Apoquel is a JAK-1 inhibitor that is specially formulated and duly approved by the FDA for use in the control and management of intense itching in dogs. It is primarily indicated in the control of pruritus secondary to allergic dermatitis. As an allergy medication for dogs, Apoquel provides instant relief from itching and may help prevent the development of secondary bacterial infections brought about by the loss of skin integrity inherent in incessant scratching. Apoquel is made up of Oclacitinib, a selective JAK-1 inhibitor.
What is Apoquel for dogs? In short, it is an allergy medicine for dogs, fully capable of putting a stop to one of the most uncomfortable manifestations of allergies – itching – within 4 hours and can provide full control of pruritus within 24 hours. It is a prescription allergy medication for dogs and as such it should never be used on other pets, especially cats, even though they may have similar clinical presentations.
While considered as a Janus Kinase inhibitor or Jakinib, Apoquel (Oclacitinib) has certain specificity to the JAK-1 enzyme. It is through this distinction that Apoquel is primarily indicated in the following.
- Control of pruritus secondary to allergic dermatitis
Pruritus or itching is one of the cardinal signs of allergic dermatitis whereby proteinaceous molecules on the surface of substances inadvertently trigger an immunologic response in dogs. This leads to the release of pro-inflammatory substances such as cytokines. There are various types of cytokines and each one or a combination of several cytokines can produce many of the symptoms associated with allergic dermatitis. Oclacitinib has been shown to be especially effective in the mitigation of pruritus by inhibiting the action of a type of cytokine that is directly involved in the development of pruritus.
There are many causes of allergic dermatitis in dogs. This can be brought about by the food that they eat, pollen or any particle that they can come in contact with, or even from the bite of ticks, fleas, and even mites. The important thing to remember is that allergic dermatitis is always an immunologic reaction to something that contains a particular protein molecule that the dog’s immune system cells are quite hypersensitive to.
- Control of atopic dermatitis
One should never confuse atopic dermatitis with an allergic dermatitis. While the cause of the skin inflammation can be determined in allergic dermatitis, the same cannot be said of atopic dermatitis. This is because atopic dermatitis, better known as eczema, is often a result of gene variation. It means that the main problem is in the genes of the dog itself and not in an immunologic response. Studies show that Oclacitinib may help control the effects of a variety of factors in the development of symptoms associated with atopic dermatitis.
Benefits of Apoquel
When given in the right Apoquel dosage, you can actually expect the following benefits.
- Improves comfort
Itching is definitely not a very comfortable experience. It disrupts almost every aspect of your dog’s existence. If you’ve seen your pooch crying or whining while scratching its ears because it is so itchy, try to imagine if it’s the whole body of your pooch that is itching. Eating and sleeping will be really uncomfortable. Your dog’s appetite will be affected since the primary motivation is to get rid of the itch. The same is true with your dog’s other activities. Giving the right Apoquel dosage can help improve the overall comfort of your pet dog.
- Prevents secondary bacterial infections
Unless your dog wears mitts or even has a muzzle to help prevent it from nibbling or biting at its itchy skin, there really is no way to prevent cuts on its skin. Its nails or claws can cut the skin, providing an entry point for bacteria such as Staphylococcus epidermidis to gain access into the underlying structures of the skin. This leads to the development of bacterial infections. By controlling the itch, you prevent your dog from scratching or biting on the itchy body part. This helps prevent loss of skin integrity for your dog.
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- Safer than steroids
Despite the fact that the human versions of JAK Inhibitors have been implicated in the development of a variety of adverse reactions, Oclacitinib has a much safer clinical profile than steroids especially in the long term control of atopic dermatitis; perhaps owing to the fact that it is a selective JAK-1 inhibitor. It should be understood that the treatment of choice for such canine condition is usually steroid. However, because of the many adverse reactions associated with steroid use, this makes Apoquel a safer bet. At any rate, you’ll have better peace of mind knowing your pooch will no longer have to endure the intense itching while also guaranteeing their safety.
- Guarantees results in a shorter time
Oclacitinib is a relatively fast-acting antipruritic allergy medicine for dogs that can provide relief from itching in as little as 4 hours while needing only the first 24 hours upon administration of the allergy medicine for dogs to put canine itching under control. Real world results, however, put the complete pruritus control to within the first 48 hours. While you may think 2 days is pretty long before your dog can achieve full control of its itching, it should be worth mentioning that other medications either don’t give complete control of pruritus or they achieve this at an even longer period of time.
How Apoquel Works
Being a part of the class of drugs that inhibit the action of a family of enzymes known as the Janus Kinases or JAKs, JAK Inhibitors effectively block the signals generated by various cytokines. Oclacitinib, the active ingredient of Apoquel, works by affecting the signaling capabilities JAK-1 to effectively block the activation of Interleukin-31 and Interleukin-6 which mediate pruritus and inflammation, respectively. Since both IL-31 and IL-6 are needed for itching and inflammation to manifest, providing Oclacitinib prevents the JAK-1 enzyme from ever activating these 2 cytokines.
Normally the Janus Kinase family of enzymes is needed in the transmission of information to the cell nucleus, leading to the transcription of the cell’s DNA and the expression of its genes. If you can recall our discussion on atopic dermatitis having a genetic origin, this is how Apoquel is able to help control the development of the canine skin condition. Since the problem in atopic dermatitis is gene variation, preventing the expression of this gene can help improve the signs and symptoms associated with canine atopic dermatitis. In other words, Oclacitinib protects your dog from being severely affected by the many risk factors related to atopic dermatitis.
