6 Otezla Side Effects You Should Know About
Key takeaways:
Otezla (apremilast) is a phosphodiesterase 4 (PDE 4) inhibitor. It’s an oral tablet that treats psoriasis, psoriatic arthritis, and mouth sores associated with Behçet’s disease.
Common Otezla side effects include diarrhea, nausea, and headache. These usually get better over time and are easily managed on your own at home. But let your prescriber know if they continue or get worse.
Rare but serious side effects can include severe digestive issues, suicidal thoughts, and significant weight loss. Your prescriber can help determine the best way to manage these side effects. In some cases, you may need to stop taking Otezla.
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Table of contents
Otezla (apremilast) is an oral tablet that treats psoriasis, psoriatic arthritis, and mouth sores associated with Behçet’s disease. It’s a phosphodiesterase 4 (PDE 4) inhibitor that reduces inflammation in the body.
Otezla is a safe and effective medication, but it also has some side effects to be aware of while you’re taking it. Knowing what to expect can help you manage your side effects and know when to seek medical care.
Otezla side effects at a glance
Below are common and rare, but serious, Otezla side effects reported in clinical studies. In most cases, you’ll start with a low dose of Otezla and increase it over the first week to help reduce common side effects. So be sure to follow the recommended dosing schedule.
Common Otezla side effects include:
Diarrhea
Nausea and vomiting
Headache
Upper respiratory tract infections
Stomach pain
Heartburn
Decreased appetite
Rare but serious Otezla side effects include:
Severe nausea, vomiting, or diarrhea
New or worsening depression
Suicidal thoughts
Significant weight loss
Keep in mind that other side effects are possible while taking Otezla. Reach out to your healthcare team for guidance for any Otezla side effects that you experience, even if they aren’t listed here.
1. Diarrhea
Diarrhea was the most common side effect reported in Otezla clinical studies. It typically happens within the first 2 weeks of treatment. And in most cases, it will go away on its own over time as your body gets used to the medication.
You can help manage diarrhea by avoiding fried or spicy foods. Be sure to drink plenty of fluids, as well, to avoid dehydration.
Otezla for psoriatic arthritis: Learn more about how Otezla works and its effectiveness for treating psoriatic arthritis
Biologic treatments: There are several biologic medications that treat psoriasis and psoriatic arthritis. Here’s an overview of the available options.
Otezla dosages: Knowing how to take Otezla can help you get the most from your medication.
Let your prescriber know if your diarrhea worsens or doesn’t improve. They may lower your Otezla dosage or suggest other ways to manage it. It isn’t common, but you may need to stop taking Otezla if diarrhea is severe and doesn’t improve.
2. Nausea and vomiting
Nausea is another common Otezla side effect. Vomiting can also happen, although it’s not as common as nausea. As with diarrhea, these side effects are more common when you start taking Otezla and usually improve over time, typically within the first month of treatment.
You can take Otezla with or without food, but taking it with food may help reduce nausea. If you do experience nausea, try eating smaller meals throughout the day. Sticking to bland foods can also help.
If your nausea is severe, or you’re vomiting frequently, let your prescriber know. You may need a lower Otezla dosage or a different medication altogether.
3. Headache
Headache is also a possible side effect of Otezla. Both tension and migraine headaches were reported in clinical studies.
Many other things can contribute to headaches. You can help manage them by getting plenty of sleep, limiting alcohol, and managing stress levels. Over-the-counter pain medications — such as ibuprofen (Motrin, Advil) and acetaminophen (Tylenol) — can also help. Just check with your prescriber first to make sure they’re a safe option for you.
If you have frequent headaches or a headache that won’t go away, let your prescriber know. They can adjust your dosage or medication if needed.
4. Upper respiratory tract infections
Otezla reduces the activity of your immune system to help manage the symptoms of certain autoimmune conditions. But this can also leave you more vulnerable to infections. Because of this, upper respiratory infections, such as the common cold, are more likely if you’re taking Otezla.
Symptoms of an upper respiratory infection can include a runny or stuffy nose, cough, and sore throat. You can typically manage your symptoms with OTC cough and cold medications. But if you develop a fever or your infection worsens or doesn’t go away, it’s a good idea to see a healthcare professional for further treatment.
