Apremilast

Apremilast is used to treat psoriatic arthritis (PsA). It is also used to treat psoriasis.

For treatment of PsA, apremilast may be used as alone or in combination with methotrexate (MTX) if there has been an inadequate response or intolerance to a prior DMARD treatment.

Apremilast is taken orally in pill form.

Apremilast is available in 10, 20 and 30 mg tablets.

The recommended dose is 30 mg twice daily: once in the morning and once in the evening. The tablets can be taken with or without food, but must be swallowed whole and not be crushed, split, or chewed.

When you begin taking apremilast the dose needs to be increased gradually. A starter package containing the 10, 20 and 30 mg tablets is required. You must follow the instructions on the starter package. The instructions will guide you through the dose increase and up to the recommended dose of 30 mg twice daily.

Apremilast inhibits an enzyme called phosphodiesterase-4, which breaks down chemical messengers in the body, these are communication modalities in the body to coordinate the immune system. When the enzyme is inhibited, less chemical messengers get broken down.

This leads to higher levels of a chemical messenger known as cyclic adenosine monophosphate. A higher level of this chemical messenger causes the body to turn down cellular signals that increase inflammation. Therefore, Apremilast helps to reduce inflammation, joint pain and tenderness and helps normalize skin in psoriasis.

Like all of the DMARDs, you will not feel the effects of apremilast right away. Some people begin to feel the effects of apremilast within a few weeks; however, it may take up to 4 months to feel the full effect. It is important to be patient and keep taking your medication.

To provide symptom relief while you are waiting for apremilast to take effect, your healthcare provider may recommend taking a steroid, such as prednisone or a non-steroidal anti-inflammatory drug (NSAID).

Lactose is a non-medical ingredient in apremilast, so the medication should not be used if you have galactose intolerance, Lapp lactose deficiency or glucose-galactose malabsorption. 

Currently apremilast has not been studied in pregnancy. Before starting apremilast, tell your healthcare provider if you are pregnant or planning to become pregnant. It is not known if apremilast passes into breast milk. Apremilast should not be used if you are breastfeeding/chestfeeding.  

Apremilast may worsen depression. Let your healthcare provider know if you experience worsening depression or thoughts of suicide while taking apremilast. 

People with a history of severe kidney disease should discuss the use of apremilast with their healthcare provider. You may require a lower dose of the medication.

Apremilast rarely can cause a fast heart rate and/or heart palpitations. Let your healthcare provider know if you have any heart conditions prior to taking apremilast. When taking apremilast report any increase in heart rate or palpitations while taking the medication.

Anyone who has had a previous allergic reaction to apremilast or any of the non-medical ingredients should avoid the medication.

Apremilast can interact with other medications you may be taking. Before starting apremilast, discuss this with your healthcare provider.

Like all medications, taking apremilast carries some risk of side effects, which must be balanced with the potential benefits. In general, the risk of joint damage and permanent disability (resulting from arthritis) is much greater than the risks of side effects from apremilast. When monitored properly the vast majority of side effects are rare, most improve over time and are reversible.

Apremilast can cause significant weight loss in some patients. Let your healthcare provider know if you start to experience weight loss while taking the medication.

Other common side effects you may experience while taking apremilast include nausea, stomach pain and diarrhea. Patients have also reported experiencing nasal congestion and sore throat (e.g., the common cold), flu-like symptoms (body aches and pains, tiredness, or fever), and headaches. Talk to your healthcare provider if any of these symptoms affect you severely.

Take your apremilast as prescribed and contact your healthcare provider if you have any concerns while taking the medication.

To avoid stomach symptoms, the dose of apremilast is gradually increased once you start the medication. Regular dosing is than divided twice daily.

Your healthcare provider will regularly monitor your weight once you start apremilast.  This is important to ensure apremilast is not causing too much weight loss.

Prior to starting apremilast your healthcare provider may order a blood test to assess your kidney function.

Blood tests are not routinely required while you are talking apremilast. Your healthcare provider may order periodic blood tests to check your blood count and follow the activity of your arthritis.

Store this medication at room temperature (15 to 30 degrees Celsius) and keep it out of reach of children.