8 Apoquel Alternatives for Dogs

Your dog is itchy, and you’re looking for solutions. Allergies and atopic dermatitis are among the most common health conditions veterinarians treat. Apoquel is a great option for many dogs with allergic skin conditions. It works quickly to relieve symptoms and has a low risk of side effects. However, Apoquel can be expensive for some pet parents, currently has no generic form, and doesn’t work for every pet. If you’re contemplating your itchy pet’s options, you might be looking for Apoquel alternatives for dogs. 

Is There an Alternative to Apoquel for Dogs?

Apoquel (oclacitinib) is approved by the FDA for use in dogs over 1 year of age to control itchiness associated with allergic skin disease (allergic dermatitis). A major benefit of Apoquel is that its quick action means it can be used as a short-term therapy for allergy flare-ups in addition to long-term management of atopic dermatitis. Apoquel starts to reduce itchiness within 4 hours, and by day 28, pet parents report around a 50 percent reduction in itchiness. [1]

Despite the effectiveness of Apoquel, there are quite a few reasons you might be interested in alternatives to Apoquel.

Cost: It could be as simple as looking for a cheaper alternative to Apoquel, which can cost several dollars per tablet, easily reaching over $100 per month. 

Age: Apoquel is only approved for dogs over 12 months of age. 

Pre-existing illness: Dogs with serious infections like pneumonia shouldn’t take Apoquel. Caution is also recommended in dogs with pre-existing cancer or who get recurrent urinary tract infections. 

Reproductive status: Apoquel isn’t recommended for pregnant or lactating dogs.

Side effects: The most common side effects are gastrointestinal (vomiting, diarrhea, and loss of appetite) and short-lived. Rarely, some pets will have increased liver enzymes or seizures. At labeled doses of Apoquel, your dog may have an increased susceptibility to infection, mange (caused by demodex mites), or development or exacerbation of tumors. These potential long-term side effects of Apoquel in dogs can be enough for some pet parents to seek Apoquel alternatives for dogs. It’s important to note that current studies don’t indicate an increased risk of malignant cancer for dogs taking Apoquel when compared to dogs taking other atopic dermatitis medications.

Efficacy: Although Apoquel is a great option for many dogs, not all pet parents will see the reduction in itch they’d hoped for.

8 Apoquel Alternatives for Dogs: Prescription, OTC, and Natural Options

Zenrelia (ilunocitinib tablets)

Zenrelia is a new FDA-approved oral medication poised to become a popular alternative to Apoquel among pet parents. Just like Apoquel, Zenrelia provides fast and effective relief for itchy dogs by disrupting the immune response that triggers allergic itch and inflammation. Both are daily medications that are safe to use in dogs at least 12 months and older. And both work quickly, easing itchy skin starting on day one. 

However, Zenrelia also offers some additional benefits that Apoquel doesn’t. 

Lower cost: Zenrelia costs less per pill than Apoquel, making it an attractive option for pet parents seeking long-term itch treatment that’s both effective and more affordable. 

Convenience: Zenrelia works with easy, once-a-day dosing, while Apoquel requires twice-daily dosing for up to two weeks to start.

No rebound itch: In a randomized, double-blind study, dogs taking Zenrelia showed continuous improvement and itch remission, whereas dogs taking Apoquel experienced rebound itch when switching from twice-daily to once-daily dosing. [2] 

As with any medication, it’s important to keep an eye out for side effects when giving your dog Zenrelia. In clinical trials, some dogs experienced side effects similar to Apoquel, such as vomiting, diarrhea, and changes in activity levels or appetite. 

Always talk to your veterinarian before starting any new medication, especially if your dog has a history of liver or kidney problems or is currently on other treatments. If you notice anything unusual, stop the medication and check in with your vet.

Read the entire package insert before using Zenrelia, including the Boxed Warning.

Cytopoint injections

Cytopoint (lokivetmab) injections for dogs with atopic dermatitis are injected under the skin (subcutaneously) every four to eight weeks. Cytopoint is a monoclonal antibody that works by disrupting the itch signal that’s activated in dogs with allergic skin disease. One injection can relieve symptoms for one to two months.

Most dogs who receive a Cytopoint injection will see a significant reduction in itchiness, with the majority seeing reductions of over 50 percent. Cytopoint might be a good option for dogs who aren’t responding adequately to Apoquel. Although Cytopoint hasn’t been tested in pregnant or lactating dogs, it may be used in breeding female dogs if the benefits to the mother outweigh any risks to the offspring.

