Apemilast

Indications

Apremilast is a tablet used to treat adults with moderate to severe plaque psoriasis (thick, scaly red patches on the skin), psoriatic arthritis (joint inflammation linked to psoriasis) and mouth ulcers caused by Behcet's disease. It is usually prescribed by a skin or joint specialist.

How It Works

Apremilast blocks an enzyme called phosphodiesterase 4 (PDE4) inside immune cells. This raises a messenger molecule called cyclic AMP, which calms the overactive immune response and reduces the inflammatory signals that cause skin plaques, joint pain and ulcers.

Dosage and Administration

Treatment is started slowly over the first 5 days to reduce stomach side effects, then continued at the usual dose of 30 mg twice daily, as prescribed by your doctor. Starter packs and 10 mg tablets are used for this build-up. People with severe kidney disease usually need a lower dose. Swallow tablets whole, with or without food, about 12 hours apart. Do not stop without talking to your doctor.

Interactions

Strong enzyme inducers such as Rifampicin, Carbamazepine, Phenytoin and Phenobarbital can lower Apremilast levels and make it less effective, so these combinations are not recommended. Tell your doctor about all medicines, including herbal products such as St John's Wort.

Contraindications

Do not take if you are allergic to Apremilast or any tablet ingredient, or if you are pregnant. Not for people with rare hereditary problems of galactose intolerance, as tablets contain lactose.

Side Effects

• Diarrhoea, nausea and vomiting, mostly in the first weeks
• Headache
• Upper respiratory infections such as a cold
• Weight loss and reduced appetite
• Tiredness and difficulty sleeping
• Low mood or depression

Get urgent medical help if you have severe or persistent diarrhoea or vomiting, especially in older people, thoughts of self-harm or suicide, worsening depression, or signs of a severe allergic reaction such as swelling of the face or difficulty breathing.

Pregnancy and Lactation

Apremilast must not be used during pregnancy. Women who can become pregnant should use effective contraception during treatment. It is not recommended during breastfeeding.

Precautions and Warnings

Tell your doctor if you have a history of depression or suicidal thoughts, as these can worsen. Your weight should be checked regularly; report unexplained weight loss. Older people and those with low body weight are more prone to severe stomach side effects and dehydration. Take extra care if you have severe kidney problems.

Overdose

Taking too many tablets may cause more severe stomach upset, headache and dizziness. Contact a doctor or go to hospital; treatment is supportive.

Therapeutic Class

Immunomodulator, phosphodiesterase 4 (PDE4) inhibitor.

Storage

Store below 30°C in a dry place, away from light and out of the reach of children.