Alternatives to Apoquel for Dogs (Includes Without Vet Prescription)

Allergies are one of the most common reasons for veterinary visits and also one of the most frustrating conditions for dogs and pet parents to deal with. Since Apoquel became available as a treatment option in 2013, it has helped many pups find relief from itchy skin and chronic, recurrent skin and ear infections.

While generally safe and well tolerated, Apoquel is not without side effects and is not appropriate for all dogs. It also comes with a hefty price tag, especially for larger dogs. Let’s explore this medication and other options for managing allergies in dogs. 

Why you may need alternatives to Apoquel 

Apoquel is a great choice for many dogs, however, there are some cases where it may not be recommended: 

• Your dog is not responding to Apoquel
• Your dog is experiencing side effects from Apoquel
• Your dog is under one year of age
• Your dog is pregnant or nursing
• Your dog has an underlying medical condition such as a severe infection, Demodex (mites), cancer, or a history of cancer
• Apoquel is not financially possible  

What are the alternatives to Apoquel for dogs? 

The best treatment options for your dog will depend on the underlying cause of their allergies. Dogs can be allergic to fleas, something in the environment (atopy), or something in their diet (food allergy). It is recommended to keep all dogs on year-round flea prevention. If your vet suspects a food allergy, they may recommend a diet trial with a prescription hydrolyzed protein diet. The treatments listed below may be beneficial in helping to manage the signs and symptoms of allergies. The goal of treatment is to decrease the frequency and severity of flare-ups. 

Important: always ask your veterinarian before giving your dog any new medication (even over the counter medication) – see the information at the end of this article.

Prescription alternatives

• Steroids (eg, prednisone): Steroids, such as prednisone, are powerful anti-inflammatory medications that can provide relief from allergy symptoms. Side effects of short-term use include increased appetite, thirst, and urination. Long-term use can lead to significant potential side effects, including weight gain and a weakened immune system. Steroids are much lower in cost, however, are used less frequently now that there are other safe and effective medications available. 
• Cytopoint: Cyotopoint is a monoclonal antibody therapy that targets and neutralizes specific proteins responsible for triggering pruritus (itchiness) in dogs. It is generally very well-tolerated with minimal side effects. Cytopoint is administered as an injection by your vet, approximately once a month. It can be costly, especially for large dogs. 
• Atopica (Cyclosporine): Atopica is an immunosuppressive drug that helps reduce itching and inflammation caused by allergies. Potential side effects include vomiting, diarrhea, and loss of appetite. 
• Hyposensitization or desensitization therapy: If an allergy test is performed to identify specific environmental allergens, individualized allergy shots are an option. In this treatment, very small amounts of antigen are injected weekly to help reprogram and desensitize the immune system. This is generally prescribed by a veterinary dermatologist. 
• Antibiotics: Dogs with allergies are prone to developing secondary skin and ear infections. It is important to appropriately treat these infections with oral and/or topical antibiotics. 

Over-the-counter alternatives

• Antihistamines (eg, Benadryl): Antihistamines can provide relief from mild itching. While generally safe for dogs, potential side effects may include drowsiness. Consult your veterinarian for appropriate dosage recommendations.
• Omega-3 fish oil: ​​Omega-3 fatty acids have anti-inflammatory properties and can support skin health. They can be found in fish oil supplements or certain dog foods. Consult your veterinarian for appropriate dosing and product recommendations.
• Shampoos and topical products: Topical products such as medicated shampoos and wipes can help promote skin health and ease mild signs of itching and inflammation. 

Holistic and lifestyle changes 

• Diet change: Identifying and eliminating allergens from your dog’s diet (generally the protein source) can help manage allergy symptoms. Hypoallergenic dog food options are available and may be recommended by your veterinarian. 
• Environmental management: Keeping your home clean and free of potential allergens, such as dust and perfume, may help in some cases. Wiping your dog’s paws off after coming in from outdoors can also help remove allergens from their skin.  
• Grooming: Proper grooming and bathing can remove allergens from your dog’s coat, reducing symptoms. Use gentle, hypoallergenic shampoos, and follow a regular grooming schedule. If your dog is prone to ear infections, weekly or as-needed ear cleaning can also be beneficial. 

Your visit at vet after using Apoquel 

If your dog is suffering from itchy skin and skin or ear infections, you will need to see your vet. Not only will they treat the infection, but they will also discuss underlying allergies and come up with a treatment plan to help manage these frustrating symptoms.

Vet diagnostics 

Your vet will begin by getting a thorough history and performing a nose-to-tail physical exam. Be prepared to answer questions about your dog’s symptoms, diet, medications, and lifestyle. The vet will evaluate your dog’s skin and ears to look for signs of allergies such as inflammation, redness, hair loss, and infection. 

