Apremilast

About Apremilast

Apremilast blocks phosphodiesterase 4 (PDE4), an enzyme inside cells, raising levels of a messenger called cAMP; exactly how this eases the diseases it treats is not well understood. The label covers active psoriatic arthritis in adults and in children 6 and older weighing at least 20 kg; plaque psoriasis in adults who are candidates for light therapy or systemic treatment, and moderate to severe plaque psoriasis in children of that age and weight; and oral ulcers of Behçet’s disease in adults. The dose rises over five days from 10 mg to the usual 30 mg twice a day (20 mg twice a day for children under 50 kg). Otezla XR, approved in August 2025, gives 75 mg once a day to adults and to children of at least 50 kg after the step-up. In severe kidney impairment the dose is taken once a day and Otezla XR is not recommended.

There is no boxed warning. The label warns of allergic reactions, including swelling of the face and throat (angioedema) and anaphylaxis; of severe diarrhea, nausea and vomiting, mostly in the first few weeks, which can call for a lower dose or a pause, with extra care in people 65 and older and in those taking medicines that can cause dehydration or low blood pressure; of depression and suicidal thoughts, so mood changes are reported and a history of depression is weighed before starting; and of weight loss, so weight is checked regularly and a child’s growth is monitored. Diarrhea, nausea, headache and upper respiratory infections are the most common side effects.

The 28-day starter packs step up to 30 mg or 20 mg twice a day, or on to Otezla XR; later fills are bottles of the maintenance strength. Switching between the twice-daily tablet and Otezla XR is the prescriber’s decision. Strong enzyme inducers such as rifampin can make it ineffective. Human pregnancy data are limited, animal studies showed pregnancy loss at high doses, and it is not known whether it passes into breast milk.

Taking Apremilast

How to take it

Follow the starter pack day by day as the dose rises, then take the maintenance dose: usually one tablet twice a day, or one Otezla XR tablet once a day. Take it with or without food and swallow the tablets whole; do not crush, split or chew them. The empty shell of an Otezla XR tablet can appear in the stool after the medicine has been absorbed.

If you miss a dose

The prescribing information gives no missed-dose rule. Patient guidance is to take it when you remember unless the next dose is nearly due, then skip it, and never to take two doses at once; ask the pharmacist if unsure.

Storage

Otezla tablets below 86°F (30°C); Otezla XR at room temperature, 68 to 77°F (20 to 25°C); both out of reach of children.

Interactions to know about

Rifampin, phenobarbital, carbamazepine, phenytoin and other strong enzyme inducers lower its levels and can make it stop working, so they are not recommended with it. No meaningful interaction was found with ketoconazole, methotrexate or a birth control pill containing ethinyl estradiol and norgestimate. Tell the prescriber about depression, kidney disease, pregnancy or breastfeeding.

This summarizes the official prescribing information. Your prescriber’s and pharmacist’s instructions, and the leaflet that comes with your medicine, take priority.

Why the cash price for Apremilast differs from pharmacy to pharmacy

Apremilast is priced as a brand, so a cash quote is mostly the pharmacy’s cost for Amgen’s product plus its markup and fee; the spread between pharmacies comes from that markup and from whether the pharmacy stocks it or orders it in. The starter pack is priced as one item; after it, Otezla comes in bottles of 60 tablets and Otezla XR in bottles of 30, each a month at the usual dose. Otezla XR is a separate product the pharmacy cannot substitute for the twice-daily tablet, so a quote is for exactly what is written; once generic tablets reach pharmacies, they can replace Otezla tablets but not Otezla XR.

Ways to pay less for Apremilast without insurance

• Ask Amgen whether its savings or patient assistance program applies to someone paying cash; many brand savings cards require commercial insurance.
• Ask the pharmacy whether generic apremilast tablets have reached the market yet.
• Compare quotes from more than one pharmacy, and confirm the starter pack or your strength is in stock before the prescription is sent.
• Once your dose is stable, ask the pharmacy to quote a ninety-day supply as well as a month.
• If cost is a barrier, ask the prescriber whether an older generic such as methotrexate, or a topical treatment, would suit your psoriasis.
• Upload the prescription to Script Unlock so licensed pharmacies can quote their cash price. You pay the pharmacy directly.

Questions to ask your pharmacist about Apremilast

1. 1.How do I follow the starter pack, and what comes after it?
2. 2.What should I do if diarrhea, nausea or vomiting is severe?
3. 3.Do any of my medicines, such as rifampin or seizure medicines, weaken it?
4. 4.Is my dose right for my kidney function, and would Otezla XR suit me?

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