Key takeaways

  • Otezla is a brand-name oral drug prescribed for plaque psoriasis, psoriatic arthritis, and ulcers in certain people.
  • Otezla contains the active ingredient apremilast and belongs to the disease-modifying antirheumatics drug class.
  • Otezla is available as an oral tablet and extended-release oral tablet under the name Otezla XR. It is typically taken once or twice daily.

The Food and Drug Administration (FDA) has approved Otezla to treat:

Drug details

You’ll find key information about Otezla below.

  • Drug form: oral tablet and extended-release (ER) oral tablet
  • Generic available? no
  • Prescription required? yes
  • Controlled substance? no

As with all medications, the cost of Otezla can vary. The actual price you’ll pay depends on your insurance plan, your location, and the pharmacy you use.

Before approving coverage for Otezla, your insurance company may require you to get prior authorization. This means that your doctor and insurance company will need to communicate about your prescription before the insurance company will cover the drug. The insurance company will review the prior authorization request and decide whether the drug will be covered.

If you’re not sure whether you’ll need to get prior authorization for Otezla, contact your insurance company or talk with your pharmacist.

Financial and insurance assistance: If you need financial support to pay for Otezla, or if you need help understanding your insurance coverage, help is available.

Amgen, the manufacturer of Otezla, offers a copay card that may reduce the cost of Otezla. The manufacturer also has a program called Amgen SupportPlus, which may assist you in finding ways to lower the cost of Otezla. For more information and to find out if you’re eligible for support, call 844-468-3952.

Generic version: Otezla is not available in a generic form. A generic drug is an exact copy of the active drug in a brand-name medication. Generics tend to cost less than brand-name drugs.

Otezla contains the drug apremilast. It’s not available as a generic drug. Apremilast is only available as Otezla and Otezla XR.

A generic drug is an exact copy of the active drug in a brand-name medication. Generics usually cost less than brand-name drugs.

Otezla can cause mild or serious side effects. The following list contains some of the key side effects that may occur while taking Otezla. This list doesn’t include all possible side effects.

For more information on the possible side effects of Otezla or for tips on managing a troubling side effect, talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. Sharing your experience helps make medications safer for everyone by giving doctors and researchers more information about how the drug works in real life. If you develop a side effect while taking Otezla and want to tell the FDA about it, visit MedWatch or call 800-FDA-1088.

More common side effects

The following list includes some mild side effects from Otezla. To learn about other mild side effects, talk with your doctor or pharmacist or visit Otezla’s prescribing information.

The more common side effects of Otezla include:

Most of these effects may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 or your local emergency number if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

ALLERGIC REACTION

For some people, Otezla can cause an allergic reaction.

This side effect wasn’t reported in the drug’s studies but has occurred since the drug was approved.

In general, symptoms of an allergic reaction can be mild or serious.

Ways to manage

For mild allergic reaction symptoms, such as a mild rash, call your doctor right away. They may recommend treatments to help manage your symptoms. They’ll also let you know whether you should keep taking the medication.

For severe allergic reaction symptoms, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms require immediate medical care because they can become life threatening. If you’ve had a serious allergic reaction to Otezla, your doctor may recommend a different medication instead.

Side effects in children

The FDA has approved Otezla to treat active PsA and severe plaque psoriasis in certain children ages 6 years and older. In clinical studies of Otezla, side effects reported by children were very similar to side effects reported by adults with plaque psoriasis.

However, during treatment with Otezla, your child’s doctor will likely monitor their body weight and height for unexpected changes. This is because weight loss is a possible side effect of Otezla. If your child experiences growth changes while taking Otezla, their doctor may recommend that they stop taking the drug. But do not make any changes to your child’s treatment plan without first talking with their doctor.

For more information about side effects of Otezla in children, talk with your child’s doctor.

The Food and Drug Administration (FDA) approves prescription drugs such as Otezla to treat certain conditions.

Otezla is FDA approved to treat three conditions:

People with plaque psoriasis and PsA often take Otezla in combination with other medications such as methotrexate (Otrexup, Rasuvo, Trexall, others), sulfasalazine (Azulfidine), leflunomide (Arava), or others.

Otezla for PsA

Otezla is approved to treat active PsA in adults and children. PsA is a condition that involves the swollen, sore joints of arthritis and the skin lesions of psoriasis. Skin lesions due to psoriasis are usually itchy, discolored patches. Sometimes, the lesions can affect your scalp.

For more information about your condition, you can visit our arthritis hub.

