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Apoquel Experience and Discussion
  • zandramezandrame
    Posts: 1088
    I wanted to start this thread for anyone who is using this drug to share their experience with it, good and bad. And to discuss any new information as it comes out, especially anything about long-term usage and side effects.

    The biggest risks known now are a higher than average occurrence of tumors, and susceptibility to infections.
    http://www.2ndchance.info/Apoquel.htm (also see the link for owner comments)
    http://skinvetblog.com/2014/02/01/apoquel-safety-how-apoquel-is-like-fine-wine-part-2/ (comments at bottom too)

    Our story. Kouda is currently on his first round of Apoquel, and will have his one-month blood/urine re-check on Friday.

    Kouda will be 3 years old in September, and he has struggled with severe allergies since he was 7 months old and spent much of his life in a cone. I've discussed our trials in other threads so I won't go over everything again, but he's had food trials, supplements, steroids, antibiotics, air purifiers and humidifiers, and all kinds of antihistamines and sprays/creams. I even make my own baby wipes because we go through so many. He had an intradermal test and has been on immunotherapy since March of 2014. He's also been on a low dose of Soloxine for borderline hypothyroidism since January. We are very used to managing his flare-ups, but this spring was really bad for him (couldn't even walk down the street without attacking himself) and brought us back to the dermatologist. We are definitely cautious, but agreed to try Apoquel if it has the potential to improve the quality of his and our lives. The goal is not to rely on Apoquel as a solution, but use it as a tool to control the worst of his flare-ups much like temporary steroids, and avoid the long-term consequences.

    During the two week loading period, with dosage twice a day, the itching was considerably controlled. It does take effect fast. (We've had to deal with new episodes of "puppy boredom" as he is able to focus on other things besides itching himself.) After that period he went to a pill once a day in the mornings, and a minimal amount of itching returns by evenings.

    He experienced no obvious side effects like vomiting, diarrhea, or lethargy. But one thing I have noticed, during the double dosage his wounds did not heal - any pre-existing skin damage stuck around, and darkened. And the exposed skin on his neck became splotchy. One week into the single dosage and his abrasions were lightening and looking more healthy. And now after almost another week they finally look like they are healing. Our management and cleaning routines are unchanged as he recovers.

    After the checkup we'll see how the dermatologist wants to proceed.
  • sunyatasunyata
    Posts: 8254
    It is not surprising that on the higher dosage that his wounds were not responding, since it is an immune-surpressant (hence the susceptibility to infections in the risks).

    It seems like a safer alternative to steroids, though. I wonder if @Sangmort has looked into this for Dragoon.

    Please keep us updated on how this works for Kouda and if there are any medium term issues that arise from using it for more than a few weeks at a time.
    Bella 2Mountains 2Nola 2
    Casey, with Bella and Nola, hanging out in the mountains of Virginia.
    I Wander, I Ride
  • StaticNfuzzStaticNfuzz
    Posts: 1814
    @Zandrame

    Like you we have been through the gauntlet with allergies on two Shibas (not related). No thyroid issues on either, but the allergy flairs have been pretty bad in the past anyway.

    We had great results with minimum side effects using Apoquel. No real issues. Maybe urinating a bit more but that was about it. It has been great because we could administer the medication for short durations during particular seasons and then stop until the following year. (BTW we have yearly blood panel done, and while on the the meds we do have urine tested to periodically to make sure kidneys are in order.)

    We found that Apoquel was really helpful when getting our dogs adjusted to allergy shots. Knock on wood so far the allergy shots are working without the need to medicate in one dog and very little meds/duration in the other.

    As far as Apoquel vs Atopic, I would administer Apoquel over Atopica. The cost of Atopica is astronomical and the ramp up time needed for the body to adjust to meds is significant The dental issues can also be problematic on Atopica. Additionally there was vet recommendation to modify the vaccination schedule as well as the diet limitation (no raw). The withdrawal time while on Atopica is drawn out as well. Stopping and starting suddenly is not a good idea.

    All around Apoquel got us through without many problems young and old dog alike. We can feed raw and quite frankly Apoquel has been a God send for the worst case dog that was literally chewing herself to pieces.

    Good luck to you, I hope the company that produces Apoquel will keep distribution and manufacturing up.

