A PDE4 inhibitor tablet
Apremilast
An oral tablet that calms inflammation in psoriasis and psoriatic arthritis without the infection screening needed for many biologics.
What is Apremilast?
Apremilast is a tablet used for psoriasis and psoriatic arthritis, usually when creams, light therapy or other treatments have not worked or are unsuitable. It works by blocking an enzyme called PDE4 inside cells, which helps turn down the chemical signals that drive skin and joint inflammation. The most common early problems are nausea, diarrhoea and headache, which often settle after the first few weeks, and some people lose weight. Because it can affect mood, your team will ask about any depression or low mood, and you should report any new or worsening mood changes. Unlike many advanced treatments, it does not usually need infection screening or regular blood-test monitoring.
Education and reference only. This is a plain-language guide to Apremilast — it deliberately contains no doses. Doses depend on the person, the brand and the reason for treatment, and belong with your prescriber. Always check the BNF, the product labelling (SmPC) and follow medical advice.
What it is
Apremilast is an oral treatment for inflammatory skin and joint disease, taken as a tablet. It belongs to a class called PDE4 inhibitors, which act inside cells to reduce inflammatory signalling. In the UK it is used for moderate to severe plaque psoriasis and for psoriatic arthritis, generally when other systemic treatments have not worked, are not tolerated or are not suitable. It is taken long term and is started with a gradually increasing schedule to reduce early side effects.
How it works
Inside immune and skin cells, an enzyme called PDE4 helps control the balance of chemical messengers that promote or calm inflammation. By blocking PDE4, apremilast shifts that balance towards less inflammation, which can reduce the redness, scaling and discomfort of psoriasis and the joint symptoms of psoriatic arthritis. Because it works differently from medicines that broadly suppress the immune system, it does not usually carry the same infection-screening requirements.
Company & origin
Originated / developed by: Amgen.
An oral PDE4 inhibitor used in the UK for psoriasis and psoriatic arthritis when other treatments have not worked or are unsuitable.
Practical use
How to take Apremilast
General, dose-free guidance — always follow your prescriber's and the leaflet's specific instructions.
- Start with the gradually increasing schedule you are given, which helps reduce early nausea and diarrhoea.
- Take the tablets as prescribed, with or without food, and try not to miss doses.
- Expect some nausea or loose stools in the first weeks, which usually settle; tell your team if they are severe or persistent.
- Let your team know if you notice marked or unexplained weight loss.
- Report any new or worsening low mood, depression or thoughts of self-harm without delay.
- Tell your prescriber if you have kidney problems, as the schedule may need adjusting.
Weighing it up
Advantages & disadvantages of Apremilast
Advantages
- Taken as a tablet and does not usually need infection screening or routine blood-test monitoring.
- Offers an option for psoriasis and psoriatic arthritis when other treatments have not worked or are unsuitable.
- Started with a step-up schedule that helps ease the early digestive side effects.
Disadvantages
- Commonly causes nausea, diarrhoea and headache, especially in the first few weeks.
- Can cause weight loss and is linked with low mood and, rarely, suicidal thoughts.
- Does not work for everyone, and benefit may take some weeks to appear.
Practical use
Good to know
The most noticeable thing early on is digestive upset: nausea and diarrhoea are common in the first weeks and usually settle, which is why treatment is started at a low level and built up gradually. Some people lose weight, so your weight may be checked, and unexplained or marked weight loss should be reported. An important caution is mood: apremilast has been linked with low mood, depression and, rarely, suicidal thoughts, so your team will ask about your mental health and you should tell them about any new or worsening mood changes. A practical advantage is that it does not usually need the tuberculosis and hepatitis screening or routine blood-test monitoring required by many biologic and JAK treatments, though your prescriber will still review you regularly.
Who should not take it / use with caution
- It is not recommended in pregnancy, and reliable contraception is advised during treatment.
- Used with caution, and with mental-health review, in people with a history of depression or suicidal thoughts.
- The schedule needs adjusting in severe kidney problems, so tell your prescriber about kidney disease.
Monitoring
- Reviewing how well the skin or joints respond over the first few months.
- Checking weight and asking about mood and mental wellbeing at reviews.
- Assessing kidney function where relevant, as the schedule depends on it.
Side effects
- Nausea, diarrhoea and headache, mostly early on and often settling with time.
- Weight loss, tiredness and cold-like or upper airway symptoms in some people.
- Low mood or depression and, rarely, suicidal thoughts, which should be reported promptly.
Key interactions
- Certain medicines that speed up its breakdown, such as some epilepsy and tuberculosis treatments, can make it less effective.
- It is not normally combined with strong immune-suppressing biologics or JAK inhibitors, so any such combination should be reviewed by a specialist.
- Tell your prescriber about all your medicines, as some can change how well it works.
Available as: Tablets taken by mouth, including a starter pack that increases the amount gradually.
Answers
Apremilast: frequently asked questions
Why do I get diarrhoea or nausea when I start apremilast?
Digestive upset is common in the first few weeks and usually settles; the gradual starting schedule is designed to reduce it, so tell your team if it is severe or lasting.
Does it cause weight loss?
Some people lose weight on apremilast, so your weight may be checked; let your team know about marked or unexplained weight loss.
Can it affect my mood?
Yes, it has been linked with low mood and, rarely, suicidal thoughts, so report any new or worsening mood changes to your team straight away.
Do I need blood tests and infection screening like with biologics?
Usually not; apremilast does not generally need tuberculosis and hepatitis screening or routine blood-test monitoring, though your prescriber will still review you.
How long before it works?
It can take several weeks to see benefit for the skin or joints, so it is worth giving it a fair trial as advised by your team.
Authoritative sources
- BNF
- NICE CKS
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