Otezla for plaque psoriasis

Otezla is approved to treat plaque psoriasis in certain adults and children. Specifically, it can be used in people who are candidates for phototherapy (light therapy) or systemic therapy (treatment that affects the entire body).

Plaque psoriasis is the most common form of psoriasis. It’s characterized by thick discolored patches of skin that often have a silver or white scaly layer.

To learn about Otezla for use in children with plaque psoriasis, see the following “Otezla and children” section.

For more information about your condition, you can visit our psoriasis hub.

Otezla for mouth ulcers caused by Behçet’s disease

Otezla is approved to treat mouth ulcers that occur with Behçet’s disease.

Behçet’s disease is an autoimmune disease. It causes damage to certain blood vessels that can lead to sores in your mouth, rashes, and other symptoms.

Otezla and children

Otezla is approved to treat active PsA and moderate to severe plaque psoriasis in certain children ages 6 years and older who weigh at least 20 kilograms (kg), or about 44 pounds (lb). Specifically, it’s approved for children with this condition who are candidates for phototherapy (light therapy) or systemic therapy (treatment that affects the entire body).

Otezla XR is also approved for the same conditions as Otezla in certain children ages 6 years and older. But, Otezla XR is used in children who weigh at least 50 kg, or about 110 lb.

For more information about Otezla treatment for children, talk with your child’s doctor.

Alcohol is not known to interact with Otezla. However, drinking alcohol, especially in large amounts, while taking Otezla might add to or worsen some side effects from Otezla.

Worsened side effects can include diarrhea, nausea, vomiting, headache, and fatigue.

If you have questions about the safety of drinking alcohol while taking Otezla, talk with your doctor or pharmacist.

Otezla can interact with several medications. It can also interact with certain supplements.

Before taking Otezla, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use. Sharing this information can help you avoid potential interactions.

Otezla and other medications

Below is a list of medications that can interact with Otezla. This list doesn’t contain all drugs that may interact with Otezla.

Different drug interactions can cause different effects. For instance, some can interfere with how well a drug works, while others can cause increased side effects.

If you have questions about drug interactions that may affect you, ask your doctor or pharmacist.

Drug metabolism inducers

Several medications can make an enzyme (a type of protein) called cytochrome P450 3A4 more active in your body. Taking these drugs with Otezla can cause your body to metabolize (get rid of) Otezla more quickly than usual. It can also make Otezla less effective.

Examples of these medications include:

Herbs and supplements

Herbs and supplements can sometimes interact with medications.

St. John’s wort

St. John’s wort can make an enzyme called cytochrome P450 3A4 more active in your body. Because of this, taking St. John’s wort with Otezla can cause your body to get rid of Otezla more quickly than usual. This can make Otezla less effective.

Here are answers to some frequently asked questions about Otezla.

Does Otezla cause hair loss?

Hair loss is not a side effect that’s been found in clinical studies of Otezla. However, some people have experienced hair loss while taking Otezla. It’s not clear if Otezla is the cause.

Psoriasis, especially scalp psoriasis, can cause hair loss.

Is Otezla an anti-inflammatory drug?

No, Otezla is not classified as an anti-inflammatory drug. Although it does reduce inflammation, Otezla does not belong to the class of drugs called anti-inflammatories.

Is Otezla an immunosuppressant?

Yes, Otezla is an immunosuppressant. This means the drug lowers (suppresses) the activity of your immune system. Specifically, Otezla works by reducing inflammation due to an overactive immune system.

How does Otezla cause weight loss?

Many people who take Otezla lose weight. There may be several factors that lead to Otezla-related weight loss.

Otezla blocks an enzyme called phosphodiesterase-4 (PDE4). In addition to its effects on inflammation, this enzyme is involved in energy metabolism. In a 2021 study, people treated with apremilast (the active ingredient in Otezla) experienced weight loss specifically by loss of their subcutaneous abdominal fat.

Also, some people who take Otezla may have a reduced appetite or diarrhea as a side effect. These effects might also cause weight loss.

I’ve heard that Otezla causes a lot of nausea and vomiting. How can I prevent this?

Yes, many people who take Otezla can have some nausea or vomiting. This will most likely occur in the first 2 weeks of taking the medication. For most people, it’s not severe, and it often goes away with continued use of the drug.

If your nausea doesn’t go away or becomes severe, talk with your doctor. To help prevent nausea and vomiting, your doctor may lower your dosage of Otezla. If this doesn’t help, your doctor may recommend stopping Otezla and trying a different treatment.