    Snf
    Post edited by StaticNfuzz at 2015-05-27 18:10:24
  • zandramezandrame
    Posts: 1088
    @StaticNfuzz, it's great to hear from someone who has used the drug for a while. If I may ask, I have a few followup questions -

    How old are your dogs?
    How long have they been on Apoquel?
    Sounds like you use it for short periods - how long are these periods, and how do you determine when to stop? Do you stop immediately, or taper off?
    Do you need to do the 2 week double/loading dose each time?
    How long did it take for the allergy shots to help?

    With Kouda, we are going on 5 weeks on Apoquel. It's great to see fur growing on his toes again. We are still waiting on the results of his checkup last week, but will continue daily dosage and have another evaluation in a month. I am concerned about becoming dependent on Apoquel though. His spring flare-up is what drove us to start, but his allergies are year-round. We don't get much of a break in SoCal seasons.
  • StaticNfuzzStaticNfuzz
    Posts: 1814
    How old are your dogs?
    How long have they been on Apoquel?
    Sounds like you use it for short periods - how long are these periods, and how do you determine when to stop? Do you stop immediately, or taper off?
    Do you need to do the 2 week double/loading dose each time?
    How long did it take for the allergy shots to help?


    The two Shibas who are treated with Apoquel are 6.5 yrs and the other is 13.5 yrs

    We have used Apoquel for two seasons (I think the product has only been on the market for 2 yrs)

    Generally the duration for dosing depends on the particular growing season here. We use the meds 12 to 16 weeks at a time. This season we have not needed to used the meds yet. Probably won't need to until July.

    Usually we stop medicating at frost depending rain, mold, and leaf litter situation. Some seasons are worse than others and each dog has its own sensitivity for flair up. You can generally tell by how much hair is being pulled out, bald patches or open wounds. We don't wait for open wounds, if they are exhibiting tell tale symptoms we go ahead with the program.

    When we begin Apoqel medication we must double dose for two weeks and then are able to back down to one dose per day at the lowest recommended amount for our dogs body weight up until frost.

    As far as allergy shots. How effective it is, dosage amount, and how long allergy shots must be given to build response will be dependent on the individual animal. It has to be monitored and worked out case by case.

    In our situation the shots took about 1.5 to 2 yrs to be fully effective. However, we still have to inject bi weekly for one dog. We were never able to go to a once a month injection schedule. However, over time mostly the allergy shots do work for us though. The cost is about $250 for 4 months of serum.

    As far as Apoquel dependency, I don't think it is a matter of being crutched on the medication, it really is more about comfort for the animal. It really provides relatively quick relief with the least amount of harm during the highest seasonal flairs.

    So far so good. We have found a balance for each dog on what to use, how much, and when. Seasonal timing seems to be the key for us in order to allow my dogs to get out there and play doing all fun stuff dogs are supposed to do. : )

    It might help to keep a journal of your dogs flairs and symptoms so you know what the differences are when you medicate no matter what medication you are using to treat allergies. It really helps in the monitoring process and reporting back to derm vet and he/she can look back @ the log themselves if they are not good listeners.

    Again good luck to you, it's like finding a needle in the haystack in regard to treatment of allergies, but the Apoquel does help with the process.

    Snf
    Post edited by StaticNfuzz at 2015-05-28 14:24:45
  • StaticNfuzzStaticNfuzz
    Posts: 1814
    Forgot to answer this question:

    when to stop? Do you stop immediately, or taper off?


    @ Zandrame: For Apoquel we dose or stop based on our journal of previous flairs and monitoring of behavior (excessive, licking, biting, chewing paws along with grouchy behavior and general skin color changes).

    We are far more into a season than we used to be before we need to medicate though, thanks to the allergy shots.

    When weaning off Apoquel, we can taper off usually within a week, every other day at first to see how it goes. If the Shiba goes back to serious itching within the week of cut back, we put back on the once a day medication without doubling up.

    I really don't yank dogs of immuno. suppression meds it's really hard on the system. Atopica takes a far longer time to wean off, a month or more. Really careful monitoring of health is in order for either meds though.

    Snf
  • MayamaMayama
    Posts: 267
    Maya's dermatologist denied giving us Apoquel. She said the meds hasn't been out long enough and there could be unknown side effects. I know she was prescribing to other patients, so I feel like she said so only because she ran out of it to give us.

    We also did a very expensive skin test, and like her blood test, everything came out negative. We are not able to try out customized immunotherapy. She also denied trying RESPIT (another type of immunotherapy that uses general allergens in the area, so no need to pin point the allergens causing troubles), saying that's just adding random allergens in Maya's body.

