Dr. Lera Clone explains Apoquel, a medication introduced in 2016 that suppresses immune overreaction to reduce itching from allergies in dogs. It's typically started twice daily for two weeks, then dropped to once daily, but carries risks including immunosuppression and possible increased Demodex mites with long-term twice-daily use.
Questions this video answers
2016
Twice a day for two weeks, then once a day thereafter.
No — longer than two weeks (and four weeks is 'pushing it') is not considered normal due to increased immunosuppression risk.
Yes; some dermatologists recommend stopping long-term Apoquel for 4 to 12 weeks prior to testing.
No — the video states a washout period is not required when switching.
Chapters
Hey, guys. Dr. Lehrer here today at Heron Lakes Animal Hospital. Today I am here with Hannah. Hana is a French bulldog. And the topic of the video is Apoquel. What is it? How does it work? And is it for my dog? Stay tuned and we'll get into that shortly. All right, guys. So one of the things that you will notice on this particular video is Hana is still in the video. Hana is actually chilling, which is why I'm keeping her in the video. So just so that you're aware, sometimes you'll notice patients on the intros that do seem to be nervous. We'll go ahead and put them back and with their parents or whatever just because we want them to, you know, be as comfortable as possible. But Hana is really enjoying the. The love that I'm giving to her right now. Right, Hana? Yeah. You're a good girl. Yes, you are. So apical. Anyways, Apicoil. What is it? It is a drug that came back in 2016 by a company, pharmaceutical company, and it is something that helps with itchiness and seasonal allergies. Does help a little bit with food allergies. It is an immunosuppressive drug to a certain degree. Typically what I tell people is imagine that the immune system is on a one to ten scale, ten being absolutely normal, one being suppressed. Most of these patients that are having allergies are having an overreaction to something. So then the immune system goes from a 10 to a 15. And so the hopes are that we will go ahead and bring the immune system back down to like, about a 10. Now, it is not immunosuppressive to the degree of, like, a person who is on chemo drugs or somebody who has HIV or something like that. So just something to be aware of. If you do it on a very high dose, it could potentially be the case, but that's usually not how it's dosed for our patients who are trying to manage their allergies. Now, in regards to whether or not, you know, kind of the different cases that we use it for, you may have recognized Hana from one of our other videos in regards to her itchy feet or swollen feet. Her feet have. Are being managed spectacularly with Apoquel. Mom's being super consistent with it. She's doing a great job. So that's one of the things that can be used for. It can be used for also lesions on the body, on the belly, sometimes on the face. They'll help. Okay, I do have some notes over here of some potential frequently asked questions. And so the the other thing is when we go ahead and we give Apoquel, usually it is going to be something that some places will start off giving it twice a day for two weeks and then after that we will go ahead and just go to once a day. It is not considered normal to keep patients on the twice a day dosing long term, meaning longer than two weeks, four weeks is really, really pushing it. The reason being is because that can cause immunosuppression and then we start getting into more hairy situations where we can have infections set up shop that we don't want to or have other conditions potentially develop as a result of the immunosuppression. In regards to what are some of the side effects besides the immunosuppression if they are on an incorrect dose or too high of a dose or too frequent of a dose. Normal stuff, diarrhea, vomiting. Sometimes you can have some changes in the white blood cell count. So that's something to take in consideration. In regards to the other thing is, can dogs who have Demodex potentially be put on Apoquel? And the short answer is ideally no. We're not really sure whether or not it will cause the Demodex to get worse or if the dogs had Demodex as a puppy. We're not sure if it's something that could cause the Demodex to come back. When having the patient on that twice a day dosing for longer than the two week period, you are definitely at an increased risk of your dogs developing Demodex. So that is something to keep in mind. Is it something that can be used with antihistamine? So Benadryl, Zyrtec, that kind of stuff? Yes, it can be used with those drugs. Can it be used with Atopica or cyclosporine? Atopica, which is also known as cyclosporine, that's a generic name of it. Or Prednisone. The answer is not really. Not ideally, if it is going to be used together, then typically we are going to be very closely monitoring your dog. E do you think that you could grab Hana because she looks like she wants to get down? I'm going to hand her off. Here we go. Okay. Thank you, Hana. You were a good girl. The other questions are, you know, is it safe to go ahead and do and use Apoquil while when we go ahead and get your dog allergy tested? So when I say allergy testing, I mean seasonal allergy or environmental allergy testing. According to the initial studies, we are showing that it's not an issue. But there are several dermatologists that if it is possible, we will have the patients off of long term Apoquel usage, meaning longer than two to four weeks. We'll have them off the Apoquel for anywhere between four to 12 weeks. The catch to that is that when we do allergy testing, usually the dermatologists want the patients to be tested for allergies four weeks after the patients are at their worst, and then they're starting to kind of come down because that allows some of those chemical markers to start developing in the body and getting up to high enough levels for us to recognize them and see them on the allergy test. So just something to keep in mind. Is it critical to have them off of it? No. Could it potentially influence the results? Yes. Let's see here. When switching from apoquil to one of those other drugs like atopica or prednisone, do you need to have a washout period? Meaning like normally when we're switching other drugs, sometimes we'll have to have three to five days between using one drug to the other? No, that is not the case with Apoquel and the other allergy drugs. So just something to keep in mind. And that's pretty much it. If you guys have questions about Apoquil, please let me know in the comment box. If you found this video helpful, please give us a thumbs up. Subscribe. If you know somebody who needs to watch it, please share it with them. Otherwise, thanks for watching. Take care of yourselves and have a blessed day.
