Otezla
Otezla (apremilast) is a tablet that's taken by mouth. It's used to treat plaque psoriasis, psoriatic arthritis, and mouth sores from Behçet’s disease. This medication belongs to the drug class called phosphodiesterase-4 (PDE-4) inhibitors. You usually start Otezla (apremilast) at a low dose. Then, the dose is slowly raised over 5 days to lower the risk of side effects like nausea and diarrhea. This medication is available as a brand-name medication. Generic versions of apremilast likely won't be available until at least 2028.
What is Otezla (apremilast)?
What is Otezla (apremilast) used for?
- Active psoriatic arthritis in adults
- Moderate-to-severe plaque psoriasis in people age 6 years and older weighing at least 44 lbs
- Mouth sores from Behçet’s disease in adults
How Otezla (apremilast) works
Otezla (apremilast) is a phosphodiesterase-4 (PDE-4) inhibitor. It works by blocking a protein in the body called PDE-4. This protein plays a role in causing inflammation in your body. Blocking PDE-4 is thought to help lower inflammation.
Drug facts
Side effects of Otezla (apremilast)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Diarrhea (17%)
- Nausea (17%)
- Upper respiratory tract infection (e.g., common cold; 9%)
- Headache (6%)
Less Common Side Effects
- Vomiting
- Stomach pain
- Indigestion
- Lower appetite
- Tiredness
Note: Side effects were reported by adults with plaque psoriasis. Side effects might differ for people with other medical conditions.
Otezla (apremilast) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Depression
- Suicidal thoughts or behavior
- Severe allergic reaction: hives; trouble breathing; swelling of the lips, tongue, or throat
More on Otezla (apremilast) side effects
The following Otezla (apremilast) side effects have also been reported
Side effects that you should report to your care team as soon as possible:
- Allergic reactions—skin rash, itching, hives, swelling of the face, lips, tongue, or throat
- Thoughts of suicide or self-harm, worsening mood, feelings of depression
Side effects that usually do not require medical attention (report these to your care team if they continue or are bothersome):
- Diarrhea
- Headache
- Loss of appetite with weight loss
- Nausea
- Vomiting
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Pros and cons of Otezla (apremilast)
Pros
- Taken by mouth
- Can take with or without food
- Dose adjustment available for people with severe kidney problems
Cons
- Dosing schedule can be confusing in the beginning
- Common to have nausea or diarrhea in the beginning
- Might not be a good option for people who've had depression or suicidal behavior
Pharmacist tips for Otezla (apremilast)
- You can take Otezla (apremilast) with or without food. Swallow the tablets whole. Don't crush, split, or chew them.
- When you first start Otezla (apremilast), you might use a starter pack to slowly raise your dose. This helps your body get used to the medication and can lessen your chance of nausea, vomiting, and diarrhea. Carefully follow the dosing instructions for each day. Ask your prescriber or pharmacist if you have any questions.
- If you vomit or have diarrhea while taking Otezla (apremilast), make sure to drink plenty of fluids so you don't get dehydrated. Tell your prescriber if these side effects happen a lot or bother you a lot, though. They might lower your dose or pause your treatment to help.
- Give your care team a list of all the medications you take. Some, like carbamazepine (Tegretol), interact with Otezla (apremilast). These drug interactions can make Otezla (apremilast) not work as well. Your care team can help make sure your medications are safe to take together.
- Talk to your prescriber about family planning, and tell them if you become pregnant while taking Otezla (apremilast). It's not clear if the medication can harm an unborn baby if taken during pregnancy, but there might be a risk. Your prescriber can help go through the risks and benefits of treatment.
Common questions about Otezla (apremilast)
No. Otezla (apremilast) isn't a biologic. Biologics are made from a living source, like plant cells. But Otezla (apremilast) is made from chemicals.
Some people might think of Otezla (apremilast) as an immunosuppressant. This is because it helps calm the immune system to lower inflammation. Some other immunosuppressants like transplant medications affect the entire immune system. But Otezla (apremilast) only dampens a part of it. It blocks a protein called PDE-4 on immune cells that play a role in causing inflammation. Otezla (apremilast) isn’t known to weaken the immune system enough to put you at risk of serious infections.
No, Otezla (apremilast) isn't a steroid. Otezla (apremilast) belongs to a drug class called PDE-4 inhibitors. Steroids and PDE-4 inhibitors both lower inflammation in the body. But they work in different ways to do this.
Stomach side effects, like nausea and diarrhea, should go away in the first few weeks after starting Otezla (apremilast). In studies with people who have psoriatic arthritis, most nausea and diarrhea started within the first 2 weeks of treatment. Then, these side effects went away within the next 4 weeks. Other side effects also generally got better over time. Tell your care team if any side effects bother you. Your prescriber might lower your dose or recommend ways to help you feel better.
