What is apremilast?

Why is apremilast prescribed?

What are the possible side effects?

What are the risks?

What else should I know about apremilast?

What is apremilast?

Apremilast belongs to a group of medicines called phosphodiesterase 4 inhibitors, which help to reduce inflammation.  is a type of disease-modifying anti-rheumatic drug (DMARD).

What are the brand names of apremilast?

The originator drug is Otezla.

What type of drug is apremilast?

Apremilast is a phosphodiesterase 4 inhibitor.

How does it work?

Apremilast works by reducing the activity of an enzyme in the body called ‘phosphodiesterase 4’ which is involved in the process of inflammation. By reducing the activity of this enzyme, apremilast can help to control the inflammation associated with psoriatic arthritis and psoriasis and thereby reduce the signs and symptoms of these conditions.

What is it used for?

It is used to treat psoriatic arthritis for people who cannot use another type of medicine called ‘disease-modifying anti-rheumatic drugs’ (DMARDs) or when one of these type of medicines did not work.

It is also used to treat moderate to severe plaque psoriasis if you cannot use one of the following treatments or when one of these treatments did not work: phototherapy – a treatment where certain areas of skin are exposed to ultraviolet light or systemic therapy – a treatment that affects the entire body rather than just one local area, such as ‘ciclosporin’ or ‘methotrexate’.

How is it taken?

Apremilast is taken orally in tablet form.

Are there any side-effects?

In some patients apremilast can cause diarrhoea and nausea.

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Why is apremilast prescribed?

Apremilast is prescribed for people with active psoriatic arthritis. It is also used to treat moderate to severe plaque psoriasis.

When and how do I take apremilast?

Apremilast is taken orally in tablet form. When you start taking apremilast you will receive a ‘treatment initiation pack’. 

Once the recommended dose has been reached, you will only get the 30mg tablet strength in your prescribed packs. You will only ever need to go through this stage of gradually increasing your dose once even if you re-start treatment.

How long does apremilast take to work?

It can take up to six months to feel the benefit of apremilast. Because it’s a long-term treatment, it’s important to keep taking apremilast (unless you have severe side-effects), even if it doesn’t seem to be working at first and even when your symptoms improve (to help keep the disease under control).

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What are the possible side effects?

In some patients apremilast can cause nausea, vomiting, diarrhoea, feeling tired, back pain, loss of appetite, stomach pain, insomnia and cough. Uncommon side-effects can include rash, weight loss or allergic reaction. 

You should discuss any side-effects with your doctor or pharmacist, but in particular if you experience feelings of depression or suicidal thoughts – these are very rare side-effects but the consequences can be very serious, so contact your doctor immediately

You should always read the patient information leaflet included with your medicines package to keep you informed about any possible side effects of your prescribed medications.

What should I look out for?

You should stop apremilast and see your doctor immediately if any of the symptoms listed above persist or worry you.

Apremilast may cause weight loss. You will need to have regular weight checks while taking apremilast.

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What are the risks?

Apremilast may cause depression. The risk may be greater in patients who have a history of depression or suicidal thoughts or actions. Families and caregivers must closely watch patients who take apremilast. It is important to tell your doctor straight away if you have new, worsened or sudden symptoms such as depression, anxiety, restlessness or irritability, panic attacks or any changes in behaviour.

Will it affect vaccinations?

You should check with your doctor before having vaccinations when taking apremilast.

Can I drink alcohol while on apremilast?

There is no known interaction between alcohol and apremilast but it is well recognised that alcohol can make your psoriasis worse. Alcohol consumption should not exceed the recommended amounts (1-2 units per day for women and 2-3 units per day for men). Your doctor may advise lower limits.

Does apremilast affect fertility or pregnancy?

The effects of apremilast in pregnancy are not known. If you are a woman of childbearing potential, you are advised to avoid becoming pregnant and must use adequate contraception while using apremilast. Talk to your doctor if you are pregnant; think you may be pregnant or planning to have a baby.

Does it affect breastfeeding?

You should not use apremilast while breastfeeding.

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What else should I know about apremilast?

Apremilast contains lactose (a type of sugar). If you have been told by your doctor that you cannot tolerate or digest some sugars you should talk to your doctor before taking apremilast.

Are there any alternatives?

A number of other drugs are used in the treatment of plaque psoriasis and psoriatic arthritis. Your doctor will discuss these other options with you.

Will I need any special checks while on apremilast?

No special checks are needed while you are on apremilast. However if you have severe kidney problems then the recommended dose is 30mg once a day (morning dose).

Can I take other medicines alongside apremilast?

Apremilast can affect the way some other medicines work. Also some other medicines can affect the way apremilast works. You should tell your doctor or pharmacist if you are taking, have recently taken or intend on taking any other medicines, including medicines without a prescription and herbal medicines.

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Page updated 11 May 2021