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If you are considering using Cytopoint (lokivetmab) for your pug or other dog, read about my experience.
Summary: My 5-year old pug began trembling within 24 hours of her Cytopoint injection. She was also lethargic and didn’t eat. Her eye mucous increased dramatically. The first week, I was worried that she was going to die. The second week, the vet had me worried that she had some sort of chronic issue like cancer. By the third week, she started feeling better. After a month, her symptoms were gone. A year later, she is perfectly healthy. According to the Cytomel studies, this is a rare reaction, but I now know of at least another dog that had a similar reaction. Maybe there are more and the vets don’t report it. Make sure you know the risks before using Cytopoint.
Day 0
My 5-year old pug, Zanna, itches all of the time. It’s especially bad when she wakes from sleeping or napping. She scratches her face, her ears, her neck, her feet, and her butt. Over the years, we’ve tried antihistamines (Benadryl and Zyrtec), and dramatic food changes. Nothing has helped. About a year ago, we moved cross-country and from the suburbs to a city high-rise. Still no change. Finally the vet didn’t know what else to try, so on Friday, 9/22/2017, I took Zanna to a doggy dermatologist. The dermatologist found a yeast infection in her ears, despite my cleaning them once a week and using drops. But that was the only issue found. They checked for parasites and other critters. We talked about possible allergy testing and allergy shots. We talked about alternatives to antihistamines for treating symptoms, and she recommended Cytopoint. I did quick research and the only noted symptoms were GI issues. So Zanna received the shot at 4:30pm on 9/22/2017 and we came home.
NOTE: There was no interaction with other dogs after Zanna received the Cytopoint shot on 9/22/2017.
She was itchy as usual that evening, and was otherwise normal that night.
Day 0 Symptoms:
(None)
Day 1
Late the next morning, she had a soft stool. I went out from noon to 4:00pm and when I came home, she was sluggish and trembling every few seconds.
https://www.facebook.com/tobyzannaswope/videos/1725009294207289/
I did some quick online research didn’t find any Cytopoint-related symptoms for trembling. I called the dog determatologist office, and they said that they have never seen that symptom in the hundreds of dogs they have treated with Cytopoint. So I watched her for an hour. When her condition did not change, I took her to the vet clinic.
Day 1 Symptoms:
Trembling (near-constant)
Listlessness and lethargy
Complete loss of appetite – She sniffed a treat and ignored it. She refused dinner. This has NEVER happened.
Eye mucus – Easily double the normal eye “boogers”
Droopy tail and ears
The symptoms appeared between 20-23 hours after the Cytopoint shot.I had to carry her to vet because she wouldn’t walk. She just stood there with her tail drooped. The vet said that dogs tremble when they’re in pain and asked if she had an inujury. She had not. The vet examined her and couldn’t find any problems with her back, hips, neck, or stomach. The vet said it could be internal pain from something that she had eaten. They did an ultrasound and there was nothing unusual. Basically, the vet had no idea what was wrong with her. Her best guess was that the site of the shot caused Zanna pain. (Maybe like a flu shot makes your arm hurt for hours?) She sent me home with a painkiller.
At home, I gave Zanna the painkiller in a pill pocket, which she sniffed twice before finally eating. An hour or so later, she stopped trembling and was able to drink some chicken broth, but refused dinner. At bedtime, I put a blanket on my bed and let Zanna sleep with me. Toby opted to sleep in his crate as usual, but I left the crate door open. Zanna didn’t have any problems during the night and eventually moved to the foot of the bed instead of snuggling with me.
Day 1 Medications:
Painkiller (Tramadol 50mg)
Day 2
The next morning, she was trembling again, but not as much, so I decided not to give her the morning painkiller. I did more research and learned that the trembling can be caused by pain, such as pain at the injection site or stomach pain. Her tummy has been a little bloated. It can also be caused by nausea. On Sunday, about 38 hours after the injection, she began licking and making bad faces like she threw up in her mouth a little bit. These are indicators of nausea.