How long Otezla (apremilast) takes to work can be different for each person. It also depends on what condition you're treating. Most people with psoriatic arthritis had benefits from the medication after 4 months. For plaque psoriasis, about 20% of people taking Otezla (apremilast) had less itchiness within the first 2 weeks. And people with Behçet’s disease might see fewer mouth sores and have less mouth pain in just 1 week. Keep in mind that it can take weeks to months to see the full effects of Otezla (apremilast). So remember to keep taking it as prescribed. Ask your prescriber if you have questions about how long it's taking the medication to work for you.
It's not clear why, but some people who've taken Otezla (apremilast) have lost weight. Some people lost 5% to 10% of their body weight while taking this medication during studies. Check your weight every so often while you're taking Otezla (apremilast). Let your prescriber know if you lose a noticeable amount of weight during treatment. Talk to your primary care provider if you're worried about possible weight loss while taking this medication.
Your prescriber might tell you to keep taking Otezla (apremilast) as long as it's helping your symptoms. This might help keep your symptoms under control. Keep in mind that it can take weeks to months to see the full effects of Otezla (apremilast). If the medication doesn't seem to be working for you or if you have side effects that bother you, talk to your prescriber about other options.
Generic versions of Otezla (apremilast) aren't expected to be available until after 2028. Talk to your prescriber about your options.
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Risks and warnings for Otezla (apremilast)
Otezla (apremilast) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Allergic reaction
Rarely, Otezla (apremilast) can cause a serious allergic reaction. Stop taking the medication and get medical help right away if you have an allergic reaction. Look out for hives; trouble breathing; or swelling in your lips, tongue, or throat.
Diarrhea, nausea, and vomiting
- Risk factors: Older adults | Taking diuretics (water pills) | Taking medications that can dehydrate you or cause low blood pressure
Nausea, vomiting, and diarrhea are common when you first start taking Otezla (apremilast). These side effects should get better and go away with time. But they can be severe and sometimes lead to dehydration (when your body loses too much fluid). Older adults and people taking medications that remove fluid from the body or lower blood pressure are at risk of dehydration.
Tell your care team if you have a lot of nausea, vomiting, or diarrhea while taking Otezla (apremilast). Your prescriber might lower your dose or pause your treatment.
Depression
- Risk factors: History of depression | History of suicidal thoughts or behavior
Some people who took Otezla (apremilast) reported having depression or feeling depressed. Before starting this medication, let your prescriber know if you've ever had depression or suicidal thoughts. They can help weigh the risks and benefits of taking Otezla (apremilast).
During treatment, watch for any unusual changes in your behavior or mood. Call your prescriber if you or someone close to you notices this. If you have suicidal thoughts or actions, call 911 right away.
Possible weight loss
Tell your prescriber if you notice you're losing weight while taking Otezla (apremilast). In studies, 12% of adults with plaque psoriasis lost weight while taking this medication. This has also happened in children who took Otezla (apremilast). Talk to the prescriber if you're worried about this possible side effect.
Drug interactions
Talk to your prescriber before starting any new medications or supplements while taking Otezla (apremilast). Some medications can lower the amount of Otezla (apremilast) in the body. These medications include rifampin (Rifadin), phenobarbital, carbamazepine (Tegretol), and phenytoin (Dilantin), among others. They can make Otezla (apremilast) work less well. So, it's not recommended to take them with Otezla (apremilast).
Otezla (apremilast) dosage
Typical dosage for Otezla (apremilast)
Usually, you start the medication at a low dose. Your prescriber will slowly raise it up over 5 days. This helps lower your risk of stomach-related side effects. The recommended dosing schedules are outlined below.
-
Adults (and children with psoriasis who are 6 years and older weighing 110 lbs or more)
- Day 1: 10 mg by mouth in morning
- Day 2: 10 mg in the morning and 10 mg in the evening
- Day 3: 10 mg in the morning and 20 mg in the evening
- Day 4: 20 mg in the morning and 20 mg in the evening
- Day 5: 20 mg in the morning and 30 mg in the evening
- Day 6 and beyond: 30 mg in the morning and 30 mg in the evening
-
Children with psoriasis who are 6 years and older weighing 44 lbs to less than 110 lbs
- Day 1: 10 mg by mouth in morning
- Day 2: 10 mg in the morning and 10 mg in the evening
- Day 3: 10 mg in the morning and 20 mg in the evening
- Day 4 and beyond: 20 mg in the morning and 20 mg in the evening
Your dose might differ if you have kidney problems.
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How much does Otezla (apremilast) cost?
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What are alternatives to Otezla (apremilast)?
Moderate-to-severe inflammatory conditions in which other treatments haven't worked:
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