What is Otezla?
Otezla is a pill we use most often for psoriatic arthritis — the joint disease that can come with psoriasis. Its generic name is apremilast. It’s also approved for plaque psoriasis, so it can help the skin and the joints together.
Otezla is a PDE4 inhibitor. PDE4 (phosphodiesterase-4) is an enzyme inside your immune cells that turns up inflammatory signals. By blocking it, Otezla dials those signals down. Importantly, it does this without broadly suppressing your immune system — which is why it needs less screening and monitoring than many of our other medications.
Otezla and Otezla XR — the two forms
Otezla comes in two forms:
- Otezla — a 30 mg tablet taken twice a day.
- Otezla XR — an extended-release 75 mg tablet taken once a day, for the convenience of a single daily dose.
Both reach the same maintenance level. Take either with or without food, and swallow tablets whole — don’t crush, split, or chew them (especially the XR form).
How to take it — the starter pack
Otezla begins with a 5-day “starter pack” that steps the dose up gradually before you reach the full maintenance dose on Day 6. This slow ramp-up matters: starting at the full dose causes far more stomach upset. Follow the pack day by day as labeled.
What to expect when starting
The most common early side effects are diarrhea, nausea, and headache. These usually show up in the first 2 weeks and often fade by around 4 weeks as your body adjusts — the starter pack is designed to soften them. Let us know if they’re severe or aren’t settling.
Improvement in your joints and skin is gradual, typically over the first 16 weeks.
No blood-test monitoring or TB test needed
This is one of Otezla’s biggest practical advantages. Because it doesn’t broadly suppress the immune system, Otezla does not require tuberculosis screening before starting, and does not require routine blood-test monitoring while you take it. For many patients, that means fewer lab visits than with other options.
Side effects to watch for
Contact us if you experience:
- Diarrhea or nausea that is severe or persists beyond the first few weeks.
- Unexplained weight loss. Otezla can cause weight loss in some patients — weigh yourself periodically and tell us if you’re dropping weight without trying.
- Headache that is bothersome or ongoing.
Important: Otezla can occasionally cause new or worsening depression or mood changes. Tell us right away about new sadness, hopelessness, or any thoughts of harming yourself — this is uncommon but we take it seriously. Let us know before starting if you have a history of depression.
Otezla for mouth ulcers
Otezla is also helpful for painful recurrent mouth ulcers (aphthous ulcers). It is FDA-approved for the oral ulcers of Behçet’s disease, and is sometimes used off-label for other recurrent canker sores. If mouth ulcers are part of your picture, ask us whether Otezla might help.
Things to avoid
- Certain strong medications that speed up drug metabolism — such as rifampin, some seizure medications, and the supplement St. John’s wort — can make Otezla much less effective. Tell us and your pharmacist about everything you take, including supplements.
- Pregnancy — there isn’t enough safety data to consider Otezla safe in pregnancy. Tell us early if you’re pregnant or planning to be so we can plan.
- Otezla is gentle on the immune system, so infections and vaccines are much less of a concern than with our stronger medications. Still, check with us before any live vaccine.
Frequently asked questions
Why do I feel nauseated or have diarrhea when I start? This is Otezla’s most common early effect and comes from how it acts on the gut. It usually eases within the first few weeks, and the starter pack is designed to blunt it. Taking each dose consistently helps.
Do I really not need blood tests? Correct — Otezla does not require the routine lab monitoring or TB screening that many of our other medications do. It’s one of the reasons it’s an appealing option for the right patient.
What if I miss a dose? Take it when you remember, unless it’s nearly time for the next dose — then skip the missed one. Never double up.
How long will I take it? Often long-term, as long as it’s controlling your symptoms and you’re tolerating it well. We’ll reassess as part of your ongoing care.
This handout is provided for educational purposes and does not replace individualized medical advice. Always follow the specific instructions given by your rheumatologist.