Apremilast (Otezla)


Apremilast (Otezla) is a prescription medicine that is approved to treat patients with psoriatic arthritis, moderate to severe plaque psoriasis, and the oral ulcers associated with Behçet's disease. Apremilast blocks the production of an enzyme called phosphodiesterase 4 (PDE4) and leads to a reduction in inflammation.

How to Take It

Dosing begins at 10 mg on the first day with a gradual increase over 5 days, up to max dose of 30 mg twice a day. The reason for this is to reduce nausea and diarrhea linked to initial treatment. Apremilast can be taken with or without food. Tablets should not be crushed, split, or chewed. Dosing is the same for psoriatic arthritis, plaque psoriasis, and Behçet's disease. Apremilast can take up to 4 months to help reduce symptoms. It is a chronic medication that will be used continuously if it is effective and well tolerated.

Side Effects

The most common side effects of apremilast include diarrhea, nausea, upper respiratory tract infection, and headache. After two weeks of treatment, most patients who had symptoms of diarrhea and nausea no longer felt the symptoms and did not have to stop treatment. More serious side effects include weight loss and depression. Your doctor may also have to decide if you should continue to take apremilast if significant weight loss occurs. Tell your doctor if you are having any feelings of depression, suicidal thoughts, or suicidal behavior.

Many patients do not experience side effects; however, for those who do, many of the minor side effects will improve with time. Side effects should be reported immediately and discussed with your rheumatologist. Apremilast does not lead to increased risk of infection.

Tell Your Rheumatology Provider

Be sure to tell your rheumatology provider about all the medications you are taking, including over-the-counter drugs and natural remedies, as some of these could affect how apremilast works. Examples of those medications include Phenytoin, Carbamazepine, Primidone, Phenobarbital, Rifampin, and St. John’s Wort.

Tell your rheumatology provider if you become pregnant or plan to become pregnant. There is not enough available data to know apremilast’s effect on pregnancy and breast feeding. If you become pregnant while taking apremilast, contact your rheumatology provider to see if this medication should be discontinued. If you have kidney disease, you should inform your rheumatologist, as apremilast’s dosages should be adjusted in patients with severe renal dysfunction.

Updated February 2024 by Lisa Carnago, FNP, and reviewed by the American College of Rheumatology Committee on Communications and Marketing.

This information is provided for general education only. Individuals should consult a qualified health care provider for professional medical advice, diagnosis, and treatment of a medical or health condition.

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