When you start taking Otezla, your doctor will gradually increase your dosage until you reach the standard dose. Your doctor may follow a specific schedule that the drug manufacturer recommends.

The following information describes the dosages that are commonly used or recommended. However, be sure to take the dosage your doctor prescribes for you.

Forms and strengths

Otezla comes as tablets that you take by mouth. It’s available in the following strengths: 10 milligrams (mg), 20 mg, and 30 mg.

Otezla XR comes as an extended-release (ER) oral tablet. It’s available in one strength of 75 mg.

Dosage for psoriatic arthritis, plaque psoriasis, and Behçet’s disease

When you first start taking Otezla, your doctor will likely increase your dosage gradually over 5 days. This is to help reduce gastrointestinal (GI) symptoms.

The adult dosing schedule for Otezla is as follows:

Day of treatmentDosage
Day 1Morning: 10 mg
Day 2Morning: 10 mg
Evening: 10 mg
Day 3Morning: 10 mg
Evening: 20 mg
Day 4Morning: 20 mg
Evening: 20 mg
Day 5Morning: 20 mg
Evening: 30 mg

On Day 6 and after, you will either take Otezla 30 mg twice per day, in the morning and evening, or Otezla XR 75 mg once per day.

Children’s dosage

Otezla’s dosage for children ages 6 years and older with PsA and plaque psoriasis will be determined by their weight. When a child first starts taking Otezla, their doctor will likely increase the dosage gradually over 5 days. This is to help reduce gastrointestinal (GI) symptoms.

The children’s dosing schedule for Otezla is as follows:

Day of treatmentDosage for children who weigh 20 to less than 50 kgDosage for children who weigh 50 kg or more
Day 1Morning dose: 10 mg
Evening dose: none		Morning dose: 10 mg
Evening dose: none
Day 2Morning dose: 10 mg
Evening dose: 10 mg		Morning dose: 10 mg
Evening dose: 10 mg
Day 3Morning dose: 10 mg
Evening dose: 20 mg		Morning dose: 10 mg
Evening dose: 20 mg
Day 4Morning dose: 20 mg
Evening dose: 20 mg		Morning dose: 20 mg
Evening dose: 20 mg
Day 5Morning dose: 20 mg
Evening dose: 20 mg		Morning dose: 20 mg
Evening dose: 30 mg

On Day 6 and after, children who weigh 20 to less than 50 kg will take Otezla 20 mg twice per day, in the morning and evening. For children who weigh 50 kg or more, on day 6 and after they will take either Otezla 30 mg twice per day, in the morning and evening, or Otezla XR 75 mg once per day.

About taking Otezla

You’ll find information about key dosage issues here:

  • When to take: It is best to try to take the drug around the same time each day. Taking the medication around the same time of day helps keep a steady level of the drug in your body. This helps Otezla work effectively.
  • If you miss a dose: If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, just take that one dose. Don’t try to catch up by taking two doses at once.
  • Taking Otezla with food: You can take Otezla on an empty stomach or with food.
  • Crushing, splitting, or chewing Otezla: You should swallow Otezla and Otezla XR tablets whole. Do not crush, split, or chew them.
  • Length of use: Otezla is meant to be a long-term treatment. If you and your doctor determine that Otezla is safe and effective for you, you’ll likely take it long term.

Overdose

Taking too much of this medication can increase your risk for serious side effects.

Overdose symptoms

Symptoms of an overdose of Otezla may include:

  • severe diarrhea, nausea, and vomiting
  • headache
  • fatigue
  • dizziness

What to do in case of overdose

If you think you’ve taken too much of this drug, call your doctor. You can also call America’s Poison Centers at 800-222-1222 or use its online tool. However, if your symptoms are severe, call 911 or your local emergency number or go to the nearest emergency room right away.

Several types of drugs can treat psoriasis, Psoriatic arthritis (PsA, and Behçet’s disease, which are the conditions Otezla is approved to treat.

Note: Some of the drugs in the following list are used off-label to treat these specific conditions. Off-label use is when a drug that’s approved to treat one condition is used to treat a different condition.

