Apremilast (Otezla) is a selective phosphodiesterase 4 (PDE4) inhibitor, approved for the treatment of psoriatic arthritis, moderate-to-severe plaque psoriasis, and Behçet’s disease-associated oral ulcers.

Precautions for Apremilast (Otezla) Administration

Pre-Treatment Assessment and Contraindication Screening

Before initiating treatment, confirm whether the patient has a history of hypersensitivity to any component of the medication.

This medication is contraindicated in patients with a hypersensitivity to apremilast or any excipients in the formulation.

Post-marketing surveillance data show that some patients may experience angioedema or allergic reactions; therefore, detailed information related to allergies must be collected before medication use.

Gastrointestinal Reactions

Diarrhea, nausea, and vomiting are the most common adverse reactions, mostly occurring in the early stage of treatment. Severe cases may require hospitalization, with a higher risk especially in patients over 65 years old or those using medications that may cause hypovolemia.

When severe symptoms occur, consideration should be given to dose reduction or temporary discontinuation of the medication immediately.

Mental Health Monitoring

Depressive symptoms were reported in 1.0% of patients with psoriatic arthritis and 1.3% of patients with plaque psoriasis.

Patients and their family members should be informed to be alert to changes in mood and report any abnormalities in a timely manner.

Dynamic Weight Monitoring

In psoriatic arthritis trials, 10% of patients experienced a weight loss of 5%-10%, and a similar change was observed in 12% of pediatric patients.

For patients with significant unexplained weight loss, evaluation should be conducted, and consideration should be given to discontinuing the medication.

Drug Interactions and Contraindicated Combinations

Concomitant use with strong cytochrome P450 enzyme inducers (such as rifampicin, phenobarbital, carbamazepine, and phenytoin) can significantly reduce the plasma concentration of apremilast, which may lead to loss of efficacy. Therefore, such combined use is prohibited.

Dosage Adjustment Strategies for Special Populations

Elderly patients: Patients over 65 years old have a higher risk of complications such as diarrhea, nausea, and vomiting, requiring enhanced monitoring.

Patients with abnormal liver or renal function: Dose adjustment is required for patients with severe renal impairment, while no dose adjustment is needed for patients with mild-to-moderate renal impairment or hepatic impairment of any degree.

Medication Monitoring for Apremilast (Otezla)

Laboratory Indicators

Regular testing of renal function (creatinine clearance) and inflammatory markers is required.

Clinical Manifestation Documentation

Periodically assess clinical parameters such as the number of swollen joints, lesional skin area, and the number of oral ulcers.