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Otezla
Otezla (generic name: apremilast) is an oral medication used to treat certain chronic inflammatory conditions such as psoriasis, psoriatic arthritis, and oral ulcers associated with Behçet’s disease. It is classified as a phosphodiesterase-4 (PDE-4) inhibitor, which helps reduce inflammation by regulating immune responses. Otezla is particularly effective in reducing the symptoms of moderate to severe plaque psoriasis and improving joint function in psoriatic arthritis. It is not an immunosuppressant and does not require lab monitoring like some other treatments for these conditions.
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Frequently Asked Questions
How long does it take for Otezla to work?
It may take several weeks for Otezla to begin reducing symptoms. Some patients may notice improvement in 2 to 4 weeks, but it can take up to 16 weeks to see the full benefits.
Can I drink alcohol while taking Otezla?
There are no specific interactions between alcohol and Otezla. However, drinking alcohol may worsen gastrointestinal side effects like nausea or diarrhea in some patients.
Is weight loss common with Otezla?
Yes, weight loss is a common side effect of Otezla. If you experience significant weight loss, contact your healthcare provider.
Can Otezla be taken with other medications for psoriasis or psoriatic arthritis?
Otezla can sometimes be used in combination with other treatments, but this should be done under close supervision by a healthcare provider to monitor for potential interactions.
Can Otezla be used for long-term treatment?
Yes, Otezla is often used for long-term management of psoriasis and psoriatic arthritis. Regular follow-ups with your healthcare provider are recommended to monitor your response to treatment.
Comprehensive Drug Guide
How Does Otezla Work?
Otezla works by inhibiting phosphodiesterase-4 (PDE-4), an enzyme involved in the production of inflammatory mediators such as tumor necrosis factor-alpha (TNF-α) and interleukin-23 (IL-23). By blocking PDE-4, Otezla helps reduce the overactive immune response that leads to inflammation, helping to alleviate the symptoms of psoriasis, psoriatic arthritis, and oral ulcers associated with Behçet’s disease.
Common Dosages
- 10 mg, 20 mg, and 30 mg tablets.
Typical Dosing
- Initial titration: Otezla is started with a titration schedule to reduce the risk of gastrointestinal side effects.
- Day 1: 10 mg once daily
- Day 2: 10 mg in the morning, 10 mg in the evening
- Day 3: 10 mg in the morning, 20 mg in the evening
- Day 4: 20 mg twice daily
- Day 5: 20 mg in the morning, 30 mg in the evening
- Day 6 and beyond: 30 mg twice daily (morning and evening)
- Maintenance dose: 30 mg twice daily, taken with or without food.
Typical Dosing
FDA Approved Indications
- Moderate to severe plaque psoriasis in adults.
- Active psoriatic arthritis in adults.
- Oral ulcers associated with Behçet’s disease.
Who Shouldn't Take Otezla?
- Known hypersensitivity to apremilast or any component of the formulation.
- Severe renal impairment, as dose adjustments are necessary for these patients.
Advice From The Pharmacist
- Take Otezla twice daily, following the titration schedule to reduce the likelihood of nausea or diarrhea.
- You can take Otezla with or without food.
- Store Otezla at room temperature away from moisture and heat.
- If you miss a dose, take it as soon as you remember, unless it is almost time for your next dose. Do not take two doses at once to make up for a missed dose.
- Be aware that Otezla may cause weight loss in some patients, and this should be monitored by your healthcare provider.
Side Effects of Otezla
Common Side Effects
- Nausea
- Diarrhea
- Headache
- Upper respiratory infections
- Weight loss
Uncommon/Severe Side Effects
- Depression or suicidal thoughts.
- Severe weight loss, particularly in patients with pre-existing conditions such as anorexia.
- Allergic reactions (rash, itching, swelling, difficulty breathing).
Risks and Warnings of Otezla
- Depression and Suicidal Thoughts: Otezla has been associated with mood changes, including depression and suicidal thoughts. Patients with a history of mental health conditions should be monitored closely.
- Weight Loss: Some patients may experience unintentional weight loss. Weight should be monitored during treatment, and any significant weight loss should be reported to your healthcare provider.
- Severe Diarrhea or Vomiting: These gastrointestinal side effects are more common during the initial dose titration phase but should decrease over time. Contact your doctor if these symptoms persist or become severe.
Interactions with Otezla
Common Drug Interactions
- CYP450 inducers (e.g., rifampin, carbamazepine): These drugs can reduce the effectiveness of Otezla by increasing its metabolism, making it less effective.
- Other immunosuppressants or biologics: Caution should be used if combining Otezla with other immunomodulating therapies, as this may increase the risk of adverse effects.
Alternatives to Otezla
- Methotrexate: A disease-modifying antirheumatic drug (DMARD) used for psoriasis and psoriatic arthritis.
- Humira (adalimumab): A biologic therapy used for treating psoriasis and psoriatic arthritis, targeting TNF-α.
- Stelara (ustekinumab): A biologic that targets IL-12 and IL-23 to treat psoriasis and psoriatic arthritis.
- Cosentyx (secukinumab): Another biologic used to treat psoriasis and psoriatic arthritis by targeting IL-17A.
