Apremilast
What is Apremilast?
Apremilast is a targeted disease modifying anti-rheumatic drug (DMARD) that is used to reduce inflammation produced by the body. In certain diseases the immune system is over active, this can target healthy tissues such as joints and the skin. Apremilast works on molecules called enzymes in the inflammatory pathway, reducing the symptoms you get from arthritis such as pain and joint swelling and reduces the chance of further damage to the joints.
What is Apremilast used for?
Apremilast is used for the treatment of Psoriasis and Psoriatic arthritis.
How is it taken?
Apremilast is a tablet that is taken twice a day. It is started at a low dose and increased up each day for the first 6 days as below:
Day 1- 10mg once a day
Day 2- 10mg twice a day
Day 3- 10mg in the morning and 20mg in the evening
Day 4- 20mg twice a day
Day 5- 20mg in the morning and 30mg in the evening
Day 6 onwards- 30mg twice a day
If you miss a dose, you should try to take it as soon as possible, however if it is close to the next time a dose is due, you should skip the missed dose.
Apremilast is usually given alongside other DMARDs such as methotrexate, or it can be taken on its own.
The tablets are supplied by the hospital pharmacy, a repeat prescription will be set up so you can collect them every 1-3 months.
The medication can take up to 12 weeks to have an effect. There are no requirements to monitor your bloods on apremilast; however if you are also on another medication such as methotrexate, you will need to continue your blood monitoring for this.
Side effects
There are a few possible side effects that can occur in a small number of people that take apremilast, these include:
- Feeling sick, vomiting and diarrhoea
- These usually settle after taking the medication for a few weeks.
- Headaches
- Weight loss
- This is often caused and should be monitored. Any unexplained weight loss should be reported to your doctor.
- Mood changes
- Depression and a very small number of suicidal tendencies have been reported. If you experience anything like this you should let your doctor know straight away.
- Increased risk of infections
- As apremilast dampens the immune system, you can be more prone to infection. You should be seen by your GP if you feel unwell in case you need antibiotics. You should withhold your apremilast if you are unwell and require antibiotics.
- You should try to avoid contact with others that have chicken pox or shingles.
Cautions of use
Interactions with other medications
- Your doctor will check if there are any medications that could interact.
- You can carry on taking your usual painkillers including NSAIDs.
Contraindications of other conditions
- Before starting any biological therapy, your bloods will be checked for infections that can become active again when the immune system is suppressed, this includes hepatitis B, C and HIV. A blood and chest X-ray is taken to exclude previous TB exposure. If you are found to have had previous TB exposure you may need to start preventative antibiotics for a short period before the apremilast is commenced.
- If you have problems with depression and low mood, apremilast may not be suitable.
Operations
- Apremilast does not need to be stopped prior to surgery.
During pregnancy and breastfeeding
- There is currently no data on apremilast in pregnancy or breastfeeding. Therefore it should not be used.
- If you are considering starting a family, contraception should be used until at least 1 week after stopping the tablets.
Alcohol
- Alcohol and apremilast do not interact, however it is recommended to take alcohol within moderation, following the guidelines of less than 14 units weekly.
Vaccinations
- Flu and the pneumonia vaccine are safe and recommended whilst taking apremilast.
- Live vaccines including the shingles vaccine are not strictly contraindicated, but the manufacturer cannot advise on the safety, so they are not recommended whilst on apremilast.
Useful Links
Versus Arthritis: http://www.versusarthritis.org
