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Methotrexate vs. Otezla

Head-to-head comparisons of medication uses, side effects, warnings, and more.

Key takeaways

Methotrexate and Otezla (apremilast) are both medications that can be used to treat psoriasis, but they have some important differences. Methotrexate is an antimetabolite, while Otezla is a phosphodiesterase-4 (PDE-4) inhibitor. Methotrexate is also used for various cancers and autoimmune conditions like rheumatoid arthritis, whereas Otezla is used for psoriatic arthritis and mouth sores from Behçet’s disease. Methotrexate is available as an oral tablet and an injection, while Otezla is only available as an oral tablet. Methotrexate is available as a generic, making it more affordable, while generic versions of Otezla are not expected until at least 2028. Common side effects of methotrexate include mouth sores and nausea, while Otezla often causes nausea and diarrhea. Methotrexate can interact with certain antibiotics and NSAIDs. Be sure your prescriber and pharmacist have a complete list of your medications.

Methotrexate

(Trexall)

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Otezla

(apremilast)

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Summary for Methotrexate

Prescription only

Methotrexate (Trexall) belongs to a drug class called antimetabolites. It’s used as chemotherapy at high doses to kill cancer cells and treat different cancers, such as acute lymphoblastic leukemia (ALL). At lower doses, methotrexate (Trexall) is considered a disease-modifying antirheumatic drug (DMARD) that treats certain non-cancer conditions, such as rheumatoid arthritis (RA). This medication is a tablet that you take by mouth. For most conditions, it’s taken once a week, but for some, it’s taken more often than that. Methotrexate (Trexall) side effects include mouth sores, nausea, and stomach upset.

Indications for Methotrexate

Cancer:

Non-cancer conditions:

Pros and Cons for Methotrexate

Pros

  • Taken by mouth, so a good option for people who don’t like needles
  • A non-steroidal option for autoimmune conditions (e.g., rheumatoid arthritis, psoriasis)
  • Doesn’t typically cause hair loss or weight gain

Cons

  • Might cause nausea and mouth sores
  • Can raise your risk for infection
  • Requires regular office visits and lab tests to check for serious side effects

Common Side Effects for Methotrexate

  • Mouth sores
  • Nausea or vomiting
  • Diarrhea
  • Stomach upset
  • Dizziness
  • Tiredness
  • Chills
  • Fever
  • Infection
  • Higher liver enzyme levels in the blood
  • Low white blood cells
  • Low platelet levels

Warnings for Methotrexate

  • Harm to unborn baby
  • Allergic reaction
  • Low blood cell counts
  • Damage to the digestive tract
  • Liver damage
  • Lung problems
  • Serious skin problems (including skin burns)
  • Kidney damage
  • Risk of serious side effects with dosing errors
  • Effect on folic acid levels in the body
  • Serious infections
  • Serious nervous system problems
  • Risk for new cancers
  • Tumor lysis syndrome
  • Changes to your ability to have children (infertility)
  • Higher risk for side effects if you have extra body fluid

Summary for Otezla

Prescription only

Otezla (apremilast) is a tablet that's taken by mouth. It treats plaque psoriasis and psoriatic arthritis in people 6 years and older. The medication can also treat mouth sores from Behçet’s disease in adults. It works as a phosphodiesterase-4 (PDE4) inhibitor to reduce inflammation. Immediate-release tablets called Otezla are taken twice daily. You start at a low dose, then it gets raised over a few days to a maintenance dose. Some people can switch to once-daily, extended-release tablets called Otezla XR. Side effects include nausea and diarrhea.

Indications for Otezla

Pros and Cons for Otezla

Pros

  • Taken by mouth
  • Can take with or without food
  • Option to switch to once-daily extended-release tablets for some people

Cons

  • Dosing schedule can be confusing in the beginning
  • Common to have nausea or diarrhea when starting
  • Might not be a good option for people who've had depression or suicidal behavior

Common Side Effects for Otezla

Warnings for Otezla

  • Allergic reaction
  • Diarrhea, nausea, and vomiting
  • Depression
  • Possible weight loss
  • Drug interactions

Prices with our coupons for Methotrexate vs. Otezla

Price Card Drug Icon
Methotrexate72 tablets / 2.5mg
$25.81$256.96
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Price Card Drug Icon
Otezla60 tablets / 30mg
$3,353.53$7,098.42
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