Introduction
Your doctor may suggest that you take Otezla (apremilast) if you have any of the following conditions:
- psoriatic arthritis
- plaque psoriasis
- canker sores caused by Behçet’s disease
Learning about possible side effects of Otezla may help you and your doctor decide whether to try this drug to treat your condition.
Otezla is a prescription medication that’s usually taken long term. The drug comes as tablets that you take by mouth. For more information on Otezla, see this in-depth article on the drug.
Like all medications, Otezla can cause mild or serious side effects. Keep reading to learn more.
What are the more common side effects of Otezla?
Some people may experience mild or serious side effects during their Otezla treatment. Examples of Otezla’s commonly reported side effects may include:
- headache
- upper respiratory infection, such as the common cold
- nausea* or vomiting*
- diarrhea*
Your doctor will recommend Otezla if they think that the improvement you may get from this treatment outweighs your risk for side effects.
The above list doesn’t include all possible side effects of Otezla. Keep reading to learn about some potential mild and serious side effects of Otezla.
* For more information about this side effect, see “Side effects explained” below.
What are the mild side effects of Otezla?
Examples of mild side effects that have been reported with Otezla include:
- headache
- upper respiratory infection, such as the common cold
- abdominal (belly) pain
- fatigue (lack of energy)
- insomnia* (trouble sleeping)
- reduced appetite
- back pain
- nausea* or vomiting*
- diarrhea*
- weight loss*
In most cases, these side effects should be temporary. Some may be easily managed, too. But if you have any symptoms that are ongoing or that bother you, talk with your doctor or pharmacist. And don’t stop using Otezla unless your doctor tells you to.
Otezla may cause mild side effects other than the ones listed above. See Otezla’s prescribing information for details.
Note: After the Food and Drug Administration (FDA) approves a drug, it tracks and reviews side effects of the medication. If you’d like to notify the FDA about a side effect you’ve had with Otezla, visit MedWatch.
* For more information about this side effect, see “Side effects explained” below.
What are the serious side effects of Otezla?
With Otezla, serious side effects aren’t common, but they can occur. Serious side effects that have been reported with Otezla include:
- diarrhea
- suicidal thoughts
- depression
- nausea* or vomiting*
- allergic reaction*
See “Side effects explained” below for details about these side effects.
* An allergic reaction is possible after using Otezla. However, it’s not clear whether this side effect occurred in studies.
Side effects in children
At this time, Otezla is only approved for use in adults (ages 18 years and older). The side effects described in this article have been seen in adults. Otezla’s possible side effects in children aren’t yet known.
However, Otezla is being studied for its safety and effectiveness in children. An ongoing study is looking at Otezla for possible treatment of moderate-to-severe plaque psoriasis in children ages 6 years and older.
FAQs about Otezla’s side effects
Get answers to some frequently asked questions about Otezla’s side effects.
What side effects would stopping Otezla cause?
Stopping Otezla doesn’t cause side effects or withdrawal symptoms. But keep in mind that stopping this medication could cause symptoms of your condition to come back. Be sure to talk with your doctor before stopping Otezla.
Do Otezla’s side effects go away?
Typically, the more common side effects of Otezla go away within about 2 weeks after starting the drug. These side effects can include non-severe nausea, diarrhea, and vomiting.* It can take a few weeks for your body to get used to the medication, and your side effects may go away after this time.
If you’re experiencing side effects that don’t go away during Otezla treatment, talk with your doctor.
* See “Side effects explained” below for details about these side effects.
Is hair loss a side effect of Otezla?
No. Hair loss wasn’t a side effect that occurred in studies of Otezla.
However, if you have plaque psoriasis on your scalp, scratching may lead to temporary hair loss. Treatments such as Otezla may reduce scalp plaques, which can help reduce hair loss from scratching. Talk with your doctor if you’re experiencing hair loss that’s severe or causes concern.
How long do Otezla’s side effects last?
It depends. For most people, the more common side effects* of Otezla usually go away after your body gets used to the medication. This typically happens within about 2 weeks after starting the drug.
