Apoquel (Oclacitinib) Use in Dogs with Itchy Skin

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Meet Cooper, a Pit Bull Terrier dog. Cooper is a new member of the Hemopet family, lives in the Midwest, and is currently taking oclacitinib maleate (Apoquel). Oclacitinib is prescribed to dogs to suppress their allergy or sensitivity symptoms such as itchy skin or rashes. This is Cooper’s story to try to treat his symptoms more naturally and getting him off the medication. This recount should not be perceived as medical advice and pet companion caregivers should consult their veterinarians. 

How Oclacitinib Works

Oclacitinib inhibits two (JAK1 and JAK3) out the four known Janus Kinase (JAK) enzymes. JAKs are important in white and red blood cell formation, immunity, inflammation, and act as sentinels in the body to protect against tumor formation. If JAKs are inhibited, inflammatory cytokines – that result in itching – are slowed or stopped. However, this could lead to an increased susceptibility to infection and neoplasms, which are new and abnormal growths of tissue in some part of a body that are characteristic of cancers such as mast cell tumors or adenocarcinoma.

According to a study funded by oclacitinib’s manufacturer, Zoetis, 16 out of the 247 dogs enrolled were diagnosed with either a confirmed or suspected neoplasm after taking the drug and were removed from the study. According to the study’s researchers, “With these confounding factors, it is unknown whether the duration of oclacitinib therapy has any relevance to the development of, or exacerbation of, neoplasia in this population of dogs.” They also noted that routine monitoring for these conditions in oclacitinib-treated patients is recommended.

Additional side effects noted include diarrhea and vomiting.

Plus, more studies have been or are being conducted on other potential side effects to oclacitinib.

Oclacitinib and NutriScan

Apoquel interferes with NutriScan testing by blunting the immune responses of white blood cells and macrophages when challenged by foreign substances including reactive foods.

Dogs should not be on oclacitinib for a minimum of two weeks prior to NutriScan testing.

Cooper’s Journey off Oclacitinib

When Cooper first came to the Hemopet family, his skin was very red and swollen (particularly around the eyes) and he was still scratching, even though he was prescribed the maximum dose for his 80 pound size. 

Granted, the red skin could have been exacerbated by stress due to the change in household, as we noticed a reddening of his skin for a few hours after going for a nail trim a few days ago.

His new parents thought, “What’s the use of this medication if it doesn’t stop the symptoms entirely? What does his excessive itching actually look like?” They saw one giant compounded problem. Is Cooper’s reaction to an environmental allergen? Do the seasonal dry weather conditions simply cause him excessively dry skin? Is Cooper having a food sensitivity reaction? Is it all of the above? We still do not know for sure.

What we do know is that there is no cure for sensitivities or allergies at this time and the best way is to minimize or eliminate them is with proper testing like NutriScan Food Sensitivity & Intolerance test, thyroid for his anxiety that may be causing some of his reddened skin, and a blood allergen test for environmental causes instead of stamping them down with oclacitinib.

All we could do was jump in with both feet. Thus far, we think we are on the right track. We must say, unraveling an 80 pound dog takes a long time compared to smaller dogs!

Again, this recount should not be perceived as medical advice and pet companion caregivers should consult their veterinarians.

#1. Washed his blanket and has bathrobe.

We washed his blanket and bathrobe with sensitive skin laundry detergent that contained no dyes or perfumes. This seemed to help curb his itching in the morning after sleeping on his blanket all night.

#2. Decreased oclacitinib from daily to every other day.

According to a study conducted by Fukuyama et al, “While oclacitinib significantly reduced itch during treatment the abrupt withdrawal led to a rapid rebound phenomenon which can be explained by an increase in pruritogenic cytokines and fast peripheral sensitization.”

Zoetis recommends loading oclacitinib maleate twice per day for up to 14 days. Then, tapering it down to once daily for maintenance therapy. However, the medication’s website says, “Yes, you can use APOQUEL for short periods. APOQUEL begins relieving the itch within 4 hours, and controls it within 24 hours.”

#3. Added coconut oil.

This is how we give him his oclacitinib. We actually started with butter until we got a jar of coconut oil.

In the evenings, we put a little in his puzzle toy with a small piece of banana like a sundae. He loves it.

#4. Rotated Cooper’s food from one protein to another.

Actually, we didn’t rotate, we went cold turkey after he was done eating his original food. Since we had about 1-2 weeks worth of food, it gave us time to get to know him and what his daily constitutional “output” was like.

We were armed with the knowledge from his former caregiver that he could not have grains or chicken. (It pains us that we cannot give him a bite of chicken because the smell makes him have long slobber drools more than anything else. We have a cloth nearby to take care of any potential flings.)

Since then, we have rotated his protein again and have plans to do that every time we need a new bag or box until we complete the NutriScan test.

#5. Added fish oil.

We added fish oil that is made of anchovies, sardines and hempseed oil. Since anchovies and sardines are smaller fish, they have less mercury than bigger fish.

#7. Occasional use of an all-natural doggie moisturizer.

Cooper scratches himself excessively sometimes. Thus far, he has created approximately three welts. When we noticed them, we gave him half or one oclacitinib tablet and put some moisturizer on him.

#6. Had a mani/pedi.

 After a few failed attempts to do it ourselves, we finally took him to the vet’s office for them to do it.

How’s Cooper doing now?

Cooper’s condition has improved greatly! His eyes are no longer swollen or red. His skin overall is pink in color. Cooper is still taking oclacitinib every so often. In fact, he had one the other morning because he just seemed so uncomfortable and was licking his paws excessively for the past couple of days. However, the frequency and dosage have been reduced for the occasional flare-up every few days or so.

Fingers crossed we can eliminate oclacitinib altogether and get him tested, and then eliminate the foods and minimize the environmental allergens causing his symptoms.

We’ll keep you updated!

This recount should not be perceived as medical advice and pet companion caregivers should consult their veterinarians. 

References

“APOQUEL® (Oclacitinib Tablet) Allergy Medicine for Dogs.”
APOQUEL®, Zoetis, www.apoqueldogs.com/.

Cosgrove, Sallie B., et al. “Long-Term Compassionate Use of Oclacitinib in Dogs with Atopic and Allergic Skin Disease: Safety, Efficacy and Quality of Life.” Veterinary Dermatology, vol. 26, no. 3, 2015, doi:10.1111/vde.12194. https://onlinelibrary.wiley.com/doi/full/10.1111/vde.12194.

Fukuyama, Tomoki, et al. “Demonstration of rebound phenomenon following abrupt withdrawal of the JAK1 inhibitor oclacitinib.”European Journal of Pharmacology, vol. 794, 5 Jan. 2017, pp. 20–26., doi:10.1016/j.ejphar.2016.11.020. https://www.sciencedirect.com/science/article/pii/S0014299916307129?via%3Dihub.

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