Apremilast

Apremilast is used to treat

• psoriatic arthritis (a condition that causes joint pain and swelling and scales on the skin).
• moderate to severe plaque psoriasis (skin disease in which red, scaly patches form on some areas of the body) in adults and children 6 years of age and older (weighing at least 20 kg or 44 pounds) who may benefit from medications or phototherapy (a treatment that involves exposing the skin to ultraviolet light).
• ulcers in the mouth in people with Behcet's syndrome (a disorder that causes blood vessel swelling in the body).

Apremilast is in a class of medications called phosphodiesterase inhibitors. It works by blocking the action of certain natural substances in the body that cause inflammation.

Apremilast comes as a tablet to take by mouth. It is usually taken twice a day. Take apremilast at around the same time(s) every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take apremilast exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Swallow the tablets whole; do not split, chew, or crush them.

Your doctor will probably start you on a low dose of apremilast and gradually increase your dose once every day for the first 5 days of treatment.

Apremilast controls psoriatic arthritis or plaque psoriasis, or treats oral ulcers, but does not cure them. Continue to take apremilast even if you feel well. Do not stop taking apremilast without talking to your doctor.

Ask your pharmacist or doctor for a copy of the manufacturer's information for the patient.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking apremilast,

• tell your doctor and pharmacist if you are allergic to apremilast, any other medications, or any of the ingredients in apremilast tablets. Ask your pharmacist or check the Medication Guide for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take while taking apremilast. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had depression, mood problems, thoughts about harming or killing yourself, or planning or trying to do so, or kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking apremilast, call your doctor.
• you should know that your mental health may change in unexpected ways and you may become depressed or suicidal (thinking about harming or killing yourself or planning or trying to do so) while you are taking apremilast. You and your doctor will decide whether the risks of taking this medication are greater than the risks of not taking the medication. You, your family, or your caregiver should call your doctor right away if you experience any of the following symptoms: new or worsening depression, talking or thinking about wanting to hurt yourself or end your life, or any other unusual changes in behavior or mood. Be sure that your family or caregiver knows which symptoms may be serious so they can call the doctor if you are unable to seek treatment on your own.
• you should know that apremilast can cause weight loss. Your weight should be checked regularly by your doctor and you should also check your weight on a regular basis during treatment with apremilast. If you notice you are losing weight, call your doctor. For children receiving apremilast, their doctor will monitor their height and weight very closely. If they are not gaining weight or growing as they should, their treatment may need to be interrupted.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Apremilast may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• diarrhea
• nausea
• stomach pain
• vomiting
• headache
• sore throat, cough, and fever
• sneezing, runny nose, and nasal congestion

Apremilast may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online (https://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from light, excess heat and moisture (not in the bathroom).

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. https://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA's Safe Disposal of Medicines website (https://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can't be awakened, immediately call emergency services at 911.

Keep all appointments with your doctor.

Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

• Otezla^®