Apoquel: Vet Says Beware The Side Effects

Apoquel For Dogs
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Post At A Glance

Does your dog have allergies or other skin conditions? Has your conventional veterinarian offered you a popular allergy drug called Apoquel®?

What Is Apoquel?

Apoquel is an anti-allergy drug that’s often prescribed by vets. It’s touted as being “a fast-acting and safe treatment for the control of acute and chronic canine pruritus.” Pruritus means itching. When your dog is itchy, you get desperate to make him feel more comfortable. Nobody wants to be itchy and constantly scratching.

A dose of Apoquel can ease your dog’s allergic itch in as little as 4 to 24 hours. And dog owners do say Apoquel works to relieve their dogs’ itching. Sounds like something you might want to try, right?

Well, not so fast … Before you expose your dog to the risks of this drug, you need to read on. If you’re using Apoquel for your dog … you’ll probably rethink your options by the end of this post.

Here’s why I would never give my dog this allergy drug. Apoquel demolishes essential parts of your dog’s internal disease-fighting systems.

Let me tell you more … so you can keep your dog itch-free and safe.

Allergies And The Immune System

An allergy is an exaggerated and inappropriate immune system response. Conventional medicine loves to suppress symptoms. Suppressing symptoms means getting rid of them without addressing the illness or disease. Allergies are an improper immune system response.

So let’s look at the drugs veterinarians often use to suppress allergy symptoms.

Allergy Drugs For Dogs

Prednisone was the first conventional allergy medication vets used for allergies. Prednisone and other steroids work by suppressing the immune system.

Then, when allergic dogs stopped responding to steroids, veterinarians started using atopica (cyclosporine). Cyclosporine was initially developed to prevent organ transplant rejections in humans. It suppresses the immune system to prevent the body from rejecting the transplant.

Atopica has a devastating and destructive effect on the immune system. Unfortunately, Atopica is still used on dogs today. This is alarming … the FDA has 17 pages of adverse events for Atopica in dogs! The case numbers are pretty shocking. What’s ironic is the fifth adverse effect on the list is pruritus, meaning itching … the very thing you want to stop!

And now … we have the latest scary allergy drug, Apoquel. It also suppresses your dog’s immune system … but in a different way.

RELATED: Read more about the risks of Atopica for dogs … 

How Does Apoquel Work?

Apoquel affects the body’s kinases. Kinases are signalling compounds that cells use to communicate with each other. In the 1980s, an Australian chemist discovered some new ones, known as JAK1, JAK2, JAK3 and TKY2. With the growing epidemic of dog allergies, pharmaceutical companies saw an opportunity. They developed a drug that would stop these JAKs in their tracks.

And they sure succeeded. The kinase inhibitor Oclacitinib maleate, under the brand name Apoquel® stops JAKs from doing their job. JAKs are key elements in controlling both growth and development. These particular JAKs do the work of:

  • Policing the body against tumor formation
  • Controlling body growth and development
  • Forming white and red blood cells
  • Ensuring antibody-producing B cells and “policing” T-cells are functioning well
  • Regulating inflammatory response

So you can see why they’re so important to your dog’s health. But he won’t get the benefit of JAKs if he takes Apoquel for dogs.

How Is Apoquel Different From Other Treatments? 

Apoquel has a unique mechanism that’s different from other allergy drugs … and that’s to interrupt JAK cell signaling compounds. Apoquel prevents JAKs from working. And without JAKs your dog’s immune system cannot function correctly.

  • JAK1 is vital for the constant surveillance within your dog’s body. Its job is to find and destroy abnormal cells that have become cancerous … before they form tumors. And it’s needed to destroy invading parasites, fungi, bacteria and viruses.
  • JAK2 is central to the production of bone marrow stem cells. These cells then become red and white blood cells and platelets.
  • JAK3 helps your dog’s antibody system (B cells) and its killer-cell system (T cells) work properly.

These JAKs all talk to each other and share information to keep your dog’s body healthy. So you can see that by preventing JAKs from working … Apoquel undermines your dog’s immune system to prevent allergic reactions.

Apoquel Research

Of course, there are clinical trials showing how dogs react to these drugs. But drug research is tricky … here’s how it’s done.

The pharmaceutical company does a very quiet study and notes when problems occur. For example … liver problems pop up 12 weeks into the trial … or tumors appear 16 weeks into the trial. They carefully record these findings in the study notes. Once they’ve gathered all the data, they prepare their formal public study. Often they end the public study review before the problems show up. So if the problems appeared at 12 weeks … they publish a 10-week study!

Apoquel research is no different.