Also keep in mind that side effects can depend on factors such as your age, other health conditions you have, or other medications you’re taking.
If you have side effects of Otezla that become severe or don’t go away, talk with your doctor.
* See “Side effects explained” below for details about these side effects, including non-severe nausea, diarrhea, and vomiting.
Is cancer associated with Otezla use?
No. Cancer wasn’t a side effect that happened in studies of Otezla.
However, people with psoriasis may have a slightly increased risk for certain types of cancer. For more details, see this article about the connection between psoriasis and cancer. And if you have questions or concerns about your cancer risk, talk with your doctor.
Side effects explained
Learn more about some of the side effects that Otezla may cause.
Weight loss
Many people lose weight when taking Otezla. This can occur partly because of how the drug works, and partly because of some of its more common side effects.
Otezla’s possible side effects include diarrhea, nausea, vomiting, and reduced appetite. Many people who take Otezla lose weight due to these side effects. However, these side effects usually go away within about 2 weeks after starting Otezla, as your body gets used to the medication. Unexplained weight loss may also occur while taking Otezla.
What might help
If you have nausea or reduced appetite from Otezla, it’s important that you still try to get enough calories. Try eating small, frequent meals or snacks. Eat foods that are bland and still provide some nutrients, such as applesauce, bananas, and broth.
If you experience severe weight loss while taking Otezla, discuss this with your doctor. Depending on your condition, and other health factors, they may recommend that you stop Otezla treatment.
Note: Otezla isn’t approved by the Food and Drug Administration (FDA) for weight loss, and it’s not prescribed for weight loss. If you’re interested in weight loss treatments, talk with your doctor about ways to help you maintain a moderate weight.
Diarrhea
Diarrhea is one of the most common side effects of Otezla. For most people, this side effect isn’t severe. It usually goes away within about 2 weeks after starting Otezla, as your body gets used to the medication.
For most people who took Otezla in studies, diarrhea wasn’t severe. However, if you lose too much fluid due to diarrhea, you could become dehydrated.
Very rarely, Otezla caused severe dehydration due to diarrhea in studies. In some of these cases, treatment in the hospital was necessary. In reports of people taking Otezla since the drug was approved, severe diarrhea has been described during the first few weeks of taking the drug. (See the “Warnings for Otezla” section for details.)
What might help
If you have diarrhea during your first few weeks of Otezla treatment, it’s important to keep yourself well hydrated. Drinking plenty of water can help prevent dehydration. Electrolyte replacement beverages, such as sports drinks, can also help keep you hydrated.
To help relieve diarrhea, you may want to consider asking your doctor if it’s safe for you to take an anti-diarrheal medication. Some over-the-counter (OTC) drug options may include Imodium A-D (loperamide hydrochloride) and Pepto Bismol (bismuth subsalicylate).
If you have diarrhea that’s severe or doesn’t improve after trying OTC or home remedies, talk with your doctor. They may recommend a lower dose of Otezla. In some cases, this side effect can be severe and even require hospitalization.
Nausea and vomiting
Nausea and vomiting are two of the more common side effects of Otezla. For most people, nausea tends to go away within about 2 weeks after starting Otezla, as your body gets used to the medication.
For most people who took Otezla in studies, nausea and vomiting weren’t severe. However, nausea may lead to vomiting, which can increase your risk for becoming dehydrated.
Very rarely, Otezla caused severe dehydration due to severe vomiting in studies. In some of these cases, treatment in the hospital was necessary. In reports of people taking Otezla since the drug was approved, severe nausea and vomiting have been described during the first few weeks of taking the drug. (See the “Warnings for Otezla” section for details.)
What might help
There are a few things you can do to try to prevent or reduce nausea. For example:
- Take small, frequent sips of water or other clear liquids.
- Eat small, frequent meals or snacks. Include bland foods such as bananas, crackers, toast, and broth.
- Get some fresh air by going for a short walk or opening a window.
- Try natural remedies that may help prevent or reduce nausea, such as ginger or acupressure.
