Otezla is a brand-name prescription drug used to treat adults with moderate to severe plaque psoriasis, active psoriatic arthritis, or oral ulcers due to Behcet’s disease. It is classified as a PDE4 inhibitor that is useful for treating certain autoimmune conditions in which the immune system attacks healthy cells. Apremilast, the active ingredient in Otezla, reduces inflammation by decreasing the body’s production of inflammatory chemicals. The recommended dosage of Otezla is 30 mg taken by mouth twice per day. Otezla can be taken with a meal or on an empty stomach.
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Otezla forms and strengths
Otezla is available as an oral tablet. The standard recommended dosage is 30 mg twice per day, but treatment is usually started with low doses to reduce the risk of side effects.
Tablets: 10 mg, 20 mg, 30 mg
People who are beginning treatment will be started on low doses, which are gradually increased (titrated) each day to reach the recommended dose. The dose is titrated over the first five days to reduce the risk of gastrointestinal side effects, like diarrhea and nausea. Otezla is available as a 14-day or 28-day starter pack to make it easy to start treatment. Follow the instructions as indicated on the starter pack.
14-day starter pack: This starter pack contains four 10 mg tablets, four 20 mg tablets, and five 30 mg tablets for the first week. It also comes with an additional supply of 30 mg tablets for the second week of treatment.
28-day starter pack: This starter pack contains four 10 mg tablets, four 20 mg tablets, and five 30 mg tablets for the first week. The pack comes with an additional supply of 30 mg tablets for the second, third, and fourth week of treatment.
Otezla dosage for adults
Otezla is FDA-approved to treat plaque psoriasis, active psoriatic arthritis, and oral ulcers associated with Behcet’s disease. Healthcare providers may, however, prescribe Otezla off-label for various autoimmune skin diseases, such as atopic dermatitis.
No matter what condition is being treated, the initial dose of Otezla is usually 10 mg for the first day. This daily dose will be increased by 10 mg each day until the final recommended dose of 30 mg twice per day is reached. The initial dosage schedule is as follows:
Day 1: 10 mg taken once in the morning
Day 2: 10 mg taken once in the morning and once in the evening
Day 3: 10 mg taken once in the morning and 20 mg taken once in the evening
Day 4: 20 mg taken once in the morning and once in the evening
Day 5: 20 mg taken once in the morning and 30 mg taken once in the evening
Day 6: 30 mg taken once in the morning and once in the evening
To make this easier, people starting Otezla may be prescribed either a 14-day or 28-day starter pack with four 10 mg tablets, four 20 mg tablets, and the remainder will be 30 mg tablets. All the pills in the starter blister packs will be organized
by the day on which they need to be taken.
| Otezla dosage chart | |||
|---|---|---|---|
| Indication | Starting dosage | Standard dosage | Maximum dosage |
| Moderate to severe plaque psoriasis | 10 mg tablet taken once in the morning | 30 mg tablet taken twice per day | 60 mg daily |
| Active moderate to severe psoriatic arthritis | 10 mg tablet taken once in the morning | 30 mg tablet taken twice per day | 60 mg daily |
| Behcet’s disease | 10 mg tablet taken once in the morning | 30 mg tablet taken twice per day | 60 mg daily |
Source: Epocrates
Otezla dosage for moderate to severe plaque psoriasis
Otezla is FDA-approved to treat moderate to severe plaque psoriasis in adults who are candidates for systemic therapy or phototherapy. Plaque psoriasis is an autoimmune condition in which the immune system attacks healthy skin cells, producing thick, scaly patches of skin on the scalp, trunk, and other areas of the body.
The active ingredient in Otezla is apremilast, a drug that belongs to a class of drugs called phosphodiesterase 4 inhibitors (PDE4 inhibitors). It is believed that by blocking PDE4, apremilast decreases the body’s production of inflammatory mediators, that is, chemicals that stimulate the immune system’s inflammatory response. Based on clinical studies, 33% of people taking Otezla experienced 75% clearer skin versus 5% of people taking placebo after four months of treatment. Compared to people taking placebo, people taking Otezla also experienced decreased itching after four months of treatment.
Standard dosage for moderate to severe plaque psoriasis: 30 mg tablet taken once in the morning and once in the evening
Maximum dosage for moderate to severe plaque psoriasis: 60 mg daily
Otezla dosage for active psoriatic arthritis
Otezla is also used to treat flare-ups of moderate to severe psoriatic arthritis (PsA), a condition in which the immune system attacks the soft tissues in healthy joints. As with plaque psoriasis, Otezla is believed to work by reducing the body’s production of substances that stimulate the inflammatory response.
Standard dosage for moderate to severe active psoriatic arthritis: 30 mg tablet taken once in the morning and once in the evening
Maximum dosage for moderate to severe active psoriatic arthritis: 60 mg daily
Otezla dosage for oral ulcers associated with Behcet’s disease
Otezla is the only drug the FDA has approved to treat oral ulcers associated with Behcet’s disease, an autoimmune disorder that causes blood vessels to swell throughout the body. Behcet’s disease can cause several symptoms, including oral ulcers, genital ulcers, swelling of the eye (uveitis), and vasculitis (blood vessel swelling). It is believed that Otezla reduces the body’s production of inflammatory chemicals by blocking PDE-4. In clinical trials, approximately half of people taking Otezla were cleared of mouth ulcers after twelve weeks of treatment, twice the rate of people given a placebo.
