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Phosphodiesterase-4 (PDE4) Inhibitor

Apremilast (Dermatology)

Brand names: Otezla

Apremilast is an oral phosphodiesterase-4 inhibitor used in dermatology for plaque psoriasis and active psoriatic arthritis where other systemic therapies are unsuitable.

Dosing — being independently re-sourced

ClinCalc Pro is rebuilding its dose data from primary open sources — the manufacturer SmPC (eMC), the WHO Model Formulary and other official references — under clinician review. This drug's structured dose is not yet published here. Confirm all doses against the product SmPC and your local formulary before prescribing.

Clinical monograph

How it works

It inhibits phosphodiesterase-4, raising intracellular cyclic AMP and thereby reducing production of pro-inflammatory cytokines involved in psoriatic inflammation.

Prescribing in practice

  • Monitor for new or worsening depression and suicidal ideation, and review continued treatment if these occur.
  • Diarrhoea, nausea and weight loss are common, particularly early in treatment, and dose titration improves tolerability.
  • Dose adjustment is required in severe renal impairment.

Monitoring

No specific blood monitoring is mandated, but monitor body weight and mental health during treatment.

Counselling the patient

  • Gastrointestinal upset is common when starting and usually settles; the dose is increased gradually at the outset.
  • Report low mood, anxiety or thoughts of self-harm to your clinician.
  • Tell your team if you experience unexplained or marked weight loss.

Evidence & guidelines

NICE recommends apremilast within its marketing authorisation for plaque psoriasis and psoriatic arthritis in specified circumstances.

Reference: ESTEEM 1 & 2 trials (Papp et al. JAAD 2015); RELIEF trial (Hatemi et al. NEJM 2019); NICE TA785; MHRA SPC Otezla; NICE TA781 (Behçet's); Drug verified in RxNorm (NLM); confirm dosing against the manufacturer SPC (eMC). Verify against your local formulary and current prescribing references before prescribing. Monograph status: clinician-reviewed (2026-07-04).

Related

Curated clinical cross-links plus same-class fallbacks.

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