She was also very lethargic. But she did eat a little breakfast. I gave her Hill’s Prescription Diet – Digestive Care canned food – about 3 Tablespoons mixed with warm water to about the consistency of grits. She peed about 30 minutes later. Several hours later, she pooped and it was only a little soft. She also ate the same thing for dinner. Throughout the day she didn’t move around much. Both pugs usually follow me around to whatever room I’m in. That morning, Zanna went in the bathroom with me and just sat there in the dark after I left. I had to go back and carry her out. She continued to show signs of nausea, and I called the vet. They recommended that I give her Prilosec OC. I gave her one in a tiny piece of Pill Pocket.
Day 2 Symptoms:
Nausea
Trembling (reduced from Day 1 to occasional tremors)
Listlessness and lethargy
Slight loss of appetite – Ate breakfast and dinner, but refused treats during the day
Eye mucus – Easily double the normal eye “boogers”
Droopy tail and ears
Day 2 Medications:
OTC for nausea (Pepcid AC 10mg)
Day 3
On Monday I worked from home to stay with her. She continued to tremble on and off. She didn’t move after I put her down. She refused to eat. She refused to drink water or broth. She threw up three times.I took her back to the vet. They gave her the following:
Subcutaneous fluids
Ultrasound – found nothing
Comprehensive blood profile
Anti-nausea injection (Cerenia)
Anti-nausea pills (Cerenia)
Stomach-coating pills (Sucralfate)
So we went home with a giant liquid bubble on the back of Zanna’s neck. She looked like Quasimodo.
She continued to be exhausted and still wouldn’t eat any food. She slept on my bed again, and at some point during the night, she jumped off the bed. She pooped on the rug by the door because I didn’t leave the door open for her to get out. And she hid under my bed. I found her around 3:00am. Around 5:00am she started trembling again and it stopped after about 5 minutes.
Day 3 Symptoms:
Vomiting
Nausea
Soft stool
Trembling (occasional tremors)
Listlessness and lethargy
Complete loss of appetite – Refused breakfast, dinner, and treats during the day
Eye mucus – Easily double the normal eye “boogers”
Droopy tail and ears
Wobbly when walking
Day 3 Medications:
OTC for nausea (Pepcid AC 10mg)
Anti-nausea injection (Cerenia)
Subcutaneous fluids
Day 4
On Tuesday, I worked from home again. (I’m fortunate to be able to do that.) Zanna continued to be exhausted and still wouldn’t eat. I forcer her to drink the stomach-coating medicine. There was a syringe involved. Poor little girl. She wouldn’t even eat the anti-nausea medicine in a Pill Pocket.
The vet called with the results of Zanna’s blood work. Everything was normal except the following:
The vet said that her liver enzyme was slightly elevated, the red blood cell count was low, and the white blood cell count was high. She requested that we come in for another round of blood work.
Around 12:00pm, Zanna showed interest in my lunch, sitting up with her perky ears. I gave her about a tablespoon of Digestive Care soft food. She ate it, drank some water, peed outside and was done. She was listless on the sofa for a couple of hours and then looked interested again. I fed her another tablespoon of food and she drank more water, and then pooped. Her BM started solid and ended soft, with yellow mucus. I had to wipe her bottom and the tissue came away yellow. She was pooping bile. She did nothing for the rest of the afternoon.
Around 5:00pm, we went back to the vet. They did more blood work. I waited in the office for the results: PCV 38% and TS 8.4.
The vet said that there were indicators that Zanna had an infection and gave her an antibiotic pill (Metronidazole). She said if Zanna gets better then come back in a week for follow-up blood work. They told me if she gets worse, then come back.
So we went home and Zanna was pretty exhausted. She refused her dinner, but took an anti-nausea pill and antibiotic pill in a Pill Pocket. She also drank some water. After she got settled she started trembling again. It lasted about 5 minutes until she fell asleep. Then she dreamed a bit.
