Otezla is the brand name of apremilast, a relatively new drug that was approved by the FDA in March 2014. It's been shown to be effective in the treatment of psoriatic disorders, as well as certain other conditions that affect the immune system. Otezla is generally well tolerated by users, but like any drug, it does have side effects you should know about if you're considering starting it. In this article, we'll examine the basics of Otezla, including those side effects, as well as some alternatives to it. (Source)

What Does Otezla Do?

Otezla, a pill that's taken daily, is a phosphodiesterase-4 inhibitor. Phosphodiesterase-4 is an enzyme that promotes inflammation, so by blocking it Otezla decreases inflammation and related symptoms, such as joint pain, skin lesions, stiffness, and swelling. Otezla has been approved for use in:

• moderate to severe psoriasis
• psoriatic arthritis
• Behçet's disease, a rare condition that causes blood vessel inflammation

Apremilast is sometimes used to treat other conditions as well. Because the FDA-approved label does not say the medication is proven safe and effective for treating these other conditions, this is called “off-label” use. Otezla is considered "off-label" when it comes to treating some conditions, such as:

• atopic dermatitis
• inflammatory bowel disease
• Crohn's disease
• ulcerative colitis

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8 Otezla Side Effects

When considering a new medication, you and your health care provider should consider your medical history, as well as your family history and the medication’s side effects, and evaluate all of this along with the medication’s potential benefits. As always, the decision to introduce any medication is your own.

Before Starting Otezla  

Be sure to let your health care provider know if you have or are experiencing:

• kidney disease: Studies have suggested that apremilast is generally safe to use if your kidney function is impaired. However, if your kidney disease is severe, the drug will stay in your system longer and is more likely to cause unpleasant side effects. You may still be able to take apremilast, but your dosage may need to be adjusted.  
• depression: Having psoriatic arthritis already puts you at risk of developing depression, and studies indicate apremilast can make depression worse. In clinical studies of the drug, some participants chose to stop taking apremilast because they became depressed and even suicidal. Be sure to let your health care provider know if you have a history of depression or suicidal ideation (thoughts of suicide), as you may need to consider safer alternatives.
• pregnancy: Otezla hasn't been tested in pregnant people, so it isn’t known if it poses a risk to pregnancy or if it can result in birth defects. Studies in animals have shown that mice given apremilast in higher doses than are used in humans have increased risk of low birth weight offspring.
• breastfeeding: We don’t know if apremilast passes into breast milk in humans, but studies on animals have found low levels of the drug in the animals’ milk. There is a recommendation on the product label advising that people who are breastfeeding not use Otezla.

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Common Side Effects of Otezla

These side effects are frequently reported with the use of Otezla, and occur within the first 2 weeks of taking it. They should get better as you continue with the medication.

1. nausea
2. diarrhea
3. headache
4. cold symptoms (stuffy nose, sneezing, sore throat)

(Source)

More Serious Side Effects

It's possible to experience more serious side effects from apremilast. If you experience any of these while taking Otezla, you should seek medical attention right away:

5. allergic reactions, including anaphylaxis (skin rash, nausea, rapid and weak pulse, dizziness, swollen tongue or throat, wheezing, trouble breathing), and angioedema (swelling under the skin)
6. severe diarrhea, vomiting, nausea, which can lead to dehydration and low blood pressure, particularly in the elderly
7. loss of appetite and significant weight loss. Psoriatic arthritis is associated with cardiovascular disease, and weight loss may be desirable in some cases. If weight loss is dramatic, however, your provider may recommend that you stop taking Otezla.  
8. symptoms of depression, including suicidal thoughts, changes in sleep, and loss of interest in usual activities

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Otezla and Drug Interactions

Be sure to tell your health care provider about any medicines you're already taking, and about any medications you may start taking while you are using Otezla. Some drugs should not be taken with apremilast, since they can cause interactions with it and render it ineffective or less effective. They include:

• anti-seizure drugs, such as carbamazepine, fosphenytoin, phenytoin, primidone
• enzalutamide, which treats prostate cancer
• mitotane, used in the treatment of adrenocortical carcinoma (cancer of the adrenal gland) and Cushing's syndrome, a condition that occurs when the cortisol hormone builds up over time
• drugs that treat active tuberculosis, such as rifampin and rifapentine
• tofacitinib (brand name Xeljanz), used in the treatment of rheumatoid arthritis, psoriatic arthritis, and ulcerative colitis
• St. John's wort, a plant often used to treat depression and other mental health conditions as well as menopausal symptoms and skin conditions, including wounds, bruises, and muscle pain

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Alternatives to Otezla

No medication is right for everyone, and Otezla isn't the only option for managing conditions such as atopic dermatitis and psoriasis. You can also make lifestyle and nutritional adjustments to ease your symptoms. Some of these, such as ice and heat therapy, and low-impact exercise, can be safely added to your routine, but if you're considering doing anything in lieu of pharmaceutical treatment, it's important to talk to your provider first.