• Skin and ear cytology: These tests involve examining cells under a microscope to check for bacterial or fungal infections that may be causing or exacerbating your dog’s symptoms. 
• Bacterial culture: In deep or complex infections, your vet may suggest a culture to grow the type of bacteria present and determine which type of antibiotic it will respond to. 
• Skin scraping: Can help diagnose parasitic infections, such as mites. 
• Food elimination diet trial: If a food allergy is suspected, your vet may recommend a diet trial, which involves feeding a hydrolyzed protein diet for three months. 
• Allergy testing: Allergy testing may involve a blood test or referral to a dermatologist for a skin test. 
• Bloodwork: May be recommended to evaluate your dog’s overall health and major organ function. Your vet may also recommend monitoring bloodwork if your dog will be on long-term medications, including Apoquel. 

Vet treatments and costs

The cost of veterinary testing and treatment will vary greatly depending on the severity of your dog’s condition, your vet’s recommended diagnostic and treatment plan, your dog’s size, and your location. Treatment often involves a combination of antibiotics to treat infection, medications to manage symptoms of allergies and itchy skin (such as Apoquel or the other options listed above), and lifestyle and environmental changes to decrease exposure to allergens. 

As an example, based on pricing from Chewy.com, the cost of Apoquel per month for a medium-sized dog on maintenance dosing may be $80, versus less than $10 for prednisone. 

The ideal prescription besides Apoquel 

The ideal prescription for your dog will depend on several factors, including their clinical signs, what they are allergic to, age and underlying medical conditions, and any financial constraints. 

Frequently Asked Questions 

Is Apoquel safe?

Apoquel is generally considered a safe and well-tolerated medication, as long as you follow your vet’s dosing recommendations. You may have heard that there is a link between Apoquel and cancer. The available research and clinical trial data on Apoquel have not established a direct link between Apoquel use and an increased risk of cancer in dogs. Some studies and anecdotal reports have suggested that Apoquel might exacerbate pre-existing cancerous conditions; however, more research is needed to determine the extent of this potential risk. If you have any concerns regarding the use of this medication, you should discuss them with your vet. 

Can my dog die as a result of excess Apoquel?

If your dog accidentally ingests an overdose of Apoquel or receives an incorrect dosage, contact your veterinarian or a pet poison hotline immediately. Overdosing on Apoquel can lead to an increased risk of side effects or more severe symptoms. In studies, this included vomiting, diarrhea, interdigital cysts, skin inflammation, papillomas, pneumonia, enlarged lymph nodes, and decreased blood cell production. 

What is Apoquel? 

Apoquel (oclacitinib) is an FDA-approved medication specifically designed for dogs to manage and treat allergic dermatitis. It works by targeting and inhibiting specific enzymes responsible for the production of inflammatory substances in the dog’s body, which are the primary cause of itching and inflammation related to allergies. 

Apoquel is a popular choice among vets because it typically provides rapid relief from itching and inflammation without the side effects associated with steroids. It is administered orally and can be used for both short-term and long-term allergy management. 

Apoquel dosing for dogs 

Apoquel dosing is determined by your dog’s weight and is typically administered by mouth, twice daily for the first 14 days, followed by once daily for ongoing maintenance. It is crucial to follow your vet’s prescription and instructions for administering Apoquel to ensure effective treatment and minimize the risk of side effects.

Below is a general guideline for Apoquel dosing from Zoetis, the manufacturer.

Side effects of Apoquel for dogs 

Apoquel is generally well-tolerated by most dogs; however, as with any medication, there is a potential for side effects. The most common side effects of Apoquel include: 

• Gastrointestinal upset – vomiting, diarrhea, or loss of appetite
• Lethargy
• Increased thirst and urination 

In rare cases, Apoquel may be associated with more serious side effects such as: 

• Changes in liver enzymes or blood cell counts
• Increased susceptibility to infection (skin, ear, urinary tract, pneumonia) 
• Worsening of pre-existing conditions, such as cancer or demodectic mange

It is important to closely monitor your dog’s health while on Apoquel, and alert your vet to any changes or concerns. If you notice a new skin growth or signs of infection, such as fever or shortness of breath, alert your vet immediately. Your vet may recommend monitoring bloodwork while your dog is on this medication. 

Important disclaimer: A dog owner should consult a veterinarian before administering new medication to their dog to ensure proper dosage and administration, identify potential interactions with other medications or supplements, address any allergies or sensitivities, receive professional advice tailored to their dog’s specific needs, and enable ongoing monitoring and follow-up to ensure the medication’s effectiveness and minimize any risks or adverse effects.