Day 4 Symptoms:
Nausea
Trembling (occasional tremors)
Listlessness and lethargy
Significant loss of appetite – Refused breakfast, ate at noon, refused dinner, ate a few treats during the day
Eye mucus – Easily double the normal eye “boogers”
Droopy tail and ears
Wobbly when walking
Day 4 Medications:
Stomach-coating pills (Sucralfate 1 GM)
Anti-nausea pills (Cerenia 24mg, 1/2 tablet 2x per day)
Antibiotic (Metronidazole 250mg, 1/2 tablet)
Day 5
During the night, Zanna peed in the bed. It soaked through a quilt, a duvet, a blanket, and a top sheet. After she peed, she didn’t move to a dry spot. When I woke, her whole back end was wet and cold. She could have jumped off the bed and gone outside, but she didn’t. She didn’t even move out of her own pee. The poor little girl. On the bright side, the duvet and the blanket were white, and there was no sign of blood in her urine.
I gave Zanna a quick bath and dried her. An hour or so later, I gave her the antibiotic and the nausea pill in a Pill Pocket. A couple of hours later, she refused breakfast and would not drink her broth.
Her itching returned 5 days after her Cytopoint shot. She began scratching her ears and face and licking and chewing on her toes. So it appears that Cytopoint not only made her very sick, it didn’t stop the itching. Around 10:30am, she still wouldn’t eat food or drink broth, but she did drink some water and then went outside where she made several poop piles trying to get all the soft poo out. I had to wipe her and the tissue came away yellow-ish/orange again. She then sat in the sunshine on the balcony for a few minutes before coming in and requesting to be lifted back onto the sofa.
I tried several times throughout the day to get her to eat food or drink some broth. Twice I got her to drink a good amount of water. She did jump on and off the sofa once. That was an improvement. But she was itchy. She especially chewed on her feet, with the occasional ear/face scratch.
Finally, after I ate dinner, when I usually give the dogs dinner, she got up and walked around in the kitchen. I gave her about a tablespoon of food. It took her a LONG time to eat it. She wouldn’t eat it from the dish and I had to give her pieces smaller than a pea, one at a time. But she ate a little. A couple of hours later, while relaxing on the sofa she began trembling again. Again it lasted for only a few minutes.
At bedtime, I decided to put Zanna in her crate, though with the door ajar. I also left the balcony door open in case she needed to go outside during the night.
Day 5 Symptoms:
Itching returned, so after all of this, it didn’t even help the original problem
Nausea
Trembling (occasional tremors)
Listlessness and lethargy
Significant loss of appetite – Refused breakfast throughout the day, ate only a little dinner with encouragement, ate a few treats during the day
Eye mucus – Easily double the normal eye “boogers”
Droopy tail and ears
Wobbly when walking
Day 5 Medications:
Anti-nausea pills (Cerenia 24mg, 1/2 tablet 2x per day)
Antibiotic (Metronidazole 250mg, 1/2 tablet, 2x per day)
Day 6
Around 3:00am, I woke to go to the bathroom. Zanna came out of her crate and followed me to the bathroom. That was an improvement because she hadn’t been following me around. She drank some water and went outside to pee. Then she went back to her crate to get more sleep. At 6:30 when I got up, she came out of her crate and immediately started scratching. Also, there was a sour smell coming from the bedding, and I think she threw up a little in the night. In the living room, she still couldn’t jump up on the sofa, and I had to help her up. Around 8:00am, she started trembling again. It lasted for around 3 minutes. Around 9:00am, she passed some really stinky gas, but when I put her outside, she didn’t go potty.
Around 9:30am, I ate breakfast, but Zanna wouldn’t leave the sofa when I fed her brother. So I offered her the Digestive soft food. She wasn’t interested. I offered her a couple of pieces of her regular hard food, and she ate it up. She then hopped off the sofa and went to her dish. So I gave her about 1/6 cup food with water. She gobbled it up. Afterwards, she licked her itchy paws continuously, taking the occasional break to burp.
