Original Question: Hello, I just wanted your opinion on Vanectyl-P. Buddy my dog has been on it long term for itching, licking etc. He was taking the pill form at the 0.5mg dosage and then we moved to the liquid form for the last 6 months or so because we had trouble getting him to eat the pills (I sometimes was under dosing at 0.3mg with the liquid form and at that time his blood check for alkaline phosphatase was high at 441). The vet said this was okay and to just monitor it at that time. A couple of months ago, the liquid form was back ordered so we went back to the pill form (0.5mg daily) again and this last blood test showed the alkaline phosphatase to be even higher at 1277?! Is that dangerously high? They are proposing we move to the more expensive Apoquel which apparently doesn't affect the organs as much as the steroid. I have heard mixed reviews about this drug. Not sure which way to go - move to Apoquel or just go back to Vanectyl-P once the liquid is available again and dose it lower at 0.3mg? What is safer for Buddy in the long run? Any suggestions would be greatly appreciated. - Barb
Thanks for your question.
I understand the scenario you’re in completely.
A common result of steroid use is an elevated Alkaline Phosphatase (ALP) from the liver. Be aware that other common ailments cause an increase in this enzyme as well such as Cushing’s disease, haptic diseases and others. I recommend you speak to your veterinarian about performing diagnostics for any other cause of an elevated ALP. It would be unfortunate if the assumption was made that this is purely due to steroid usage while another underlying disease is developing undetected.
The switch to Apoquel is in the attempt to prevent further negative side effects of steroid usage. It is certainly expensive. This drug works at the skin level to prevent the itch that they experience due to allergies. So it basically relieves the irritation caused by allergies and improves quality of life. It doesn’t dampen the body’s allergic response like steroids do but given the side effects, it is greatly preferred for management of allergic skin disease in dogs.
I will make a note that allergies are often diagnosed without full diagnostics to investigate for contributing factors. I have seen bad recurrent bacterial infections that have been diagnosed as allergies and that could have been resolved with courses of antibiotics and using shampoo. This would eliminate the need for a lifetime of expensive medication. I do encourage you to review the diagnosis of allergies with your veterinarian until you’re confident that it is the right diagnosis. You could also go for a visit with a veterinary dermatologist to review the diagnosis but also look for other treatment options that might be cheaper and healthier. They would certainly have more ideas and might diagnose a concurrent condition that is exacerbating the allergic skin disease.
I hope this helps.
Dr. Clayton Greenway