Otezla Side Effects, Uses, Dosage, and Warnings

Otezla, a brand name of apremilast drug kind, is a medication used for treating active psoriatic arthritis symptoms in adults. It relieves swelling in the joints and around them as well as tenderness, but Otezla is not a cure for this disease, nevertheless. Evenmore, only small numbers of people that aware on Otezla side effects.

Besides psoriatic arthritis, this drug is also a medication for treating moderate to severe plaque psoriasis. It supports the treatment of phototherapy or others received by people with the said disease. Otezla acts as an inhibitor that inhibits an enzyme spontaneous production from human immune system that affects particular cells which contribute to inflammation in the body.

We know the drug is extremely helpful yet we aware, too, that nothing comes with only its good side. This article will discuss about Otezla side effects and along with that are its uses, how much patients should take it a day and warnings that follow.

Otezla Side Effects; Precaution

Otezla Side Effects, Uses, Dosage, and Warnings
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Before taking the medicine, you should read and follow all the instruction on the medicine package and label. You should, as well, tell all your medical officers about any allergies you have, medicines you consume, and conditions you are in now. You shouldn’t take Otezla if you have allergy to apremilast.

Things you must tell your doctor in order to make sure this drug is safe for you are:
  • If you have any history related to either depression or suicidal thoughts or actions. This is pretty important because people tend to have depression or thoughts about suicide as Otezla side effects during their medical treatment using this medicine. Your doctor will check the progress you make at regular visits and your family as well as other caregivers should be alert to your symptoms and mood changes.
  • Whether you have kidney disease or not.
  • If you take seizure medication, like phenobarbital, carbamazepine, and phenytoin for example.
  • If you’re in medical treatment of either HIV/AIDS or tuberculosis.
  • Whether or not you are pregnant or planning to become pregnant. Food and Drug Administration (FDA) of United States approved this drug on 2014 for treating adults with said diseases and may be used for pregnant women. Yet in Europe, it is contraindicated during pregnancy as it led to miscarriages and other pregnancy problems in experiments using female pregnant monkeys and mice. Conclusion: it is still unknown whether Otezla can harm an unborn baby.
  • If you’re breastfeeding a baby. It is also unknown if Otezla can harm a nursing baby.
Like has been mentioned before, US FDA approved this drug for treating adults, so do not give Otezla to anyone under 18 years old without prescription.

Otezla Usage

Otezla usage suggestions for
Picture by: otezla.net

Take Otezla precisely as your doctor prescribes you. Follow all instructions and directions on the medicine package and label. Your doctor may change the dosing schedule or your dose sometimes to ensure you get the best outcome. Do not increase or lessen the amount of Otezla, and you shouldn’t consume it longer than it is recommended.

Otezla usage suggestions:
  • It can be taken with or without food.
  • Swallow it whole without chewing, breaking, or crushing the tablet.
  • Store at room temperature. Keep it away from heat and moisture.
  • Record your body weight meticulously during Otezla treatment. If you undergo any major weight loss as one of the Otezla side effects, go tell your doctor immediately.
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The usual dose for adults with psoriatic arthritis is as follows:
  • Day 1: 10 mg orally once a day (AM)
  • Day 2: 10 mg orally twice a day (AM and PM)
  • Day 3: 10 mg orally once a day (AM); 20 mg orally once a day (PM)
  • Day 4: 20 mg orally twice a day (AM and PM)
  • Day 5: 20 mg orally once a day (AM); 30 g orally once a day (PM)
Maintenance dose: 30 mg orally twice a day (AM and PM). Maintenance dose starts from Day 6 and after.

If you miss a dose, take the missed dose as soon as you remember. But skip it if your next scheduled dose comes up closer. Don’t take any extra medicine to make up the missed dose.

For patients with severe kidney disorders, Otezla dosage should be reduced to 30 mg once per day. It is suggested, for starting dosage titration in this group, that this medicine be titrated using only the AM schedules and skip the PM doses.