Talk with your doctor if you have nausea or vomiting that doesn’t go away or becomes severe. They may recommend a lower dose of Otezla for you. Or, they may prescribe medication for you to take as needed.
Depression
Depression has happened in people taking Otezla, but it isn’t common. And suicidal thoughts or behaviors are even more rare. These side effects may be more likely to develop if you have a history of depression.
Depression may cause symptoms such as feelings of hopelessness, loss of interest in things you used to enjoy, and trouble concentrating.
What might help
If you notice mood changes while taking Otezla, talk with your doctor. They may recommend lowering your dose or stopping Otezla. They may also recommend that you get treatment for depression.
If you have thoughts of harming yourself, call 911 or your local emergency number.
Note: If you’ve been diagnosed with depression, Otezla may make your condition worse. If you’re currently being treated for depression, it’s important to continue with your treatment plan while taking Otezla. See the “Warnings for Otezla” section below for more details.
SUICIDE PREVENTION
If you think someone is at immediate risk of self-harm or hurting another person:
- Call 911 or your local emergency number.
- Stay with the person until help arrives.
- Remove any guns, knives, medications, or other things that may cause harm.
- Listen, but don’t judge, argue, threaten, or yell.
If you or someone you know is considering suicide, get help from a crisis or suicide prevention hotline. Try the National Suicide Prevention Lifeline at 800-273-8255.
Insomnia
Although it isn’t common, Otezla can cause insomnia.
Insomnia refers to trouble falling asleep or trouble staying asleep. This side effect is usually mild. For most people, insomnia tends to go away within about 2 weeks after starting Otezla, as your body gets used to the medication. Insomnia didn’t cause anyone to stop taking Otezla in studies.
What might help
For mild insomnia, following good sleep hygiene is usually helpful. Sleep hygiene refers to healthy habits that can help you get a good night’s sleep.
Here are some tips that might help improve your sleep quality:
- Stick with a consistent sleep schedule, even on the weekends. This helps your body get used to falling asleep and waking up around the same times.
- Follow a 30- to 60-minute routine of relaxing activities before bedtime. For example, try taking a warm bath or listening to soothing music.
- Don’t have caffeine starting 7 hours before bedtime, because it can keep you awake.
There are also some treatments such as natural supplements and OTC sleep aids that may help. Talk with your doctor or pharmacist to help you choose a safe option.
If you have insomnia that’s severe or causes concern, talk with your doctor.
Allergic reaction
Like most drugs, Otezla can cause an allergic reaction in some people. However, it’s not clear whether this side effect occurred in studies of the drug.
Symptoms can be mild or serious and can include:
- rash
- itchiness
- flushing (warmth, swelling, redness, or discoloration in your skin)
- swelling under your skin, typically in your eyelids, lips, hands, or feet
- swelling of your mouth, tongue, or throat, which can make it hard to breathe
What might help
If you have mild symptoms of an allergic reaction, such as a mild rash, call your doctor right away. They may suggest an OTC medication to manage your symptoms. Examples may include an oral antihistamine such as Benadryl (diphenhydramine) or a topical* product such as hydrocortisone cream.
If your doctor confirms you had a mild allergic reaction to Otezla, they’ll decide if you should continue using it.
If you have symptoms of a severe allergic reaction, such as swelling or trouble breathing, call 911 or your local emergency number right away. These symptoms could be life threatening and require immediate medical care.
If your doctor confirms you had a serious allergic reaction to Otezla, they may have you switch to a different treatment.
* Topical means applied to the skin.
Keeping track of side effects
During your Otezla treatment, consider keeping notes on any side effects you’re having. Then, you can share this information with your doctor. This is especially helpful when you first start taking new drugs or using a combination of treatments.
Your side-effect notes can include things like:
- what dose of drug you were taking when you had the side effect
- how soon after starting that dose you had the side effect
- what your symptoms were from the side effect
- how it affected your daily activities
- what other medications you were also taking
- any other information you feel is important
Keeping notes and sharing them with your doctor will help your doctor learn more about how Otezla affects you. And your doctor can use this information to adjust your treatment plan if needed.
