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Targeted Synthetic DMARD — Phosphodiesterase-4 (PDE4) Inhibitor

Apremilast

Brand names: Otezla

Apremilast is an oral phosphodiesterase-4 inhibitor used for psoriatic arthritis, plaque psoriasis, and Behcet's disease oral ulcers.

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, increasing intracellular cyclic AMP and thereby modulating the production of pro-inflammatory and anti-inflammatory mediators.

Prescribing in practice

  • Depression and suicidal ideation have been reported, so assess mental health and counsel patients and carers to report mood changes.
  • Diarrhoea, nausea, and weight loss are common, particularly early in treatment, and the dose is up-titrated to improve tolerability.
  • Dose reduction is needed in severe renal impairment.

Monitoring

Monitor body weight, gastrointestinal tolerability, and mental health (including mood and suicidal ideation).

Counselling the patient

  • Report any new or worsening low mood, anxiety, or thoughts of self-harm.
  • Nausea and diarrhoea are common at first and usually improve; report troublesome or persistent weight loss.
  • Take as directed; the dose is increased gradually when starting.

Evidence & guidelines

Use in psoriatic arthritis and psoriasis is supported by the PALACE and ESTEEM trial programmes and relevant NICE guidance; consult the SPC.

Reference: NICE TA433; PALACE 1–4 Trials; MHRA Drug Safety Update (depression/suicidality 2019); 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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