Potential Side Effects
While JAK Inhibitors administered to humans are known to cause a host of serious side effects such as thrombocytopenia, anemia, and neutropenia, Apoquel side effects are generally considered as mild and typically include the following.
However, this does not mean that it is completely safe. There have been notable adverse reactions, too, such as the following.
- Increased susceptibility to infections such as demodetic mange, urinary tract infections, ear infections, pneumonia, and pyoderma
- Exacerbation of neoplastic conditions such as histiocytoma
- Blood abnormalities
- Tremors or seizures
- Decreased levels of immunoglobulins
- Decreased levels of leukocytes or white blood cells
- Bloody diarrhea
- Increased lipase and cholesterol levels
While these Apoquel side effects can be the cause of concern, most experts agree that these are still a lot more manageable than other atopic dermatitis treatments like steroids. Moreover, the number of dogs that exhibited these reactions were significantly smaller than control.
Things You Should Know about Apoquel
Apoquel (Oclacitinib) is a type of allergy medicine for dogs that is specifically intended for the control of itching and inflammation secondary to atopic and allergic dermatoses. It is a prescription-only medicine that, while generally safer than steroids in the management of atopic dermatitis, still presents with several adverse reactions. This drug should only be given to pooches that are at least 12 months old. Apoquel is available in 3 different tablet formulations: 3.6 milligrams, 5.4 milligrams, and 16 milligrams. It works really fast. While its package insert says that complete control of itching can be achieved within 24 hours, real world experience puts it at 48 hours. Still, it is relatively fast. These should be stored in a controlled environment where the ambient temperature is anywhere between 68 degrees Fahrenheit and 77 degrees Fahrenheit.
What You Should Tell Your Vet before He Prescribes Apoquel
It is critical to inform the vet if your pet is allergic to any component of the drug. If your pooch also has a serious infection or even cancer, it should not receive Apoquel. It is worth remembering that Oclacitinib naturally suppresses the immune system, too, although not by that much compared to the effects of steroids. Dogs that are used for breeding, are nursing puppies, or are pregnant are also not advised to be given Apoquel. Also, do not forget to tell your vet the age of your pooch as Apoquel should never be administered to pooches that are younger than 12 months of age.
How to Give Apoquel to Your Dog
The recommended starting Apoquel dosage is 0.4 to 0.6 milligrams per kilogram of body weight (equivalent to 0.18 to 0.27 milligrams per pound of dog body weight) to be given every 12 hours. This should be given to your pooch for the next 14 days or as your veterinarian deems necessary or appropriate. It is important to recognize the fact that the FDA does not approve giving Apoquel beyond these recommended limits. You can adhere to the following initial Apoquel dosage recommendations. Take note that these should be administered twice daily, 12 hours apart, for 14 days.
- 6 to 9.9 pounds – half of a 3.6 milligram tablet
- 10 to 14.9 pounds – half of a 5,4 milligram tablet
- 15 to 19.9 pounds – one piece 3.6 milligram tablet
- 20 to 29.9 pounds – one piece 5.4 milligram tablet
- 30 to 44.9 pounds – half of a 16 milligram tablet
- 45 to 59.9 pounds – two pieces 5.4 milligram tablet
- 60 to 89.9 pounds – one piece 16 milligram tablet
- 90 to 129.9 pounds – one-and-a-half 16 milligram tablets
- 130 to 175.9 pounds – two pieces 16 milligram tablets
Upon completion of the initial Apoquel dosage, the dosing will be reduced to once every day. This will still follow the same dosage recommendation as in the initial phases of the treatment. However, it is critical to understand that this is a guide. Your veterinarian will have to determine the best therapeutic regimen for your pooch.
Apoquel can be administered to your dog with or without food.
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What to Do If You Miss a Dose
As much as possible, do not miss a dose since the therapeutic effects of Oclacitinib are optimally timed for best results at 12 hours. Missing a dose will lead to some changes in the plasma levels of the active ingredient of Apoquel. As such, it is important to give your dog the Oclacitinib missed dose the moment you remember it. However, if it is already close to its next scheduled dose, then you can proceed with the next dose by simply forgetting the missed dose entirely. Don’t ever double up on the next dose though as this has the potential to result in toxicity.
What to Do in Case of Apoquel Overdose
The serious adverse reactions of Apoquel are quite rare. However, when these do occur, it is imperative to waste no time in bringing your pet to the vet clinic especially one with emergency facilities. The same is true in an allergic reaction.
Some Drug Interactions
Apoquel (Oclacitinib) may interact with cyclosporine, glucocorticoids, steroids, and other agents that suppress the immune system of dogs. If you are also giving your dogs over the counter medications, herbal supplements, vitamins, and minerals, or any other pharmaceutical agent, it is important to inform your vet about these before the initiation of Oclacitinib therapy.
Apoquel is a JAK Inhibitor that specifically targets the enzymes needed in the activation of specific cytokines to control pruritus that is commonly associated with canine allergic dermatitis and to control atopic dermatitis by preventing the expression of the defective gene. It is a relatively safer treatment option for atopic dermatitis than steroids and works exceptionally fast, too. However, it is critical to stick to dosage recommendations and other guidelines as specified by your vet.
- Catherine Barnette, DVM, Oclacitinib, VCA
- Itchy Dog: Causes and Treatment, Best Friends Animal Society