Apremilast belongs to a group of medicines called phosphodiesterase 4 inhibitors. It helps reduce inflammation and is used to treat adults with active psoriatic arthritis who have had an inadequate response to, or who have been unable to tolerate, a previous disease-modifying antirheumatic drug (DMARD).
Apremilast is also used to treat certain adults with moderate to severe plaque psoriasis and adults with Behçet’s disease who have oral ulcers. This page focuses on its use in psoriatic arthritis.
How does it work?
Apremilast works by reducing the activity of an enzyme in the body called phosphodiesterase 4 (PDE4).
PDE4 is involved in the control of inflammatory processes. By reducing its activity, apremilast helps regulate the production of inflammatory substances and can reduce inflammation associated with psoriatic arthritis.
Apremilast is a targeted treatment but is not a biological medicine. It can be used on its own or in combination with other DMARDs.
Who can get it?
Apremilast is available on prescription only (POM) and is intended for adults.
Treatment should be started by a specialist experienced in treating psoriasis or psoriatic arthritis. Your specialist will consider your symptoms, previous treatments and overall health before prescribing it.
Apremilast may not be suitable for people who are allergic to apremilast or any of its ingredients. It must not be used during pregnancy. Your doctor should also be told if you have a history of depression, suicidal thoughts or other mental health problems.
How is it used?
Apremilast is taken by mouth as tablets.
Treatment is started at a low dose, which is gradually increased over the first five days to help reduce the likelihood of side effects such as diarrhoea and nausea.
The usual adult maintenance dose is 30 mg twice daily, taken approximately 12 hours apart, usually in the morning and evening. It can be taken with or without food.
The usual dose-increase schedule is:
- Day 1: 10 mg in the morning.
- Day 2: 10 mg in the morning and 10 mg in the evening.
- Day 3: 10 mg in the morning and 20 mg in the evening.
- Day 4: 20 mg in the morning and 20 mg in the evening.
- Day 5: 20 mg in the morning and 30 mg in the evening.
- Day 6 onwards: 30 mg in the morning and 30 mg in the evening.
People with severe kidney problems may be prescribed a lower maintenance dose.
Treatment should be reviewed regularly. If there is no evidence of a beneficial response within approximately 24 weeks, your specialist may reconsider whether treatment should continue.
What are the side effects?
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects associated with apremilast. Experiencing a side effect does not mean that everyone taking the medicine will develop it.
Very common side effects
(may affect more than 1 in 10 people)
- Headache, including tension headache or migraine.
Common side effects
(may affect up to 1 in 10 people)
- Upper respiratory tract infections, such as a cold, runny nose or sinus infection.
- Stomach or upper abdominal pain.
- Indigestion or acid reflux.
- Frequent bowel movements.
- Loss of appetite.
- Back pain.
- Difficulty sleeping.
- Migraine or tension headache, where not already included above.
Diarrhoea, nausea and vomiting are most likely to occur during the first few weeks of treatment. They often improve within approximately four weeks. Contact your doctor if these symptoms are severe or do not improve, particularly if you are unable to drink enough fluids.
Uncommon side effects
(may affect up to 1 in 100 people)
- Hives or nettle rash (urticaria).
- Allergic reactions.
- Weight loss.
- Bleeding from the stomach or bowel.
- Anxiety or changes in mood.
- Suicidal thoughts or behaviour.
Depression and suicidal thoughts
Apremilast has been associated with depression, suicidal thoughts and suicidal behaviour, including in people who have not previously experienced depression.
Tell your doctor promptly if you notice new or worsening depression, changes in mood or behaviour, thoughts of suicide or any other concerning mental health symptoms. Seek urgent medical help if you or someone else is in immediate danger.
Seek urgent medical attention if you develop signs of a serious allergic reaction, such as swelling of the face, lips, mouth, tongue or throat, or difficulty breathing.
If any side effect becomes serious, or if you notice a side effect not listed here, speak to your doctor or pharmacist.
Marketed by
Apremilast is known commercially as Otezla and is marketed in the UK by Amgen Ltd
Reviewed: September 2026
Version ID: 2/APR/PAT/09/26