Warnings for Otezla
Otezla may not be right for you if you have certain medical conditions or other factors that affect your health. Talk with your doctor about your health history before you take Otezla. Factors to consider include those in the list below.
Kidney problems. If it’s possible that you may have kidney problems, your doctor may check your kidney function with a blood test. If you have kidney disease, let your doctor know before you start taking Otezla. Depending on the condition of your kidneys, your doctor may recommend a lower dosage of Otezla for you.
Allergic reaction. If you’ve had an allergic reaction to Otezla or any of its ingredients, you shouldn’t take Otezla. Ask your doctor what other medications are better options for you.
Depression or suicidal thoughts. If you have a history of depression or suicidal thoughts or actions, Otezla may make these worse. Some people have experienced depressed mood and thoughts of suicide while taking this drug.
Make sure to talk with your doctor about your history of mental health conditions before taking Otezla. Your doctor will help you consider the risks and benefits of Otezla. If you both decide that you’ll take Otezla, your doctor will monitor you closely during your treatment.
Also, if you’re currently being treated for depression, it’s important to continue your current treatment plan while taking Otezla. This may include continuing to take any prescribed medications and keeping therapist appointments.
Taking drugs that interact with Otezla. Certain drugs can interact with Otezla in a way that prevents Otezla from being effective. If you’re currently taking a medication that interacts with Otezla in this way, your doctor may prescribe a different medication for your condition.
Some examples of these drugs include:
- Tegretol (carbamazepine) or Tegretol XR
- Luminal (phenobarbital)
- Phenytek (phenytoin)
- Rifadin (rifampin)
Alcohol use and Otezla
Drinking alcohol while taking Otezla could worsen some side effects of this medication, including:
- diarrhea
- nausea
- vomiting
- headache
- fatigue (lack of energy)
The more alcohol you drink while taking Otezla, the more severe these side effects could become. If you drink alcohol, talk with your doctor about how much alcohol is safe for you to drink while taking Otezla.
Pregnancy and breastfeeding while taking Otezla
It isn’t known if Otezla is safe to take during pregnancy. Some animal studies have shown harmful effects on the fetus when Otezla was given to pregnant females.
If you’re pregnant, or planning to become pregnant while taking Otezla, talk with your doctor. They can help you consider the risks and benefits of continuing Otezla.
It isn’t known if Otezla is safe to take while breastfeeding. In animal studies, Otezla passed into breast milk when the drug was given to pregnant females.
If you’re breastfeeding or planning to breastfeed, talk with your doctor about the risks and benefits of using Otezla.
What to ask your doctor
Otezla is meant to be a long-term treatment for psoriatic arthritis, plaque psoriasis, or canker sores from Behçet’s disease. When you’re considering taking this drug, it’s helpful to know what side effects may possibly happen. For most people, the side effects of Otezla are mild and usually improve after a few weeks.
If you have questions about the side effects of Otezla, talk with your doctor or pharmacist. Here are some questions you may want to ask:
- Am I at higher risk for side effects than others?
- Would Otezla interact with any other medications I’m taking?
- What should I do if I have side effects that won’t go away?
- Should I continue my psoriasis cream, or will it increase any of Otezla’s side effects?
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Ask a pharmacist
Q:
I would like to drink alcohol at an upcoming special event. Is it safe for me to stop Otezla temporarily, to avoid worsening some of its side effects?
Anonymous patient
A:
You should never stop taking Otezla without talking with your doctor. Although stopping Otezla doesn’t cause symptoms, stopping and restarting the medication increases your risk for side effects.
Keep in mind that drinking alcohol can make some side effects of Otezla worse. In general, if you choose to drink alcohol, you should do so in moderation. This means having up to 1 to 2 drinks per day, depending on your body size. Make sure to talk with your doctor about how much alcohol is safe for you to drink while taking Otezla.
Dena Westphalen, PharmDAnswers represent the opinions of our medical experts. All content is strictly informational and should not be considered medical advice.
Disclaimer: Healthline 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 other 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.
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