How to Take Otezla (Apremilast)
Otezla (apremilast) should be started at a lower dose and titrated up over 5 days to reduce gastrointestinal side effects, with a maintenance dose of 30 mg twice daily taken orally. 1, 2
Dosage Titration Schedule
- Day 1: 10 mg in the morning only 1, 2
- Day 2: 10 mg in the morning and 10 mg in the evening 1, 2
- Day 3: 10 mg in the morning and 20 mg in the evening 1, 2
- Day 4: 20 mg in the morning and 20 mg in the evening 1, 2
- Day 5: 20 mg in the morning and 30 mg in the evening 1, 2
- Day 6 and thereafter: 30 mg twice daily (maintenance dose) 1, 2
Administration Guidelines
- Otezla can be taken with or without food 2
- Tablets should be swallowed whole - do not crush, split, or chew 2
- For patients with severe renal impairment (creatinine clearance <30 mL/min), the dose should be reduced to 30 mg once daily 1, 2
- For patients with renal impairment requiring dose reduction, use only the morning schedule during titration and skip the evening doses 2
Common Side Effects and Management
- Most common side effects include diarrhea, nausea, upper respiratory tract infections, and headache 1, 3
- Gastrointestinal side effects typically occur within the first 2 weeks of treatment and usually resolve within 4 weeks without dose adjustment 1, 4
- Patients 65 years and older are more prone to experience dehydration complications from GI side effects 1, 2
- Monitor for weight loss; if >5% from baseline occurs, consider discontinuation 1
- Be aware of potential depression risk; discuss this possibility before starting therapy 1, 2
Drug Interactions
- Apremilast is metabolized by cytochrome P450 1
- Avoid using with strong CYP450 inducers (e.g., rifampin, phenobarbital, carbamazepine, phenytoin) as they may decrease effectiveness 1
- Review medication lists before starting therapy and periodically thereafter 1
Special Considerations
- No routine laboratory monitoring is required 1
- Use during pregnancy only if benefit justifies potential risk to fetus 1
- In cases of severe diarrhea, nausea, or vomiting, dose reduction or suspension may be necessary 2, 3
- There is limited evidence supporting combined use with other systemic or phototherapy treatments for psoriasis 1
Otezla offers the benefits of oral administration without the need for laboratory monitoring, making it an appropriate choice for patients who prefer to avoid injections and frequent blood tests 1.