Apoquel vs. Atopica: a comparison of two medications to control atopic dermatitis in dogs

By Jon Plant, DVM, DACVD

Atopica® (cyclosporine) and Apoquel® (oclacitinib) are separate and distinct medications. Both are used for controlling the signs and symptoms of atopic dermatitis (“allergies”) in dogs. They are two of the most effective allergy treatments for dogs. Let’s see how they compare.

Availability of Atopica and Apoquel

Atopica was FDA approved more than 10 years ago and is widely available as a prescription drug through veterinarians.

Apoquel was launched in January 2014, but the demand quickly exceeded the manufacturing capacity of the manufacturer, Zoetis. This has led to very limited availability and backorders. Most veterinary clinics are unable to order any Apoquel at all. Zoetis anticipates that production will be able to keep up with the demand in the spring of 2015.

Cost of Atopica and Apoquel

Atopica comes in four sizes: 10, 25, 50 and 100 mg capsules. It is dosed based on your dog’s body weight. Each size is priced differently and larger dogs may require more than one capsule. Depending upon your dog’s weight, the initial cost may range from $1.50-$10 per day. Significant rebate programs are often available when purchases are made through veterinarians (as much as 50% off ) but not through online pharmacies. The cost often goes down over time if the dose is able to be reduced.

Apoquel comes in three sizes: 3.6, 5.4, and 16 mg tablets. Dogs less than 90 pounds need only take 0.5 or 1.0 tablet per day, long term. Big dogs will require 1.5 or 2.0 tablets per day. A novel feature of Apoquel is that all three tablets are priced the same. There isn’t much information on the retail pricing of Apoquel available, but it is likely to be around $1.50-$2.00 per tablet in most veterinary hospitals that have it in stock.

Dosing of Atopica and Apoquel

Atopica comes as capsules, which are fairly large in the 100 mg size. Pet owners often find the larger size difficult to administer. The initial dose is 5 mg per kg body weight. In most cases, it is given once daily for the first month. If your dog responds well, the dose can often be reduced to every 48 hours or even twice weekly. It is then given long-term, or at least during the seasons that your dog itches from allergies.

Apoquel comes as scored tablets, which are fairly small and easy to administer. There is a narrow dose range of 0.4-0.6 mg per kg of body weight. Your veterinarian will sometimes need to use half of two different sizes to get the proper dose. For up to 14 days, Apoquel is administered twice daily. In cases of chronic itch in dogs, it is given once daily, long term. Apoquel has a short half-life, meaning that it doesn’t persist for long in the blood stream. Missing even one dose may result in a return of the itching behavior. Establishing a daily routine or setting an iPhone reminder is important. Check out the Itchology app on Facebook, which has a built in medication reminder.

Speed of Atopica and Apoquel in reducing itch

Atopica does not usually achieve its maximum effect on itching until after daily dosing for four weeks.Apoquel vs Atopica

Apoquel reduces itching quickly, often within one day. There is a major reduction in itching within 7 days in most dogs. In a head-to-head study, Apoquel reduced the itch level more than Atopica during the first 14 days. There is often a slight increase in itch level when Apoquel dosing is switched from twice daily to once daily, usually at 14 days of therapy.

Side effects of Atopica and Apoquel

Both Atopica and Apoquel affect the immune system. An allergy is, after all, an overactive immune system. Atopica is considered immunosuppressive, effecting T-cells. Apoquel is considered immunomodulatory, blocking transmission of the itch sensation, among other activities. Both medications have the potential to increase the risk of dogs getting infections. In reality, this is uncommon at recommended doses. In clinical trials, skin infections (pyoderma) do occur, but dogs with allergies often get skin infections whether they are taking one of these medications or not.

Atopica is associated with vomiting and diarrhea more often than Apoquel. In a review study compiling results of 672 dogs treated with Atopica, vomiting occurred in 25% and diarrhea or soft stools in 15% of dogs. Usually, veterinarians and pet owners can overcome this, with a slight modification of dosing.

Apoquel is uncommonly associated with vomiting or soft stools (1-2% of dogs). In most studies, these occur with a similar frequency in placebo-treated dogs and those treated with Apoquel. Because Apoquel is still relatively new, it is prudent to monitor our patients rather closely. I recommend an examination, complete blood panel and urinalysis at 0, 3, and 6 months, then every 6 months while taking Apoquel, for now.

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About skinvet

Jon Plant, DVM, is a Diplomate of the American College of Veterinary Dermatology, founder of SkinVet Clinic and developer of RESPIT, regionally-specific immunotheray for atopic dermatitis of dogs and cats. He is a member of the International Committee on Atopic Diseases of Animals, the past President of the Portland Veterinary Medical Association and the Dermatology Section Editor of the Journal of the American Animal Hospital Association.
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6 Responses to Apoquel vs. Atopica: a comparison of two medications to control atopic dermatitis in dogs

  1. Patty Toska says:

    We have a 13 yr.old Border Collie.. She was a 3 mo. old rescue. when we got her from the Humane Society in Calif. She has always had skin problems. Nothing ever worked for her. We moved to Ohio, in 2009. Our vet put her on Atopica, It was like a mirical, no itiching at all……Took her off for the winter, and when we put her back on in the spring, we gave her a pill on Saturday evening and had her in ER at midnight,. They gave her a cortisone shot, that really helped. Next night same thing happened, back to ER. Went to our Vet on Mon. She called the manufacture and they said 2% of dogs will have this reaction on the second time around. So this year she put her on Apaquel. The first night she had a seizure. We have not given her anymore, and she has been fine, except for the itching continues. Do you have any suggestions? We really need help.
    Thank you
    Joe m& Patty Toska

    • skinvet says:

      I don’t believe seizures have been linked to Apoquel. Hopefully your vet reported it to the drug manufacturer Zoetis. Allergy immunotherapy may be an option for your dog. Ask your vet.

  2. Charles Saxton says:

    This is the ONLY product that has work for my dog. However, I can not find anyone to re-fill his prescription. No one has the product! Can i order online?

    • skinvet says:

      Charles, Apoqeul would need to be prescribed by the veterinarian who takes care of your dog. They will be able to fill you in on the details of their supply, but in general, the supply of Apoquel is improving slowly but surely.

  3. Hello from Catalonia.
    We have a dog crossed with golden retrevier weighing 28kg and sterilized.
    It has recurrent episodes of itching that we control with prednisolone for 6 days at doses of and 30-25-20-15-10 and 5 mg and let rest until they scratch a lot. (Veterinary prescription).
    We tried many feed and some very expensive but it doesn’t goes better.

    We want to trie it with atopic or Apoquel.
    What do you recommend?

    Thanks a lot.

    • skinvet says:

      Hi Clara,
      You’ll need to talk with your dog’s veterinarian to get a recommendation. There are a number of things to consider — availability, concurrent medications, etc.

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