Otezla side effects
Otezla (apremilast) is an oral non‑biologic medication for psoriasis, psoriatic arthritis, and Behçet’s mouth ulcers. Side effects range from mild to serious.
Most common side effects
- Nausea
- Diarrhea
- Headache (including tension headache)
- Upper respiratory tract infection
- Weight loss
Other possible side effects:
- Vomiting
- Back pain
- Joint pain
- Abdominal pain
- Common cold symptoms
- Indigestion
- Fatigue
- Insomnia
Serious side effects
- Anaphylaxis (hives, swelling, trouble breathing)
- Severe gastrointestinal reactions (diarrhea, nausea, vomiting) especially in the first weeks
- Worsening depression or suicidal thoughts
- Unexplained, significant weight loss
If you experience persistent or severe reactions, contact your healthcare provider. You can report side effects to the FDA at 1‑800‑FDA‑1088 or www.fda.gov/medwatch.
Otezla FAQs
What does Otezla treat?
- Active psoriatic arthritis
- Plaque psoriasis in candidates for systemic therapy or phototherapy
- Oral ulcers in Behçet’s disease
How does Otezla work?
Apremilast inhibits phosphodiesterase 4 (PDE4), reducing inflammation and symptoms like swelling, redness, and pain.
What should you tell your healthcare provider before taking Otezla?
- Allergy to apremilast or any inactive ingredient
- History of depression or other mood disorders
- Kidney disease
- Pregnancy or plans to become pregnant
- Breastfeeding or plans to breastfeed
Is Otezla safe with other medications?
Avoid strong CYP450 inducers:
- Phenytoin
- Rifampin
- Carbamazepine
- Phenobarbital
What if you miss a dose?
Take it as soon as you remember, unless it’s near the next dose. Do not double-dose.
Recommended titration schedule
To minimize gastrointestinal side effects, increase dose gradually over 6 days:
- Day 1: 10 mg once
- Day 2: 10 mg twice
- Day 3: 10 mg morning, 20 mg evening
- Day 4: 20 mg twice
- Day 5: 20 mg morning, 30 mg evening
- Day 6 onward: 30 mg twice daily
Severe kidney impairment: 30 mg once daily with similar titration.
How long until Otezla works?
Some benefit appears in the first weeks; most see significant improvement by 12–16 weeks.
Does Otezla cause weight loss?
Clinical trials showed:
- Psoriatic arthritis: 5–10% weight loss in 10% on Otezla vs. 3.3% on placebo
- Plaque psoriasis: 5–10% weight loss in 12% vs. 5% on placebo
- Behçet’s disease: >5% weight loss in 4.9% vs. 3.9% on placebo
How might Otezla make you feel?
Initial side effects like nausea, diarrhea, headaches, and upper respiratory infections often subside over time. Monitor mood closely and report any changes immediately.
Related medications
- Rituxan (rituximab)
- Xeljanz XR (tofacitinib)
- Rinvoq (upadacitinib)
- Actemra (tocilizumab)
- Orencia (abatacept)