Safety And Efficacy Studies About Apoquel

A study conducted by the manufacturer, Zoetis Inc, to test the drug’s safety and efficacy stated:

“There were no fatalities and no abnormal health events that necessitated hospitalization in either the study phase [day 0–7 (+3 days)] or the continuation phase [day 8–28 (±20 days)] of the study. Given that the majority of dogs in the placebo group withdrew after the completion of the study phase, the incidence of abnormal clinical signs was similar in both groups.” So, it seems from these comments that the drug is fairly safe … but the duration of the study was only 7 days!

Long Term Studies Of Apoquel

There was a “continuation phase” after the 7 day study period, from 8 to 30 days. The researchers report:

“Six dogs (four oclacitinib and two placebo group) were withdrawn from the study during the continuation phase for abnormal health events. Abnormal health events were reported in 11 of 179 oclacitinib-treated dogs post-study. These were as follows: diarrhea (four dogs; severe enough to warrant cessation of treatment in one dog); vomiting (four dogs); fever, lethargy and cystitis (one dog); an inflamed footpad and vomiting (one dog); and diarrhea, vomiting and lethargy (one dog).” 

So about 6% of dogs tested had abnormal health events. Maybe that doesn’t seem very high to you. But keep in mind that was only for 30 days! If your dog takes this drug, he could be on it for years! Years … while the drug compromises his immune system. That’s a very heavy price to pay.

The manufacturer quotes a study that says it is safe for long-term use … but the study results say something different.

Apoquel Adverse Effects During Studies

  • 1 dog got euthanized after 450 days of Apoquel. The dog had developed abdominal ascites and pleural effusion of unknown etiology. This means that he had a fluid-filled abdomen and chest.
  • They euthanized another 6 dogs because of suspected malignant neoplasms. Those are cancers that spread easily … but aren’t detected because of immune suppression.
  • Two dogs each developed a Grade II mast cell tumor  after 52 and 91 days.
  • One dog developed low-grade B-cell lymphoma after 392 days.
  • Two dogs each developed an apocrine gland adenocarcinoma. One was dermal, the other an anal sac. These problems happened after only 210 and 320 days on Apoquel.
  • One dog developed a low-grade oral spindle cell sarcoma after 320 days. It’s a very painful oral cancer for dogs.

Is it worth the risk? I certainly don’t think so.

Is Apoquel Safe For Dogs Of All Ages?

No. Even the manufacturer has posted a warning. Apoquel is limited for use in dogs over 12 months old. They conducted a margin of safety study on 6 and 12-month old dogs. The study on 6-month old dogs ended quickly. They had developed bacterial pneumonia and demodectic mange infections!

Here’s the warning on the company’s website:

“IMPORTANT SAFETY INFORMATION: 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.”

In the 12-month old dogs here are the symptoms likely related to Apoquel:

  • Papillomas (warts)
  • Interdigital furunculosis (cysts) with related dermatitis symptoms
  • Edema of feet
  • Pneumonia
  • Lymphadenopathy (abnormal or swollen lymph nodes) in peripheral nodes

Yes, you read right. The side effects include various types of skin diseases. But skin problems are what you’re trying to control by using Apoquel for dogs. The drug was also found to lower white and red blood cell count. And it impacted certain types of lymphatic tissue … lymph nodes as well as bone marrow.

RELATED:Fight back against cancer in dogs with these top home remedies …

Real-Life Side Effects Of Apoquel

When cancer cases come to me, the dogs on Atopica or Apoquel have the same oncologist records. They always note that the oncologist recommends stopping Apoquel or Atopica treatment. Of course, it’s too late for that to make any difference at all. But it is an encouraging sign that the problems with these drugs are well known.

Apoquel Alternatives: What Are Your Options?

There is good news! There are better and safer alternatives to this dangerous allergy drug.

Allergies have become an epidemic. When we use the word “allergies” we often mean food sensitivities and intolerances. They’re not always true food or environmental allergies. Food sensitivities and intolerances are about 15 times more common than true allergies. It’s exhausting for owners to continually read ingredients on bags of dog food. And it’s frustrating to try therapy after therapy.

Alternative Therapies to Apoquel

Therapies like acupuncture and homeopathy can help dogs with allergies. But acupuncture results tend to be short term and may need repeating every couple of weeks. Homeopathy works well. Just know that it can be a slow process. Your homeopath will usually need to prescribe a series of remedies until you find one that works for your dog.

