cholesterol and lipase.
Less than 1 percent of the dogs in the study receiving this therapy have had very severe side effects like pyoderma, demodicosis, neoplasia, pneumonia, ear infections and urinary infections.
Apoquel is not approved for cats, but there have been some desperate cases of using Apoquel on cats.
"Do not use APOQUEL in dogs less than 12 months of age or those with serious infections. APOQUEL may increase the chances of developing serious infections, and may cause existing parasitic skin infestations or pre-existing cancers to get worse"~Source: Zoetis
The Bottom Line
An allergy is the abnormal response of the immune system. Itching is the reaction of that response that shows us that something is wrong. Every drug that works on stopping that boring itch is, essentially to a lesser or greater extent, a blocker of the immune system.
Let’s not forget the most important thing: all above mentioned drugs, including Apoquel for dog allergies, are easing the symptoms of allergy, and while they make life easier for both the dog and the owner in the given situation, they are not the solution to the main problem – allergy cause - which must be determined for the sake of the future of the dog and life quality. Also, it is important to treat secondary infections as well.
About the Author
DVM Ivana Vukasinovic is a veterinarian in Belgrade, capital city of Serbia.
She received her B.S from University of Belgrade in 2012, and her master’s degree from Veterinary University, Belgrade.
Before eventually becoming director of Vetanima Doo, company that sells animal food, medicine and supplements, she has worked in many different fields of sales.
After finishing college, she started working as sales person in the biggest Serbian bookshop chain, and being passionate about books, she had reached the position of publisher.
After leaving this field, she started working as a veterinary commercialist, and then landing a job as veterinarian at veterinary pharmacy, in the same company in which she is now acting as director.
When she is not working, she is either glued to some fantasy book or cooking for friends. She currently resides in Belgrade with her cat Mile.