Zanna was pretty sleepy throughout the day, but when she was away, she spent lots of time licking the tops of her feet. (Note that she had a bath on Day 3 and hasn’t stepped foot outside except on the balcony rug or grass. There are no foreign objects on her feet. They just itch.
In the afternoon she showed signs of wanting food, so I hand-fed her about 1/6 cup of dry food with no adverse reactions. She also managed to jump up on the sofa when properly motivated with the sight of me eating ice cream. My pugs love ice cream and I usually give them a little scrape of the bowl when I’m finished. Today, she got a treat instead. Later in the evening, but before dinner, I gave her her nausea medicine.
My pugs’ usual diet is 1/3 cup Life’s Abundance Grain Free dry food each for breakfast and dinner. Toby gets a heaping measuring cup and Zanna gets a level one. At dinner, they also get a couple of chunks of wet food chopped up and mixed in. Zanna tolerated a little hard food at breakfast and in the afternoon. So for dinner, I gave her about 3/4 of her usual 1/3 cup measuring scoop. I added some water and she ate heartily. After dinner she chewed on her feet some more.
Day 6 Symptoms:
Itching increased
Nausea decreased
Trembling (occasional tremors)
Listlessness and lethargy decreased
Appetite increased
Eye mucus – Easily double the normal eye “boogers”
Droopy tail and ears decreased
Walking more normally
Late in the evening before bedtime, Zanna kept hiding under the rollaway bed. I had an out-of-town visitor, and I set up the rollaway bed in the great room. On two separate occasions I found her hiding under there. I know dogs do that when they’re not feeling well, but she didn’t get sick or anything.
At bedtime, she was a little excited and bouncy, wanting to sleep on the big bed with me, but I put her in the crate. Around 1:00am I woke to go to the bathroom and let her out. She had a quick drink of water and went outside to pee. I then put her back in her crate. There were no issues with sickness in the bed.
Day 6 Medications:
Anti-nausea pills (Cerenia 24mg, 1/2 tablet 2x per day)
Antibiotic (Metronidazole 250mg, 1/2 tablet, 2x per day)
Day 7
Zanna woke acting fairly normal. There was less than usual itching, but still some itching. Still giant eye boogers that I had to wipe off. She happily ate the Pill Pocket with her Antibiotic. Because we had only one anti-nausea pill left, I tried not giving it to her, and she had no adverse reactions. She ate her slightly reduced breakfast of 3/4 of her measuring cup. As usual, I added water and she ate happily, if a little slower than usual. The same at dinner. She ate her evening antibiotic in a Pill Pocket.
Throughout the day she started following me around more, but was still low-energy. She would jump off the sofa only for food. She wouldn’t jump on it. She still had occasional tremors.
Day 7 Symptoms:
Itching increased
Trembling (occasional tremors)
Listlessness and lethargy decreased
Appetite increased
Eye mucus decreased
Droopy tail and ears decreased
Day 7 Medication:
Antibiotic (Metronidazole 250mg, 1/2 tablet, 2x per day)
Day 8 and 9
Zanna was doing much better. She took the antibiotics with no problem, and ate her full 1/3 dry food with water at breakfast and dinner. Her energy was better, and she was back to itching for hours every day. Her energy was not 100% and she still wouldn’t jump on the sofa.
Day 8 and 9 Symptoms:
Itching back to pre-Cytopoint levels
Trembling a little (occasional tremors)
Listlessness and lethargy minimal
Day 8 and 9 Medication:
Antibiotic (Metronidazole 250mg, 1/2 tablet, 2x per day)
Day 10 – 12
Zanna was still itchin, but eating normally. On Day 10 she had 6 soft stools throughout the day. This could be because of the antibiotics. She began jumping on the sofa and behaving normally. On Day 12, I took Zanna back for a repeat blood draw.