RELATED: Find a quick fix for your dog’s allergies …

Combine Therapies To Fight Allergies

I use homeopathy, but I use it alongside my tailored Allergy Elimination 4 Pets Program. It’s based on the original work in NAET (Nambudripad’s Allergy Elimination Technique). I find it works incredibly well for over 90% of the patients I treat. A good analogy is when you run a virus application on your computer. It cleans up the glitches. The system I use works to clean up your pet’s “computer.” Over my many years of experience with holistic modalities, that’s what I’ve found works best. It’s non-invasive, non-toxic … and helps create a stronger immune system. An immune system that can and will fight off cancer and disease. Unlike Apoquel … which stops that intolerable itching at the high cost of:

  • A low white cell count
  • A low red cell count
  • Stunted growth
  • Increasing your dog’s risk of cancer

When I became a veterinarian I vowed to protect the health of our pets. I wanted to make them healthier and help them live longer and happier lives. Sometimes, with all these new and confusing drugs that pet owners rush to, I feel like I’m swimming upstream.

5 Ways To Get The Allergic Itch Under Control

Before you jump ahead into my top alternatives there are a few things you should do first.

  •  Feed a rotating diet. Ideally, feed novel proteins. A novel protein is a protein that your dog has never had before. One great novel protein to try is rabbit.
  • Get an air purifier for your home. Removing allergens from the air will reduce the number of allergen stressors.
  • Test Vitamin D3 levels. 75% of dogs fed commercial food are D3 deficient. Vitamin D levels are very important when it comes to allergies.

Now let’s nip the itch in the bud. 

1. Topical Solutions For Allergic And Itching Dogs

Use a topical product that works to calm the source of the itchy skin and inflammation. Dogs have 10 times more mast cells on their skin than people do. So it’s no surprise they’re constantly scratching … but scratching increases the intensity of the itching, because it activates more mast cells. When your mother told you that the more you scratched that mosquito bite, the more it would itch … she was spot on!

So if you can nip the first itchy spot in the bud, you’re way ahead of the game. Itching begets scratching and if we can handle the first set of itches we may win the battle.

Here are some things you can use to help the itch.

  • Derma Drops by Spa Diggity Dog: Apply to itchy spots as soon as you can.
  • Zymox: This comes in a spray-on or cream formula. It’s excellent for itchy hotspots. You can find it on Amazon. Make sure you get the one without hydrocortisone which is a steroid. 
  • Baking Soda: You can make a poultice and slurry it on the area.
  • NuStock: A great dependable product to nip itching in the bud.

Remember … many dogs have seasonal allergies. You can give these products during the common allergy seasons, the spring and fall. Another important point is that it’s difficult to get dogs off of Apoquel, so you need something on hand.

2. Chinese Herbs

Zhu Dan Tablets from Seven Forests can help with the itch. I recommend giving these with a meal.


  • ½ pill to 1 pill twice a day for a smaller dog
  • 1 pill two to three times a day for a medium dog
  • 2 pills two or three times a day for a large dog

3. Histoplex by Biotics Research

Histoplex is a blend of herbal extracts shown to help regulate the immune systems. I find it works well for our dogs also.


  • A small dog can get ½ pill twice a day
  • Medium dog 1 pill twice a day
  • A large dog can have up to 3 pills twice a day while 2 pills twice a day usually suffices.

4. Betathyme

Betathyme is a naturally formed steroid that can help to stop that itch. Follow the directions on the label.

5. Atronex by Standard Process

This is a very nice product that helps to curb the itch. Like Betathyme, follow the directions on the label.

There’s one more approach I like to suggest to complete the anti-itching process.

Allergy Elimination Techniques

While topical solutions win the battle, I feel my allergy elimination wins the war. That’s because it can correct the immune system’s perception of the item as an allergen. This turns the allergic dog into a non-allergic dog.

Allergy elimination techniques reboot, harmonize and revitalize your pet’s immune system responses. It corrects the immune system … so it behaves properly and doesn’t overreact. Some pets will need a direct consultation to assess and go over long term skin problems. For dogs with a less complicated history, you can often help them with an at-home kit.

Sometimes I feel that the world of modern medicine has gone mad with 1 in 2 dogs getting cancer. And yet this is a new anti-itch drug that not only opens up the door to cancer – but hangs up a welcome sign! Apoquel looked like a miracle for dogs with allergies … and the owners watching them itch. Unfortunately, it turned out to be anything but. 

Thankfully these Apoquel alternatives are much safer and healthier as you try to help your dog.

RELATED: Dog allergies: DIY remedies that work …


Cosgrove S, Wren J, Cleaver D, Martin D, Walsh K, Harfst J, Follis S, King V, Boucher J, Stegemann M. Efficacy and safety of oclacitinib for the control of pruritus and associated skin lesions in dogs with canine allergic dermatitisNational Center Of Biotechnology Information. 5, July 2013.

Cosgrove S, Cleaver D, King V, Gilmer A, Daniels A, Wren J, Stegemann M. Long-term compassionate use of oclacitinib in dogs with atopic and allergic skin disease: safety, efficacy and quality of lifeNational Center Of Biotechnology Information. 26, June 2015.


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