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.
Dosing begins at 10mg on the first day with a gradual increase over 5 days, up to max dose of 30mg 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 as long as it is effective and well tolerated.
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 without stopping treatment. More serious side effects include body weight loss and depression. Tell your doctor if you are having any feelings of depression, suicidal thoughts, or suicidal behavior. Your doctor may also have to decide if you should continue to take apremilast if significant weight loss occurs.
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.
Be sure to tell your rheumatology provider about all of 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 December 2020 by Suleman Bhana, MD, and reviewed by the American College of Rheumatology Communications and Marketing Committee.
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.