No contraindications, precautions, or warnings are listed on the U.S. label for Cytopoint. Rarely, a dog could have a hypersensitivity (allergic) reaction to Cytopoint resulting in anaphylaxis, facial swelling, and hives.

Cytopoint can be used as a solo treatment or in conjunction with other medications for allergic dermatitis. A potential drawback of Cytopoint is its financial cost. A single injection can cost anywhere from $50–$200 depending on your dog’s weight, easily costing over $1,000 annually. For pet parents having difficulty affording Apoquel, Cytopoint is unlikely to be a more affordable alternative to Apoquel. 

Corticosteroids

Pet parents looking for an affordable Apoquel alternative for dogs may discuss corticosteroids like prednisone with their veterinarian. Corticosteroids act as anti-inflammatories to reduce the effects of allergens on the skin, reducing itchiness. Doses are usually given orally and may be tapered to the lowest effective dose.

Steroids aren’t typically recommended in dogs with active fungal infections, viral infections, Cushing’s disease (hyperadrenocorticism), gastrointestinal upset, or congestive heart failure. Use with caution in pets with liver or kidney disease. 

Steroids are very effective at reducing itchiness, so you’re likely to get the desired effect. Unfortunately, you’re also likely to see side effects, especially with long-term treatment. Excessive urination, drinking, and hunger are common, even with short-term administration. You can also see coat changes, weight gain, panting, vomiting, diarrhea, increased liver enzymes, pancreatitis, muscle wasting, and more. Prednisone should not be given to pregnant dogs.

Temaril-P is another option, which is a combination product that includes prednisolone and the antihistamine trimeprazine. Anecdotally, dogs taking Temaril-P may need lower doses of steroids and may see fewer side effects. Speak with your veterinarian about this option. 

If corticosteroids are discontinued, they should be tapered rather than suddenly stopped. Corticosteroids are usually recommended as short-term treatment for flare-ups or when waiting for longer-acting medications like cyclosporine to take effect.

Cyclosporine (Atopica or Cyclavance)

Cyclosporine is an oral immunosuppressant drug that is FDA-approved for use in dogs to control atopic dermatitis. The medication specifically affects cells that are involved in allergic reactions. Cyclosporine can take several weeks to take effect, so it’s used for long-term management of allergic skin disease instead of flare-ups. 

Cyclosporine isn’t recommended for dogs with cancer. Caution is recommended for dogs with diabetes mellitus or kidney disease. 

The most common side effects of cyclosporine include short-term vomiting, loss of appetite, and diarrhea. Other side effects include excessive growth of the gums (gingival hyperplasia), diabetes, excessive fur growth, and other skin changes. Because this medication is immunosuppressive, the dog may be susceptible to infections or cancer, though evidence that cyclosporine increases cancer risk is currently lacking.

Cyclosporine isn’t recommended in pregnant or lactating dogs. Dogs should be at least 6 months old and weigh over 4 pounds.

While waiting for cyclosporine to take effect, your veterinarian may recommend short-term treatment with Apoquel or steroids. Cyclosporine is a good option to try in dogs who haven’t responded adequately to Apoquel. Cyclosporine has generic forms and is usually more affordable than Apoquel. 

Antihistamines

Antihistamines like Zyrtec (cetirizine), Benadryl (diphenhydramine), or hydroxyzine may be recommended for dogs with mild skin allergies before moving to medications like Apoquel or Atopica. These oral medications work by reducing the body’s responsiveness to histamines that cause allergic symptoms. 

Many types of antihistamines are available over the counter, and they’re usually quite affordable for many pet parents. However, antihistamines very often have low efficacy for allergies in dogs. This means they’re rarely recommended as a sole therapy for dogs with chronic or severe skin allergies, though they may serve as an adjunctive treatment. Dosage is not the same in dogs as in people, so consult with your veterinarian before administering antihistamines to your dog.

Like almost all oral medications, you can see gastrointestinal side effects like vomiting or diarrhea. Antihistamines can also cause drowsiness. Some antihistamines may be an option for pregnant or lactating dogs, though you should always double-check with your veterinarian.