Otezla Side Effects

Otezla Side Effects, Adverse Reaction Frequency
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This drug affects its users in some ways. The Otezla side effects can be categorized as common effects, where common effects has two groups of more common and less common side effects, allergic signs, and major side effects which you should call your doctor immediately whenever you have one of them.

The common side effects may not require any medical attention. These happen because your body needs to adapt with how Otezla works. In time your body gets used to this medicine, the common side effects will disappear. But still you should consult your health care professional if any of the following side effects continue, or if there’s any that takes your concern.

More common otezla side effects:
  • Nausea,
  • Diarrhea,
  • Headache or another body aches or pain,
  • Cold symptoms like sneezing, stuffy nose, chills, and sore throat,
  • Cough,
  • Ear congestion,
  • Headache, severe, and throbbing, and
  • Voice loss.
Less common otezla side effects
  • Belching,
  • Burning, itching, pain in the hairy areas, pus at the root of the hair,
  • Heartburn,
  • Indigestion,
  • Muscles aches,
  • Stomach discomfort, upset, or pain,
  • Upper abdominal or stomach pain, and
  • Vomiting
On the contrary with the previous ones, the following side effects will need medical attention. Check with your doctor immediately if these occur during Otezla treatment.

Allergic signs:

  • Hives, itching, rash,
  • Difficult breathing or swallowing,
  • Swelling of your hands, feet, face, lips, throat, eyelids, or lips,
  • Fast heartbeat,
  • Fever,
  • Hoarseness,
  • Irritation,
  • Joint pain or stiffness,
  • Tightness in the chest

Major side effects:

  • Major weight loss,
  • Mood changes, like feeling empty or sad, lose the interest and pleasure, and irritability,
  • New or worsening depression,
  • Thoughts of hurting yourself or even suicide,
  • Discouragement, and
  • Behavior changes, like lack of appetite, tiredness, and having trouble with concentrating and sleeping.
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Otezla Warnings

Otezla Side Effects In Comparison
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As there are so many Otezla side effects both minor and major, you should continue reading the following warnings.

1. Diarrhea, Nausea, and Vomiting

These three are listed as more common side effects of Otezla. Though has been stated that the common ones may not need any medical attention, still the occurrences of diarrhea, nausea, and vomiting should not be underestimated.

Wrong measurement can lead to severe side effects and complications.

There have been post marketing reports of severe diarrhea, nausea, and vomiting associated with the use of Otezla. Most events occurred within the first few weeks of treatment. In some cases, patients were hospitalized. Patients 65 years of age or older and patients taking medications that can lead to volume depletion or hypotension may be at higher risk of complications from severe diarrhea, nausea, or vomiting.” (Drugs.com)

2. Depression

It is strongly suggested that patients should tell their doctor if they have any history of depression or suicidal thoughts or behavior, as taking Otezla may increase such reactions of depression. The prescribers have to thoroughly weigh the benefits and risks in treating such patients with Otezla.

Patients and their families or other caregivers should be alerted the possible occurrences of depression, suicidal thoughts, or other drastic mood changes and to call the healthcare providers immediately if such effects occur. Then, the prescribers should evaluate whether to continue treating the patients with Otezla after that.

3. Weight Decrease

During treatment with Otezla, weight decrease from 5% to 10% of body weight is still understandable and considered common. But still, patients should have their body weight monitored consecutively. Any major or unexplained weight loss should be evaluated and prescribers should consider discontinuing treatment with Otezla.

Drug Interaction

Otezla Side Effects Interactions - Harptimes.com
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It is not recommended to use cytochrome P450 enzyme inducers, such as phenobarbital, rifampin, phenytoin, and carbamazepine, at the same time with using Otezla. Enzyme inducers work in reducting the aprmilast systemic exposure which leads to Otezla efficacy loss.