Other DMARDs

Otezla belongs to a class of medications called disease-modifying antirheumatic drugs (DMARDs). Other DMARDs that treat psoriasis, psoriatic arthritis, or Behçet’s disease include:

Medications from other drug classes

Medications in other drug classes may also be used as alternatives to Otezla for certain diseases. Examples of these drugs include:

  • retinoids for psoriasis, PsA, or Behçet’s disease, such as:
    • acitretin
    • isotretinoin (Absorica, Amnesteem, Claravis, others)
  • immunosuppressants for psoriasis, psoriatic arthritis, or Behçet’s disease, such as:
  • biologics for psoriasis or psoriatic arthritis, such as:

Herbs and supplements

Some people also use herbs and dietary supplements as a remedy for psoriasis, PsA, or Behçet’s disease. Examples of these supplements include:

Be sure to talk with your doctor before trying any herb or dietary supplement as a remedy psoriasis or PsA. For most of these supplements, either there’s very little research showing that they work, or research findings are inconsistent.

Otezla vs. Humira

You may wonder how Otezla compares with other medications that are prescribed for similar uses. For example, find out how Otezla compares to Humira.

If you can become pregnant, are breastfeeding, or are using birth control, it’s important to consider whether Otezla is a safe choice for you.

You can refer to this article for more information. If you have additional questions, talk with your doctor.

Otezla and biologic medications can both be used to treat psoriasis and psoriatic arthritis. But keep in mind that Otezla isn’t a biologic.

Biologics are drugs that are made from living organisms, such as immune system cells. Otezla, however, is made from chemicals (as many drugs are).

Otezla is an immunosuppressant drug that works by lowering (suppressing) the activity of your immune system.

Here are some points to consider when comparing Otezla to biologic drugs:

  • In some instances, biologic drugs may carry more risks of potentially serious side effects.
  • Biologic drugs are often more expensive than Otezla. This is because biologics typically cost more to research and manufacture than traditional drugs such as Otezla.
  • Otezla is a tablet that you take by mouth. Biologic therapies are all given by injection.

Keep in mind that your doctor will make treatment choices based on your individual needs. They’ll consider several factors, such as your age, other conditions you may have, your risk for side effects, and the severity of your condition.

There are various types of biologic therapies. Examples include:

Biologics are medications that can be made from sugars, proteins, or nucleic acids, or from microorganisms, tissues, or cells. Traditional drugs are usually made from chemicals or plants.

Otezla works in a unique way compared to other medications that treat plaque psoriasis, psoriatic arthritis (PsA), or Behçet’s disease. It blocks an enzyme called phosphodiesterase-4 (PDE4), which is found in immune cells.

By blocking this enzyme, Otezla decreases the body’s production of inflammatory molecules. The actions of these molecules can lead to the symptoms of plaque psoriasis, PsA, and Behçet’s disease. Therefore, decreasing their production helps reduce symptoms.

I’ve always used creams for my psoriasis. How does a pill help treat my psoriasis?

When you apply creams and other medications to your skin, your skin absorbs the medication. They reduce inflammation and excessive cell growth in the area around where you apply the medication. These drugs are usually the first medications that doctors recommend to treat psoriasis.

Pills for psoriasis work from the inside out. They work throughout the body by blocking the body’s production of chemical messengers that cause inflammation and cell overgrowth on the skin.

Before taking Otezla, talk with your doctor about any medical conditions you have. Otezla may not be appropriate for you if you have certain medical conditions. These include:

  • Depression: Depressed mood can occur in some people who take Otezla. Some people experience thoughts of suicide while taking Otezla. Although this isn’t common, it may be more likely in people who have had depression in the past.
  • Kidney problems: If you have kidney problems, you may need to take a lower dosage of Otezla.
  • Allergic reaction: If you’ve had an allergic reaction while taking Otezla or to any of its ingredients, you should not take Otezla. Your doctor can recommend another drug that can treat your condition.
  • Pregnancy: If you’re planning a pregnancy or can become pregnant, talk with your doctor before taking this medication. For more information, see this article on pregnancy, breastfeeding, and birth control.
  • Breastfeeding: If you’re breastfeeding or are planning to do so, talk with your doctor before taking this medication. For more information, see this article on pregnancy, breastfeeding, and birth control.

Note: For more information about the potential negative effects of Otezla, see the “Otezla side effects” section.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

  • Call or text the 988 Lifeline at 988 or chat at 988lifeline.org. Caring counselors are available to listen and provide free and confidential support 24/7.
  • Text HOME to the Crisis Text Line at 741741 to connect with a volunteer crisis counselor for free and confidential support 24/7.
  • Not in the United States? Find a helpline in your country with Befrienders Worldwide.
  • Call 911 or your local emergency services number if you feel safe to do so.

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you’re not in the same household, stay on the phone with them until help arrives.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.