    Maya got put back on Atopica, which I really hate. I want to get a 2nd opinion, but they are the only dermatologist in this area. For the past 2 months, she's taking Atopica every 3 days, and things are under control, however, May / June have always been the "good months", so we'll have to see how it goes in August.

    Pure holistic treatments weren't going anywhere and we just can't watch her suffer anymore. We are really worried about the long term side effects of Atopica, but seems like there's no other options, at least with this doctor.

    We are at lost. :(
    Shiba Inu Maya's blog and FB page
  • zandramezandrame
    Posts: 1088
    @StaticNfuzz, thank you very much for your responses! At our next check up I'll ask about spreading the doses a bit more. A few days after the last visit he developed conjunctivitis in his left eye. We got a non-steroid antibiotic from the vet, and it resolved, but then switched to his right eye. Infections, yay.

    @Mayama, I would seek a second opinion, if anything to find a doctor willing to give you Apoquel as an alternative to Atopica. If you visit SoCal, I can refer you to our dermatologist. It's still very good that you did the skin test - even though it didn't find anything, that is still a piece of an answer. It's possible she doesn't have typical environmental allergies (atopy), and instead has contact dermatitis, which would involve a different kind of diagnosis. Stuff like detergents, metals, and fabrics, even plant oils. We have found that Kouda is very sensitive to industrial floor cleaners used at hotels, convention halls, some indoor training centers, as well as cedar oil (CedarCide).
    http://www.peteducation.com/article.cfm?c=2+2111&aid=508
    http://www.petmd.com/dog/conditions/skin/c_multi_contact_dermatitis?page=show
  • MayamaMayama
    Posts: 267
    @zandrame, thanks for the information. I just found another dermatologist an hour away from us. We'll probably go get a 2nd opinion. Really hope the experience will be better.
    Shiba Inu Maya's blog and FB page
  • zandramezandrame
    Posts: 1088
    @Mayama, before you travel to see a new dermatologist you should, if you haven't already, call and ask if they have Apoquel to prescribe for new patients. This may be the case with your current dermatologist, and you could ask them the same question. It was supposed to become more widely available in April, but sounds like that may not have happened. Some vets can only obtain enough for existing patients. But tell them straight up that you are looking for an alternative to Atopica (this is my assumption), and what your expectations for the visit are. If they don't have it, keep looking.

    You do have a well documented history of her symptoms on your blog, with pictures. Plus the results from her skin test. And the fact that Atopica helps means her immune system is overreacting to something. That response, "the meds hasn't been out long enough and there could be unknown side effects," is silly when you are already using a drug with severe known side effects (Atopica). Yes, there are potential side effects, but it is YOUR choice to weigh the alternatives and balance them with her quality of life. A four week trial could determine its usefulness without committing long-term, since results are fast.

    I am curious to see the details of her skin test though, maybe in the testing thread. It is odd to have no reactions at all. Kouda's results weren't off the charts, but a lot of minor irritants together are still a cumulative burden.
  • StaticNfuzzStaticNfuzz
    Posts: 1814
    Zamdrame states

    "A few days after the last visit he developed conjunctivitis in his left eye. We got a non-steroid antibiotic from the vet, and it resolved, but then switched to his right eye. Infections, yay."

    Thought it worth mentioning .....We notice conjunctivitis occurs with allergy flairs. Once the body adjusts and meds have flairs under control those issues reduce quite a bit, often to none at all. It is not uncommon for anal glands to be irritated or ear infections to occur when a dog goes into full allergy flair. It's all part of the body's response to inflammation unfortunately. In our case we know it is allergies that cause them.

    Yeah, all those seemingly minor things that appear to be separate random problems of health that have one continually running to the vet often are really pointing to one major issue, that of allergies.

    In regard to Maya, Zandrame mentions , "It's possible she (Maya) doesn't have typical environmental allergies (atopy), and instead has contact dermatitis, which would involve a different kind of diagnosis. Stuff like detergents, metals, and fabrics, even plant oils. We have found that Kouda is very sensitive to industrial floor cleaners used at hotels, convention halls...."

    We also noticed this during some of our hotel stays as well when we travel. The chemicals used to disinfect the carpet and fumigate certainly can be hard on the respiratory system. We (humans) have at times reacted to the fumes so I am sure any dog who has to be directly on the ground in contact and having a super sensitive nose is going to be affected much more severely.