Allergy shots

Did you know that dogs can get allergy shots, too? Allergy shots (allergen-specific immunotherapy or ASIT) are often considered the most efficacious treatment for dogs with environmental allergies. The shot dose increases over time until reaching a maintenance level. Frequency of injections usually starts at two shots per week and then decreases to a shot every two weeks. Allergy shots are given under the skin, but there is an alternative form ASIT that is given under the tongue (sublingually). 

You will usually have to work with a veterinary dermatologist to get your dog allergy shots. They’ll run a test called intradermal allergy testing (IDAT) to find out what your pet is allergic to and then develop the allergy shots that will reduce your pet’s hypersensitivity to the allergens. 

Side effects are limited. Some dogs react painfully to injection sites. The site may be red for a short while after injection with a brief increase in itchiness.

Allergy shots are the only treatment that directly addresses the underlying cause of the disease rather than managing the symptoms. They’re a great option for pet parents who aren’t seeing the effect from Apoquel that they’d hoped for or who are concerned about Apoquel’s side effects. So, what are the negatives? Well, you’re looking at several thousand dollars early in the course of treatment for the dermatologist consult, IDAT, and allergy shots. It can also take months to a year to know if they’re working, so you’ll likely be treating your dog with other medications in the meantime.

Special dermatological diets

There are special diets for dogs with allergies. Some diets are intended for dogs with food allergies, such as novel protein or hydrolyzed protein diets, but prescription diets for dogs with itchy skin due to environmental allergies are also an option.

Examples of these diets include:

• Royal Canin Veterinary Skintopic
• Purina ProPlan Veterinary Diets DRM Dermatologic Management
• Hill’s Prescription Diet Derm Complete

These diets work by promoting a healthy skin barrier through a specific blend of nutrients.

Prescription dermatologic diets can be used in conjunction with other allergy treatments. The main drawbacks to dermatological diets are their cost—they are much more expensive than your usual dog kibble—and the fact that they require a veterinary prescription. For many dogs, a diet alone will not manage their symptoms. You also need to ensure that you’re feeding an age-appropriate diet by checking the AAFCO statement to see if the food is approved for growing puppies, adult dogs, or dogs who are pregnant or lactating. 

Supplements: Omega-3 fatty acids

Several natural alternatives to Apoquel exist, with supplements being a category that pet parents are often interested in exploring. One option to consider is omega-3 fatty acids.

Omega-3 fatty acids are important for cellular membranes, helping to keep the skin healthy. Although a healthy dog gets sufficient omega-3 fatty acids from a well-balanced diet, your allergic dog might benefit from supplementation in the form of gel capsules or oils added to their food.

Omega-3 fatty acids should be used with caution in dogs who have recurrent pancreatitis or diarrhea. This supplement can cause vomiting and diarrhea. Omega-3 fatty acids may affect platelet activity, resulting in increased bleeding risk. It’s possible to overdo omega-3 fatty acids, so make sure to consult with your veterinarian regarding an appropriate dose. These may be a good option for pregnant or lactating dogs.  

These items are unlikely to manage your pet’s itchy skin on their own but may be useful in mild cases and/or in conjunction with other treatments. Omega-3 fatty acids may reduce the necessary dosage of cyclosporine needed for dogs with atopic dermatitis. There are other supplements, such as quercetin, which you could discuss with your veterinarian. Studies looking into the efficacy of supplements are always ongoing.

How to Help Allergic Itch in Dogs: Other Tips and Advice

Keep in mind that your itchy dog may do best with more than one medication or therapy. If your dog is showing an insufficient response to Apoquel, you may consider adjunctive therapies rather than completely switching to an alternative. Your veterinarian will also want to rule out flea allergies and food allergies before assuming that you’re dealing with environmental allergies. Lastly, if your dog has inflamed skin, pustules, hair loss, or other skin issues, make sure to ask your veterinarian about ruling out skin infections. You’re unlikely to see a good response if you’re working off the wrong diagnosis or aren’t managing co-occurring skin conditions!

References

1. Cosgrove, Sallie B et al. “A blinded, randomized, placebo-controlled trial of the efficacy and safety of the Janus kinase inhibitor oclacitinib (Apoquel®) in client-owned dogs with atopic dermatitis.” Veterinary dermatology vol. 24,6 (2013): 587-97, e141-2. doi:10.1111/vde.12088
2. Elanco Animal Health. Data on File.