In 2014, Zoetis released an oral medication that significantly changed how itchy dogs are treated today. Apoquel (oclacitinib maleate) is an FDA-approved medication for use in dogs at least 12 months of age to treat atopic and allergic dermatitis. In 2024, a flavored, chewable form of Apoquel was made available (pork liver flavor, containing pork and soy). Apoquel has provided a way to quickly address itching in dogs, with relief possible in as little as four hours.
Controlling the Itch
Generally, the three primary reasons a dog might be itchy are:
- External parasitism (fleas, mites, etc.)
- Airborne allergies (atopic dermatitis)
- Dietary sensitivity (allergic dermatitis)
Prior to the release of Apoquel, treating an itchy dog was difficult and largely disappointing. Typical treatments included:
- Control of external parasites (spot-on topicals, flea/tick collars, oral medications, lime-sulfur dips)
- Steroids (these had multiple side effects, including excessive drinking, urination, and appetite)
- Modified cyclosporine (cost-prohibitive for many dog owners)
- Hyposensitization therapy (injectable or sublingual, which can take months to years to have an effect, only 60% to 70% success rate),
- Strict dietary therapy with a prescription diet (hydrolyzed or novel protein/novel carbohydrate)
- Medicated baths
- Oral antihistamines
- Omega-3 fatty acid supplements
Enter Apoquel for Dogs
Apoquel is an immunomodulator (JAK inhibitor) that inhibits cytokines involved in the itch and inflammation pathways. Onset to relief is as soon as four hours. The approved dose of Apoquel is 0.18 to 0.27 mg oclacitinib/lb (0.4 to 0.6 mg clacitinib/kg) body weight, administered orally, twice daily for up to 14 days, and then administered once daily for maintenance therapy. Apoquel can be used seasonally, or throughout the year. Apoquel can be given with or without food. Apoquel is available in 3.6 mg, 5.4 mg, and 16 mg tablets and is a prescription medication. Follow your prescriber’s recommendation for dosages, but you can access the Zoetis dosing chart here.
Cautions With Apoquel
Apoquel should not be used in dogs less than 12 months old, dogs who are breeding, pregnant or nursing, or dogs who have severe infections. Apoquel can make a dog more susceptible to infection, including demodicosis (overgrowth of Demodex mite) or severe cancerous conditions. Dogs on Apoquel should be monitored for these potential conditions.
While Apoquel is not likely to increase the risk of new cancers, it can make pre-existing cancer worse. In other words, a pre-existing tumor may get bigger. Apoquel can be given with antibiotics and vaccines. According to Zoetis, Apoquel has not been evaluated for use in conjunction with steroids, cyclosporine, or other systemic immunosuppressive agents.
Apoquel Side Effects
The most commonly reported side effects in the post-approval period include vomiting, lethargy, inappetence, and diarrhea.
In the itchy dog, external parasites and infections will still need to be treated, as these disease states can cause more problems than just itching.
There are dogs whose itch cannot be fully controlled using Apoquel, and for those cases, a discussion with the dog’s veterinarian or a veterinary dermatologist is recommended for additional or replacement therapies.