    @ Mayama, Keep in mind, allergy issues can flip flop, double up or symptoms parallel at any time. Make sure you discuss with your derm vet which medication the dog should be off of and for how long when the testing is done. Sometimes a dog needs to be off of all meds for several weeks. In the northern regions it is best to test in winter before flairs occur (if one has that option).

    Also, contact dermatitis, inhalation, and digestion allergies often do overlap. All things should be considered in the treatment plan. This is why I mentioned in an earlier thread to journal in order to track what occurs over time and when.

    Honestly you have to look at and treat the body as whole system when it comes down to allergy problems. Unfortunately it's usually not one, but the many that need to be modified in successive stages as part of an individual treatment process for each dog. : (

    Good luck...
    Snf
  • zandramezandrame
    Posts: 1088
    @StaticNfuzz, very good points, thank you. I have suspected that the eye stuff could be related to allergies, but he has never had eye symptoms before. It could be an evolution of his problems, or something novel like a food intolerance - we did get a bag of new Merrick treats containing potato, and have stopped giving them.

    So there's another question concerning Apoquel - have you experienced (or heard of) it controlling some aspects of allergic inflammation while making others worse? Kouda's primary aggravations, his itchy feet and chin, have been nearly completely controlled on Apoquel. It seems strange for new symptoms to emerge while on such a powerful suppressant.

    My suspicion was that a slightly weakened immune system might be more prone to eye infections, allergy related or not, which were never a problem before.
  • StaticNfuzzStaticNfuzz
    Posts: 1814
    You ask: have you experienced (or heard of) it controlling some aspects of allergic inflammation while making others worse?

    We have not experienced that specifically. It is possible that the Apoquel may not be fully effective for your dog at this point. The ramp up time may take longer. In some dogs over time they require higher doses as well. Talk to your vet. They may need to modify things if either is the case.

    The medications be it Apoquel or Atopica do have a transition period in regard to gut. The meds may contribute to digestive problems..... and with that being said, watery eyes etc can be somewhat related to gut issue as well.

    So many meds can change gut and skin flora. When that's out of whack it can manifest symptoms in other areas of the body.

    Throwing this out there also, another factor is that the runny eyes could be random and not related. Maybe your dog has an eye issue. Inverted eye lash (it takes just one to irritate), seed cataract, pressure that goes up and down with different meds or dry eye caused by certain meds.

    Snf
    Post edited by StaticNfuzz at 2015-06-17 18:18:28
  • zandramezandrame
    Posts: 1088
    Apoquel availability update -

    I was told by our veterinarian on Monday that Apoquel was going to be in short(er) supply again for a few months. The manufacter had switched to a different binding agent and the tablets were falling apart. Today the dermatologist confirmed the story, and said supply should be fine for existing patients, while new patients will be put on a waiting list.
  • lawryslawrys
    Posts: 4
    This thread has seemed to gone dead, but I wanted to post my experience with Apoquel.

    I have an itchy Shiba (Thor), most likely due to a combination of food and environmental allergies. My vet prescribed apoquel and it started doing wonders for the itching! It also worked really quickly, with (seemingly) very little side effects.
    After a few months of being on Apoquel, Thor developed Demodicosis (aka demodectic mange aka demodex). I asked if this could be due to the apoquel, but he said he had never seen a link. However, if you look at the actual prescribing info from the manufacturer, it does say dogs on apoquel have increased susceptibility to demodicosis.
    I can't say for sure if Thor developed mange because of the apoquel, but I can say I think it's very likely.
    So, now Thor is off the apoquel, and we're still dealing with residual skin issues from the mange. He ended up getting a yeast skin infection while recovering from the mange which is just not wanting to go away. And, because he's off apoquel, he's also a lot more itchy now.
    Wish me luck in helping this itchy pup!
  • Lrose1990Lrose1990
    Posts: 80
    I've heard good things about apoquel, but never used it personally. My understanding is that it's newer and supposed to work by inhibiting certain pathways in the body that lead to itching (JAK-Stat is the name, I think). As with any medications, there may be side effects and if there are, you should talk to your vet... people here may have had experiences, but vets are trained in how the drugs work/how to deal with side effects. Make sure your concerns are known, too! I know from experience clients are often kinda overwhelmed and when there's a lot on your mind, you may forget to mention concerns, etc.

