Otezla (apremilast) is an oral medicine used to treat:

• Moderate to severe plaque psoriasis
• Active psoriatic arthritis
• Behçet's disease oral ulcers

Apremilast belongs to a class called PDE4 inhibitors (phosphodiesterase 4 inhibitors). It works inside cells by blocking the PDE4 enzyme, which regulates the production of inflammatory proteins. Reducing these signals decreases inflammation in the skin and joints.

Unlike biologic medicines, Otezla does not require injections and does not involve blood test monitoring for immune suppression

Treatment does not start at the full dose straight away. A starter pack gradually increases the dose over the first few days to reduce the chance of stomach upset. Your doctor will provide the starter pack and walk you through the schedule. From the maintenance dose onwards, the tablet is taken twice daily with or without food.

Take the missed dose as soon as you remember. If it is nearly time for your next dose, skip the missed dose and continue your normal schedule. Never take two doses at once.

Contact your doctor or emergency services. There is no specific antidote.

• Store below 30°C
• Keep in the original packaging
• Keep out of reach of children

Side effects are most common during the first few weeks, particularly during the starter titration period.

Very common side effects:

• Diarrhoea: common especially in the first 2 weeks. Usually mild and often resolves with time. Drink plenty of fluids
• Nausea: often improves as your body adjusts to the medicine
• Headache
• Upper respiratory infections
  
  

Common side effects:

• Back pain
• Vomiting
• Decreased appetite and weight loss: if you lose a significant amount of weight, tell your doctor

Serious side effects:

• Depression and suicidal thoughts: Otezla has been associated with depression and, in rare cases, suicidal ideation. If you experience worsening mood, hopelessness, or any thoughts of self-harm, stop taking Otezla and seek medical help immediately

Tell your doctor about any previous mental health conditions before starting Otezla.

• Strong CYP3A4 inducers (rifampicin, carbamazepine, phenytoin, St John's Wort): significantly reduce apremilast levels, reducing its effectiveness; avoid
  
  

Otezla generally has a lower interaction profile than many other systemic medicines for psoriasis.

Do I need blood tests while on Otezla?

Unlike biologic medicines and some other immunosuppressants, Otezla does not require routine blood monitoring for immune suppression or drug levels. This is one of its practical advantages. Your dermatologist or rheumatologist will monitor your response to treatment at follow-up visits.

Why does it start at such a low dose?

The 5-day starter titration gradually increases the dose to allow your body to adjust and reduce the severity of stomach side effects such as nausea and diarrhoea. Going straight to the full dose of 30 mg twice daily increases the likelihood of significant gut upset. Following the titration schedule carefully is important for tolerability.

Ace provides accurate and independent information medically reviewed on prescription medications. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.