5. Unintentional weight loss
Unintentional weight loss is another possible Otezla side effect. It’s not clear why this happens, but it could be due to:
Decreased appetite (on its own or as a result of other Otezla side effects, such as nausea and diarrhea)
Improved metabolism as a result of decreased inflammation
Increased ability to exercise as autoimmune symptoms improve
Most of the time, weight loss from Otezla isn’t a major problem. But excessive weight loss can lead to nutritional deficiencies, as well as muscle and bone loss. These issues can be harmful to your health, and they can be especially risky for children. It’s a good idea to let your prescriber know about any significant weight changes you experience during Otezla treatment. They can help determine if a lower Otezla dosage or different medication is needed to prevent unintended weight loss from affecting your health.
6. Depression and suicidal thoughts
Otezla may increase your risk for new or worsening depression. It may also raise the risk of suicidal thoughts and behaviors. These side effects aren’t common, but they can be serious if left unaddressed. Report any mood changes to your healthcare team right away. They can take steps to help manage your symptoms, which may include stopping Otezla treatment.
For additional resources or to connect with mental health services in your area, call SAMHSA’s National Helpline at 1-800-662-4357. For immediate assistance, call the National Suicide Prevention Lifeline at 988, or text HOME to 741-741 to reach the Crisis Text Line.
Frequently asked questions
It depends. Hair loss wasn’t a reported Otezla side effect in initial clinical studies. In fact, some studies show that Otezla may improve certain types of hair loss when other treatments aren’t effective. That being said, Otezla can reduce your appetite and cause unintentional weight loss. And rapid weight loss, as well as nutritional deficiencies, can lead to hair loss. So it’s a good idea to check in with your prescriber if you’re losing hair while taking Otezla.
No. Otezla isn’t associated with liver problems. And you don’t need a dosage adjustment if you’re living with liver problems while taking it. In rare cases, you may have elevated liver enzyme levels while taking Otezla. But this symptom is typically mild and doesn’t lead to more serious liver damage or problems down the line.
No. Otezla doesn’t seem to have any additional long-term side effects you should be concerned about. A study reviewed the safety of Otezla over 5 years and found no increased risk of serious side effects with long-term treatment. Otezla may even have fewer risks of serious side effects, such as serious infections and liver problems, than other common treatments for the same autoimmune conditions.
The bottom line
Otezla (apremilast) is an oral medication that treats psoriasis, psoriatic arthritis, and Behçet’s disease. Common Otezla side effects include diarrhea, nausea, and headache, especially when starting treatment. In most cases, you can manage these side effects on your own at home and they’ll improve with time. But if they worsen or don’t improve, be sure to let your prescriber know.
More serious Otezla side effects include depression, suicidal thoughts, and unintended weight loss. If these side effects occur, your prescriber can determine if you can keep taking Otezla or if a different treatment option may be safer for you.
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References
Amgen. (2024). Otezla- apremilast tablet, film coated [package insert].
Estébanez, A., et al. (2019). Apremilast in refractory alopecia areata. International Journal of Trichology.
Ferguson, L. D., et al. (2021). Effect of the phosphodiesterase 4 inhibitor apremilast on cardiometabolic outcomes in psoriatic disease—results of the Immune Metabolic Associations in Psoriatic Arthritis study. Rheumatology.
Guo, E. L., et al. (2017). Diet and hair loss: Effects of nutrient deficiency and supplement use. Dermatology Practical & Conceptual.
Jaime, K., et al. (2024). Risks associated with excessive weight loss. StatPearls.
LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. (2017). Apremilast. National Institute of Diabetes and Digestive and Kidney Diseases.
Mease, P. J., et al. (2023). Apremilast long-term safety up to 5 years from 15 pooled randomized, placebo-controlled studies of psoriasis, psoriatic arthritis, and Behçet’s syndrome. American Journal of Clinical Dermatology.
Zerilli, T., et al. (2015). Apremilast (Otezla): A new oral treatment for adults with psoriasis and psoriatic arthritis. Pharmacy and Therapeutics.
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