Standard dosage for mouth sores associated with Behcet’s disease: 30 mg tablet taken once in the morning and once in the evening
Maximum dosage for mouth sores associated with Behcet’s disease: 60 mg daily
Otezla dosage for children
Otezla is not approved for use in children.
Otezla dosage restrictions
People with liver disease or mild to moderate kidney disease do not need dosage adjustments, but people with severe kidney disease need to take a lower dose of Otezla. Otezla levels may be higher in people with severe kidney disease than those in people without severe kidney disease. People with severe kidney disease should skip the afternoon doses in the titration dosage schedule and, after the first five days of titration, take a recommended dose of 30 mg daily.
Some people, though, may need close monitoring for adverse effects of apremilast, including people with a history of depression or suicidal thoughts. Otezla may worsen depression in some people.
People who are allergic to apremilast or any of the inactive ingredients in Otezla should avoid this medicine.
How to take Otezla
Otezla is usually taken as a tablet twice per day—once in the morning and once at night—with or without food.
Take this medicine as directed.
Otezla will be started at a low dose, which will gradually increase each day for the first five days. Follow the chart on the Otezla starter kit
label for instructions on how to take the medication. You may have to take a certain tablet in the morning and the evening during the first five days. There is only one pill to take on the first day. Swallow the tablet whole. Do not crush, break, divide, or chew it.
Store Otezla in a closed container at room temperature (below 86°F).
Otezla dosage FAQs
How long does it take Otezla to work?
Apremilast can take up to four months to reduce symptoms.
What happens if I miss a dose of Otezla?
Take a missed dose as soon as it’s remembered. However, if it is almost time for the next dose, skip the missed dose and take the next dose on schedule. Never take two doses to make up for a missed dose.
How long can you take Otezla?
Otezla can be taken for as long as it effectively reduces symptoms without causing problems with side effects.
How do I stop taking Otezla?
Otezla can be stopped at any time without causing withdrawal or other problems.
Some people stop taking Otezla because of side effects. People who experience severe adverse reactions, such as suicidal thoughts, worsening of depression, or severe diarrhea will probably be switched to a different drug by their doctor. Other side effects of Otezla, such as abdominal pain, back pain, diarrhea, upper respiratory tract infections, or tension headaches could warrant the discontinuation of the medication. Finally, significant weight loss may be a sign that Otezla needs to be stopped. Healthcare providers will ask patients taking Otezla to monitor their body weight and report any significant weight loss. Always get medical advice from a healthcare professional before stopping Otezla.
What is the maximum dosage for Otezla?
The maximum daily dose of Otezla is 60 mg per day.
Can you overdose on Otezla?
Get immediate medical help if too much Otezla is taken.
What interacts with Otezla?
Certain drugs may cause problems when combined with Otezla. The most concerning are drugs that interfere with the body’s ability to break down apremilast in the body.
Apremilast is primarily metabolized by an enzyme in the liver called CYP3A4. Some drugs block this enzyme (called “inhibitors”) and some speed it up (called “inducers”). When drugs block apremilast metabolism, apremilast levels go up in the blood, increasing the risk and severity of side effects. Patients and caregivers may need to watch out for side effects, such as gastrointestinal problems or weight loss, if CYP3A4 inhibitors, like ketoconazole or erythromycin, are taken with Otezla.
When drugs speed up apremilast metabolism, apremilast levels quickly go down, decreasing the effectiveness of the drug. The most significant inducers include certain anticonvulsants, like carbamazepine and phenytoin; some tuberculosis drugs, such as rifampin; and St. John’s wort, a popular herbal remedy. A healthcare provider may need to adjust doses or find alternative treatments if drug interactions become a problem.
What happens when you mix Otezla and alcohol?
The FDA does not prohibit or warn against drinking while taking Otezla. However, alcohol may worsen side effects of Otezla. It is not usually recommended to mix Otezla and alcohol.
Is it safe to take Otezla during pregnancy?
The effects of Otezla on an unborn baby are unknown. Animal studies have shown that apremilast might increase the risk of spontaneous abortion, fetal death, or abnormal skeletal development in a fetus. The benefits of taking Otezla during pregnancy should be weighed against potential risks.
For women who are breastfeeding, healthcare providers do not know if Otezla affects lactation or a nursing infant. Based on animal studies, it is likely that apremilast is present in human milk, but its effects on the infant are unknown. Consult a healthcare provider on whether it’s safe for you to take Otezla while breastfeeding.
Related resources for Otezla dosages:
Apremilast
, StatPearlsApremilast (Otezla)
, American College of Rheumatology (ACR)Apremilast drug summary
, Prescriber’s Digital ReferenceBehcet disease
, StatpearlsOtezla
, EpocratesOtezla prescribing information
, U.S. National Library of MedicineOtezla HCP
, AmgenPlaque psoriasis
, StatPearlsPsoriatic arthritis
, StatPearls
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