    I heard a lunch lecture about Hill's new derm defense food recently; I'm sort of skeptical about it's ability to work on it's own, since they seem to have tested it only in dogs with concurrent treatment (with steroids, apoquel, etc), but it's worth a shot if allergies are thought to be the cause of the itching? It's supposed to help bolster the skin's natural barrier? Again, I'm kinda skeptical because the rep wasn't able to answer student questions about statistical significance, etc, but she may have just been nervous and not expecting that caliber of questioning.
  • ShibaLuv19ShibaLuv19
    Posts: 16
    I want to share my personal experience with Apoquel. My cream Shiba Rasu is almost 2 years old and has had issues with allergies since he was around a year old. He was in a cone for a very long time, and nothing we tried seemed to be working. It was very frustrating, especially since I work at a vets office and see this sort of thing every day. I had almost lost hope that Rasu would ever be without a cone.
    I eventually took him in to see our dermatologist. We did the food trials and the steroids for the itching which caused him to leak urine randomly while laying around. I was a bit skeptical as well when I first heard of the Apoquel. I admit I went online and read reviews and one or two case studies. I worried that if I started it, that the medication would not be readily available if I were to run out. I was tired of seeing my little puppy be so miserable all the time and decided to give it a shot.
    Its been about nine months now that we have been giving the Apoquel. His bloodwork came back great and best of all he is cone free! It has been a real life saver. It not only changed our life but the lives of so many pets and owners who walk through the doors of the hospital were I work. I highly recommend it. So far I have not noticed any side effects. He is on a low dose and it still seems to be effective even after nine months. I will continue to give the Apoquel because it improves the over all quality of his life. If and when anything should occur long term, I will deal with that bridge when I come to it. For now my Rasu is happy and as healthy as he can be and that is what matters! :)
    photo tmp_16118-20160622_194912-2080362105_zpsolroxdsc.jpg
  • spacedogsspacedogs
    Posts: 226
    This is probably in the wrong place, but as an allergy sufferer myself I am keenly aware of my dogs allergies. I had thought (incorrectly) most of my life that my allergies were food, pet, and seasonal related, and this was reinforced by multiple doctors through my childhood and teenage years. In my 20's I saw an allergist who did a basic scratch test and told me I wasn't allergic to anything at all. In my 30's I pushed my GP hard and saw an Immunologist, and after some extensive testing found out that I was in fact allergic to nearly everything I owned (all of my personal care products, all of my makeup, all of my cleaning products, anything with rubber or flexible plastic parts, ALL rubbers with the exception of nylon and silicone, most synthetic fibers, wool alcohol, ALL parabens, and any caine-mix medication which ironically are primarily used to treat topical itching and are in most compounds for allergic dermatitis).

    When I suspect my dog has an allergy, if the symptom is not immediately noticeable to be food related (gas, stool discrepancies, etc.) I go through the same process of elimination with their surroundings as I would with food. Remove all toys, shampoos, blankets, all cleaning products you use on anything they touch and replace only with items you are POSITIVE they are not allergic to. Don't rule anything out without evidence that it's safe. They could be allergic to something as unassuming as your perfume, deodorant, floor cleaner, or fabric softener.

    My apologies if you've had extensive allergy testing done and ruled out these sorts of things already, but if you haven't please do consider them.
  • zandramezandrame
    Posts: 1088
    @ShibaLuv19, thanks for your story! Apoquel really is a useful drug.

    @spacedogs, this thread is specifically about using Apoquel to treat allergy symptoms. We have other threads about allergy testing and other remedies.
    http://www.shibainuforum.org/forum/discussion/7174/allergies-and-allergy-testing/p1
    http://www.shibainuforum.org/forum/discussion/6355/all-kinds-of-known-shiba-allergies/p1

    After discussing this at length with our dermatologist, I learned the goal should always be to use Apoquel as a temporary measure. There are side effects, and the longer the drug is used the more prone the dog will be. It is best to try to determine what the dog is actually allergic to and treating that simultaneously. Apoquel covers up the itchiness but cannot address the cause. It should be used as a tool to allow the dog to recover in the short-term and let other therapies take effect for the long-term.

    An update on our case, we had Kouda on Apoquel for 6 months then weaned him off. He has now been on SLIT (sublingual immunotherapy) for over 2 years, and has maintained his skin quality since we stopped Apoquel. Earlier in the thread I talked about other issues he had while on Apoquel, eye and ear infections, which have completely resolved off the drug. We keep a bottle on hand for any immediate flare-ups, but haven't had to use it yet.

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