In a complete classification, there are total of 70 kinds of drugs that are known to combine with Otezla or apremilast. The classifications cover major, moderate, and minor drug interactions.

By definition, major drug interactions means the combinations should be avoided because the risk is greater than the benefit, moderate drug interactions means the combinations are commonly avoided unless under certain circumstances, while minor drug interactions means the combinations minimize the risk.

Some common medications which are examined to be combined with Otezla are aspirin, Fish Oil, folic acid, ibuprofen, metformin, and Vitamin D3.

All in all, do not stop taking any medications without advice from your healthcare providers despite all of the Otezla side effects that may occur to you. But then again, it is strongly recommended to tell your doctor about all the medicine you’re taking at the moment before you take Otezla.

Potential Advantages and Disadvantages

Otezla Side Effects Potential Advantages and Disadvantages - Harptimes.com
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Taking apremilast in the brand of Otezla should be under prescriptions because taking it carelessly without healthcare providers’ consent will only worsen ones diseases. It could lead to other adverse effects, such as interstitial lung disease, or liver toxicity.

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It is also possible to increase the risk of serious infections besides all the side effects Otezla causes, like depression, suicidal thoughts or behavior, weight loss, and drug interactions.

Further disadvantage of this drug is its cost. The wholesale acquisition cost (WAC) is USD1.875 (equals to IDR25.040.625) and the average wholesale price (AWP) is USD2.250 (equals to IDR30.006.000) for 60 tablets of 30 mg apremilast. While for 2-week starter apremilast, the WAC is USD843,75 (around IDR11.252.250) and the AWP is USD1.012,50 (around IDR13.502.700).

From the prolog in the first two paragraphs, we know that Otezla is extremely helpful in reducing the symptoms of psoriasis and active psoriatic arthritis in adults. But what else are the Otezla advantages? Do they outweigh the disadvantages or do they really worth the Otezla side effects?

Well, psoriasis is a chronic inflammatory disease that affects around up to 3% of the world population. It is taking up almost all the population of Indonesia, the fourth most populous country in the whole world.

While psoriatic arthritis is a disease that happens in around 30% of people with psoriasis. Patients with both diseases usually experience decreased functionality, quality of life, and productivity, highly potential in work absence and even long-term disability.

Now, with the right amount of dose, Otezla can help to overcome the possible disability ones have to undergo in the future because of psoriasis and psoriatic arthritis.

Otezla Side Effects In Comparison

Otezla Side Effects In Comparison
Otezla Side Effects In Comparison credit : Harpmagazine.com

Apparently, Otezla (apremilast) is not the only medication which is able in treating patients with psoriasis and psoriatic arthritis. There is also Stelara (ustekinumab) in comparison that is also can do the same. Let’s take a look at how these two drugs differ from each other.

People take Otezla by mouth as it forms an oral tablet, while Stelara should be injected. As these two are both specialty drugs to treat certain diseases, their cost are expensive. However, the estimated monthly cost for Stelara is a little bit higher than Otezla.

We’ve learned about Otezla side effects which include common and major ones. Stelara, like all drugs, has them as well. Their common side effects are pretty similar: headache and respiratory infections.

But instead of diarrhea, nausea, and weight loss that Otezla causes, Stelara affects in tiredness and nose or throat infections. Meanwhile, the major side effects of Stelara are allergic reaction with symptoms like wheezing, tightness in the throat, and trouble breathing. And also increase the risk of skin cancer.

How about their effectiveness in treating patients? When using the medicines with DMARD (disease-modifying anti-rheumatic drug) treatment, Otezla shows that more than one-third of patients have improvement by 20%, while Stelara shows that about one-half of patients have improvement by 20% and about one-fourth of patients have 50% improvement.


After all, this article aims to give the information about what Otezla side effects are and what it is good for. It is always in our sane mind to hopefully never get the chance to take any apremilast in our lifetime due to any reason. Let’s live a healthy life!




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