Day 10 Symptoms:
Itching normally
Soft stool
Day 10 Medication:
Antibiotic (Metronidazole 250mg, 1/2 tablet, 2x per day)
Day 13
Zanna has returned to her pre-Cytopoint behavior, and has completed her round of antibiotics. The vet called with the results of Zanna’s bloodwork.
The vet said that she appears to have a urinary tract infection and will need to go on another round of antibiotics. Also, Zanna’s immunity is still off and the vet is concerned that she might have cancer.
So I spoke with the dermatologist. She said that the albumin and globulin results can be a result of chronic inflammation. This would be the case for cancer, sure, but also if Zanna has had a UTI for a long time and we didn’t know it. It’s common for them to show no symptoms. If it were cancer, her Calcium levels would be off, and they are normal. So it’s likely the UTI causing those results. The SDMA value is related to her kidneys, and could also be affected by her UTI. Similarly, her red blood cells are a sign of anemia, and could be anemia due to a chronic infection – like a UTI. So, Zanna is going on a new round of antibiotics to help her UTI, and when she finishes the medication, we’ll do another urine test and add a urine culture.
Day 14-28
I’ve been giving Zanna her UTI antibiotic every day after breakfast and after dinner. Her stool is a little soft, but otherwise, she’s acting normal. She’s still itching regularly, though not to the extent that she did before Cytopoint.
RESEARCH
Here’s some of my research:
STUDIES:
http://onlinelibrary.wiley.com/doi/10.1111/vde.12376/full
Details about bad reactions in those studies:
There were no hypersensitivity-related reactions (e.g. wheals, vomiting) reported immediately post-dosing. One dog (2.0 mg/kg lokivetmab), a 4-year-old male dachshund mixed breed dog that had been on weekly ASIT for the past year, had a possible injection site reaction comprising two subcutaneous nodules near the site of injection beginning on Day 5 that resolved spontaneously by Day 42 without treatment; causality was confounded by concomitant use of SC ASIT that was discontinued at the time of the reaction. The remaining reported adverse events occurred in no more than one dog per group; of these, there were two events considered by the clinician to be severe. The first dog (0.5 mg/kg lokivetmab) had haemorrhage associated with iatrogenic laceration of a body wall vessel following cystocentesis at the Day 56 visit and recovered with hospitalization and treatment. The second dog (0.5 mg/kg lokivetmab) had pre-existing bilateral pinnal irritation and otitis externa but the severity for right pinna irritation became severe on Day 24; the dog was withdrawn in order to administer medications not permitted by the study.
The first case was a 4-year-old neutered female English cocker spaniel; significant findings on Day 0 before treatment with lokivetmab included fever (39.8°C), mild regenerative anaemia, slight polychromasia and three nucleated red blood cells per 100 white blood cells; platelets were clumped and an accurate count was, therefore, unavailable. Treatment with cefpodoxime proxetil was initiated (Day 8) to treat a cough associated with tracheobronchitis of one day duration. Immune-mediated haemolytic anaemia and immune-mediated thrombocytopaenia were diagnosed (Day 12); remission was achieved by Day 43 with immunosuppressive treatment.
Info about how Cytopoint works:
https://vitalanimal.com/cytopoint-answer-itch/
1+ Years Later
Zanna has no lasting medical issues from the Cytopoint. 6 months after the shot, her blood work was normal. No white/red blood count issues. No liver and kidney issues. It’s 2019, and I’m still convinced that the Cytopoint caused the issues, though the vet and doggy allergy doctor never agreed with me or documented it.
Zanna continued to itch all the time. I tried different food and it didn’t help. I was nearly convinced that it was jut a behavioral issue when my vet recommended that we try Apoquel. She said that if Zanna had any bad reactions, she could stop taking it and it would be out of her system quickly. It helped DRAMATICALLY. She continues to take the pill every day an NO LONGER ITCHES. It’s wonderful.
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