Otezla (apremilast)

What it is

Otezla (apremilast) is a pill that blocks an enzyme called PDE4, which is involved in inflammation inside cells. Lowering this enzyme’s activity reduces inflammation in the joints and skin. It treats psoriatic arthritis and plaque psoriasis (and mouth ulcers of Behçet’s disease). It is not a biologic and does not work like one — it gently turns down several inflammatory signals at once rather than switching one off completely — and it is often chosen by patients who prefer a pill to an injection.

Before starting

Before starting, we check kidney function with a blood test, because the dose is reduced if the kidneys work slowly — the medicine is cleared through the kidneys, and the lower dose keeps levels in the right range. We also note your weight, because some patients lose a modest amount of weight on Otezla and we follow it over time. One genuine advantage: Otezla does not require tuberculosis screening or routine lab monitoring during treatment, which many patients find reassuring. Tell us about your other medicines — a few (such as certain seizure medicines and rifampin) can make Otezla less effective by clearing it too fast.

How it’s given

It is a tablet taken by mouth twice a day, morning and evening, with or without food. The dose is increased slowly over the first week using a starter pack — this gradual build-up is there because starting at full dose causes stomach upset in many people, while stepping up lets your body adjust. Swallow tablets whole; do not crush or split them. Once you reach the full dose, simply continue twice daily.

What to expect

Joint and skin improvement builds over the first 3–4 months; results are usually judged around 4 months. The most common side effects happen early: loose stools or diarrhoea, nausea, and headache. For most people these ease within the first few weeks as the body adjusts — that is exactly what the slow starter week is designed for. Some people lose a little weight over time; tell us if weight loss is more than modest. A small number of people notice low mood on Otezla — if your mood changes noticeably, tell us so we can help and review whether the medicine still suits you.

Everyday guidance

If stomach upset is troublesome in the first weeks, taking doses with a small amount of food often helps. If you miss a dose, take it when you remember, unless the next dose is near — then skip and continue as normal. Keep taking Otezla even when joints and skin feel good; stopping lets inflammation return. Because no routine labs are needed, your follow-up visits focus on how you are actually doing — joints, skin, weight, and mood. Questions or side effects that are not settling: call (361) 400-7700.