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Golden Retriever scratching an itch on its head outdoors.
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If your dog has allergic dermatitis or atopic dermatitis, your vet might prescribe Apoquel®. Allergy-related itching in dogs is common, and something veterinarians deal with daily. Most allergies in dogs aren’t curable. However, with the right diagnosis, management, and treatment, controlling the uncomfortable symptoms is possible. Apoquel is especially useful in treating atopic dermatitis or environmental dermatitis, such as allergies to pollen or grasses, etc. which you can’t control the source of. Read on to learn more about how Apoquel for dogs works and its benefits and limitations.

What Is Apoquel, and How Does it Work?

FDA-approved Oclacitinib (sold under the brand name Apoquel) is an oral medication used to manage the inflammation and itchiness associated with allergies in adult dogs, says Dr. Karyn Wesley, assistant professor of practice in the College of Veterinary Medicine at the University of Arizona.

The fast-acting drug inhibits specific proteins (called Janus kinase enzymes), which trigger the itch response resulting from allergic skin diseases and atopic dermatitis in dogs. “With Apoquel, the immune system’s signaling cascade is halted before it can send the inflamed, itchy signals,” Dr. Wesley says.

When Do Vets Prescribe Apoquel, and When Won’t They?

Apoquel is a well-tolerated and effective alternative to antihistamines and steroids, the traditional options for allergy itch relief. “Only about 30% of dogs with environmental allergies will respond to antihistamines,” Dr. Wesley says. “Moreover, multiple antihistamines are available to try, and one cannot predict which, if any, will be of help to each individual.”

Apoquel won’t provide relief for all dogs either, but it tends to be more effective for more patients than antihistamines.

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Dr. Wesley says that steroids work hard and fast (within one to two days) to relieve itchiness, but some dogs experience less-than-desirable side effects from these drugs. “Moreover, steroids may not be safe for some dogs, such as those with heart disease, kidney disease, and/or certain liver problems,” she says. Apoquel rarely has serious side effects and is safe to use alongside other medications such as antibiotics, antiparasitics, antifungals, anti-arthritis, thyroid, and seizure drugs.

While Dr. Wesley says that Apoquel is one of her favorite allergy treatments in her toolbox for itchy dogs, it isn’t right for every allergy-related diagnosis. “This product is labeled for use in dogs one year of age or older; therefore, I may consider alternative treatments for puppies,” Dr. Wesley says. “The manufacturer also advises against its use in breeding dogs, pregnant dogs, or nursing mothers.”

Dr. Wesley explains that studies show dogs using Apoquel haven’t shown any consistent increase in new cancer development when compared to control populations. “I avoid this medication in dogs for whom cancer is a concern based on their history or my exam findings,” says Dr. Wesley.

Dr. Diana M. Simões is a Diplomate of the American College of Veterinary Dermatology and owner of Dermatology Pet Care. She says that caution and discretion are necessary in patients with severe secondary infections, untreated parasitic or fungal disease, and autoimmune disease.

Bull Terrier rolling on the grass outdoors at sunset.
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“Because Apoquel alters the way the immune system may respond in some scenarios, it may increase the risk for certain infections in some dogs,” Dr. Wesley says. She says that, for this reason, your veterinarian may recommend lab work and an updated exam before starting treatment with Apoquel and periodically if your dog receives long-term medication rather than just to offer relief during an allergic flare-up.

The drug may also increase a dog’s susceptibility to the Demodex mite. Dr. Wesley says Apoquel isn’t a good option if your dog has an active Demodex infection.

Efficacy and Limitations of Apoquel

Dr. Simões says many robust studies show Apoquel can be a safe and effective treatment option for many allergic patients. It doesn’t work for every dog, though. “Efficacy depends on the underlying cause of the allergy, proper diagnosis, patient response, degree of severity, and more. No allergic patient is ever ‘one size fits all,'” she says.

According to Dr. Wesley, there is research to support that the large majority of dogs with environmental allergies (reports of about 70%) will experience a reduction in itchiness when using Apoquel. She says it works hard and fast when it’s effective, with some dogs seeing a significant decrease in itchiness within the first day. For others, it may take longer.

“Apoquel may control the itchiness elsewhere on the body better than it controls ear itchiness,” Dr. Wesley says. If your dog has super itchy and inflamed ears, she says they may need additional care to keep them as comfortable as possible and the ears free of secondary infection.

French Bulldog eating from a bowl at home.
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For food-related allergies, Dr. Wesley says a specific diet prescribed by your veterinarian may be the best option to relieve itchiness. “In some cases, Apoquel may help support the work of the food,” she says, but it won’t be the primary treatment.

How to Administer Apoquel?

“Apoquel comes in oral tablet form, as well as a chewable treat-like form to make administration to pets even easier,” Dr. Wesley says. You can give the tablets with or without food. If the medication is effective, you should see your dog’s itchiness diminish within 24 hours.

Your veterinarian may prescribe Apoquel twice daily for up to two weeks and then reduce the dose to once daily. In other cases, starting with one dose a day will be sufficient. Because the effects of Apoquel wear off within 12 to 24 hours, a daily dose is necessary to maintain your dog’s comfort levels. A twice-daily dose isn’t recommended for long periods as it can increase the chance of side effects.

Never give more Apoquel than your veterinarian recommends. Overdoses can lead to immune suppression and side effects, such as gastrointestinal upsets, skin inflammation or growths, and enlarged lymph nodes.

Apoquel Side Effects

“Apoquel is generally well tolerated in most dogs with few side effects when used appropriately,” Dr. Simões says. However, she explains that Apoquel can have bone marrow-suppressing side effects at high doses. This is another reason why it’s important to administer only the prescribed amount.

While side effects are rare, the most common of these include:

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Sometimes, side effects will be mild and resolve over time, but always let your veterinarian know if you observe anything abnormal, including changes to your dog’s skin, energy levels, appetite, breathing, or urination. It’s normal for your veterinarian to conduct periodic blood work analyses to monitor for any atypical side effects while your dog takes Apoquel.

Other Allergy Treatment Options

Don’t worry if your dog doesn’t respond to Apoquel or your veterinarian determines it isn’t the best option. “Apoquel is one of several treatment options available for allergic patients, and a good veterinary dermatologist is the best equipped to assess which are best suited for each individual allergic patient,” Dr. Simões says. She explains that prescription and over-the-counter options include allergen immunotherapy, other non-steroidal allergy medications, steroids, and topical therapies (such as medicated shampoos or creams).

Depending on your dog’s type of allergy, their symptoms, and their severity, your veterinarian may use a combination of treatments. Dr. Wesley says that some “trial and error” can be involved to determine the best combination for your dog.

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