How does this medication work? What will it do for me?
Apremilast belongs to the class of medications called immunosuppressants. It is used to treat adults with moderate-to-severe plaque psoriasis who may respond to phototherapy or systemic therapy. It may also be used to treat adults with psoriatic arthritis who cannot use other disease-modifying treatments, or have tried other treatments which were either not effective, or not well-tolerated.
Plaque psoriasis is a non-contagious skin condition in which parts of the immune system become active, causing inflammation. Psoriatic arthritis is an autoimmune illness which causes joint inflammation. This medication works by reducing the activity of a chemical produced in the body that causes this inflammation.
Apremilast is also used to treat mouth ulcers associated with Behcet's disease. Behcet's disease is a rare autoimmune disorder which causes blood vessel inflammation resulting in mouth sores, rashes, and other symptoms throughout the body.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
What form(s) does this medication come in?
Each pink, diamond-shaped, film-coated tablet, engraved with "APR" on one side and "10" on the other, contains 10 mg of apremilast. Nonmedicinal ingredients: microcrystalline cellulose, lactose monohydrate, croscarmellose sodium, magnesium stearate, polyvinyl alcohol, titanium dioxide, polyethylene glycol, talc, and iron oxide red.
Each brown, diamond-shaped, film-coated tablet, engraved with "APR" on one side and "20" on the other, contains 20 mg of apremilast. Nonmedicinal ingredients: microcrystalline cellulose, lactose monohydrate, croscarmellose sodium, magnesium stearate, polyvinyl alcohol, titanium dioxide, polyethylene glycol, talc, iron oxide red, and iron oxide yellow.
Each beige, diamond-shaped, film-coated tablet, engraved with "APR" on one side and "30" on the other, contains 30 mg of apremilast. Nonmedicinal ingredients: microcrystalline cellulose, lactose monohydrate, croscarmellose sodium, magnesium stearate, polyvinyl alcohol, titanium dioxide, polyethylene glycol, talc, iron oxide red, iron oxide yellow, and iron oxide black.
How should I use this medication?
The starting dose of apremilast is 10 mg daily on the first day, then 10 mg taken in the morning and again in the evening on the second day. The dose is increased by 10 mg each day until the recommended adult dose of 30 mg taken by mouth twice daily has been reached. This gradual dose increase helps to reduce the risk of gastrointestinal side effects such as nausea, vomiting, and diarrhea.
Apremilast tablets must be swallowed whole with some fluids. Do not split, crush, or chew the tablets. It may be taken with or without food.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor.
If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater (e.g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
Who should NOT take this medication?
Do not take this medication if you:
- are allergic to apremilast or any ingredients of the medication
- have galactose intolerance or glucose malabsorption (a rare hereditary condition)
- are pregnant
- are breast-feeding
What side effects are possible with this medication?
Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.
The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.
The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.
Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.
- abdominal discomfort
- back pain
- decreased appetite
- flu-like symptoms (e.g., body aches, fever, fatigue)
- respiratory tract infection (common cold)
- trouble sleeping
Although most of the side effects listed below don't happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:
- rapid or pounding heartbeat
- signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
- symptoms of a lung infection (e.g., shortness of breath, cough, chest pain)
- weight loss
Stop taking the medication and seek immediate medical attention if any of the following occur:
- severe diarrhea, nausea, or vomiting
- signs of bleeding in the stomach (e.g., bloody, black, or tarry stools; vomiting blood or material that looks like coffee grounds)
- signs of a serious allergic reaction (e.g., abdominal cramps, difficulty breathing, nausea and vomiting, or swelling of the face and throat)
Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.
Are there any other precautions or warnings for this medication?
Before you begin using a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should use this medication.
Depression: Apremilast may contribute to episodes of depression or thoughts of self-harm. If you have depression or a history of depression, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
If you experience symptoms of depression such as poor concentration, changes in weight, changes in sleep, or decreased interest in activities, or notice them in a family member who is taking this medication, contact your doctor as soon as possible.
Diarrhea, nausea and vomiting: Apremilast can cause severe diarrhea, nausea, or vomiting, which in turn can lead to dehydration, low blood pressure and also contribute to heart problems. Certain other medications, such as diuretics (water pills) can also cause dehydration. If you experience symptoms of dehydration, such as thirst, decreased urine or tear production, dizziness, or headaches, contact your doctor as soon as possible.
Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.
Other medications for psoriasis: The safety of using apremilast in combination with other more potent immunosuppressants or biologicals for the treatment of psoriasis has not been studied. If you are using other medications to treat psoriasis, discuss the safety of doing so with your doctor. Because the safety of combining these therapies has not been evaluated, it is not recommended at this time.
Pregnancy: Apremilast should not be used by women who are pregnant, as there is not enough information about the safety of its use during pregnancy. If you become pregnant while taking this medication, contact your doctor immediately.
Breast-feeding: It is not known if apremilast passes into breast milk. If you are a breast-feeding mother and are taking this medication, it may affect your baby. If you are breast-feeding, you should not take this medication.
Children: The safety and effectiveness of using this medication have not been established for children.
Seniors: Seniors may be at an increased risk of developing complications as a result of severe diarrhea, nausea, and vomiting.
What other drugs could interact with this medication?
There may be an interaction between apremilast and any of the following:
- estradiol and norethindrone
- lumacaftor and ivacaftor
- St. John's wort
If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:
- stop taking one of the medications,
- change one of the medications to another,
- change how you are taking one or both of the medications, or
- leave everything as is.
An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.
Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.
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