Let's take a look at what these changes can involve.

Psoriasis

Dietary changes may reduce the severity of your psoriasis symptoms.

• Experts recommend avoiding foods that can cause inflammation, such as alcohol, dairy, refined carbohydrates (white bread, white bread, pasta), saturated and trans fats (there may be a link between fats and the development and worsening of psoriasis symptoms), foods high in added sugar, and foods high in gluten.
• Adding certain foods may help reduce chronic inflammation, including fish, lean protein, plant-based proteins (tofu, tempeh), fruits, vegetables, beans, lentils, nuts, seeds, olive oil, and whole grains.

Lifestyle changes can also help alleviate your psoriasis symptoms.

• Smoking can not only worsen psoriasis and make it more difficult to treat, it can actually increase your risk of developing the condition. Quitting smoking can reduce psoriasis flares, increase the periods in which you have no psoriasis symptoms, and reduce your risk of developing other diseases. It's hard to stop smoking, so don't hesitate to reach out for help if you’re ready to quit.
• Results of research into the effects of regular exercise on psoriasis vary, but it appears both that having psoriasis can cause you to limit the amount of exercise you get, and that getting regular exercise can help reduce your psoriasis symptoms. Include your health care provider or care team in any plans you make to safely increase your activity level.

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Psoriatic Arthritis

Psoriatic arthritis, a condition that causes inflamed, swollen, and painful joints, affects some people with psoriasis. As with psoriasis, dietary and other lifestyle changes such as quitting smoking and avoiding alcohol can help. Suggestions include:

• Follow a diet rich in foods that prevent inflammation, such as omega-3 fatty acids (salmon, sardines, mackerel, and nuts), olive oil, lean protein, and cruciferous vegetables.
• Maintaining a healthy weight can help alleviate symptoms and prevent further disease development. Being overweight is linked to psoriatic arthritis as it increases risk of developing the condition, tends to make symptoms worse, and potentially limits the effectiveness of medical treatments.
• Talk to your healthcare provider about what you can do to change everyday tasks in order to protect your joints, an important step to feeling your best.
• Exercise can be a challenge with psoriatic arthritis, but it's still vital to managing your discomfort. Low-impact exercises such as tai chi, walking, swimming, and strength training are useful for stabilizing and supporting joints.
• Stress can cause psoriatic arthritis to worsen, so learning to manage it can help you feel better. Your provider may recommend meditation, mild yoga, and integrative therapies such as massage, acupuncture, and music therapy.
• Applying ice and heat can help dull pain, reduce swelling and inflammation, and increase circulation, loosening up muscles.
• While there's not a lot of information about the uses of natural medicine for psoriatic arthritis, a combination of acupuncture, turmeric, sarsaparilla, and vitamin D might be effective when used along with pharmaceutical care. More research is needed into the usefulness of these interventions.

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Atopic Dermatitis

Atopic dermatitis (AD) is treated with a combination of immunosuppressant drugs, topical ointments, diet, and avoidance of triggers, but there are some alternative methods of management to explore, which may also be effective when used in combination with pharmaceuticals.

• Acupuncture may be a safe and effective way of reducing AD symptoms, although there's not enough available data to say that it should be used instead of pharmaceuticals.
• Hypnotherapy has been shown to have a statistically significant benefit to people with AD, reducing itching, scratching, and sleep disturbances, even in patients who have been difficult to treat with conventional methods.
• Tuina is a massage found in traditional Chinese medicine that is used to align the muscles, bones, and tendons. One study on children suggested tuina reduced AD symptoms and rates of relapse.
• While many questions remain about the timing of administration and dosing, it's possible that probiotics may be beneficial in reducing symptoms of AD.
• Vitamin D supplementation may help decrease the severity of AD.
• CBD has anti-inflammatory properties, and while more studies are necessary, its therapeutic potential for AD is promising.
• Antioxidants, such as vitamin A (found in eggs, leafy greens, mango, and fish oils), vitamin C (found in cruciferous vegetables and citrus), vitamin E (found in almonds, peanuts, pumpkin, and sunflower seeds), and selenium (found in seafoods and Brazil nuts) could be helpful in the management of AD.

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The Bottom Line on Otezla Side Effects

Otezla is very effective in the treatment of autoimmune conditions such as psoriasis, psoriatic arthritis, and atopic dermatitis. It also has some surprising side effects, such as depression and weight loss, so it isn’t the right fit for everyone. Ultimately, the decision to use Otezla is yours, and so is the choice to adopt lifestyle changes that may ease the symptoms of your autoimmune condition. WellTheory's Care Team can support you in making diet and lifestyle changes, evaluating next steps, and finding a community of others who share your experiences.