What Is Apremilast?

Apremilast is an oral phosphodiesterase 4 (PDE4) inhibitor sold under the brand name Otezla, manufactured by Amgen Inc. It is FDA-approved to treat plaque psoriasis in adults (and pediatric patients weighing at least 20 kg) who are candidates for phototherapy or systemic therapy, active psoriatic arthritis in adults, and oral ulcers associated with Behçet's disease in adults.

Unlike many other psoriasis and psoriatic arthritis treatments that are injectable biologics, Apremilast is taken as a pill, making it a convenient option for patients who prefer oral medication. It is not a biologic and does not suppress the immune system as broadly as traditional immunosuppressants.

How does Apremilast work?

Apremilast works by inhibiting an enzyme called phosphodiesterase 4 (PDE4) inside immune cells. PDE4 normally breaks down a signaling molecule called cyclic AMP (cAMP). By blocking PDE4, Apremilast raises cAMP levels, which in turn reduces the production of pro-inflammatory chemicals (like TNF-alpha, IL-17, and IL-23) while increasing anti-inflammatory signals (like IL-10).

Think of it like turning down the volume on your immune system's overactive inflammatory response — rather than shutting it off entirely, Apremilast helps rebalance the inflammatory signals that drive psoriasis and psoriatic arthritis symptoms. This targeted approach means fewer systemic side effects compared to broad immunosuppressants.

What doses are available for Apremilast?

• Otezla 10 mg tablet — used during the 5-day titration period
• Otezla 20 mg tablet — used during the 5-day titration period
• Otezla 30 mg tablet — standard maintenance dose (taken twice daily)
• Otezla Starter Pack — 5-day titration kit containing 10 mg, 20 mg, and 30 mg tablets
• Otezla XR 75 mg extended-release tablet — once-daily formulation (no titration required)

How hard is it to find Apremilast in stock?

Apremilast (brand name Otezla) is not currently on the FDA Drug Shortage list, and there are no widespread supply disruptions as of 2026. However, because Apremilast is a specialty medication, it is typically dispensed through specialty pharmacies rather than your local retail pharmacy. This means you won't find it on the shelf at CVS or Walgreens — you'll need to go through your insurer's preferred specialty pharmacy network.

The main barriers to accessing Apremilast are prior authorization requirements and step therapy (many insurers require you to try methotrexate or another systemic agent first). These administrative hurdles can delay access by days or weeks, even though the drug itself is in supply. If you're having trouble getting Apremilast, Medfinder can help you navigate the process and find a pharmacy that can fill your prescription.

Who Can Prescribe Apremilast?

Apremilast is most commonly prescribed by:

• Dermatologists — for plaque psoriasis
• Rheumatologists — for psoriatic arthritis
• Internal Medicine physicians — may prescribe for either condition
• Family Medicine physicians — can prescribe, though specialty referral is common

Because Apremilast is not a controlled substance and does not require specialized monitoring like some biologics, any licensed prescriber can write a prescription. However, most insurance plans require the prescription to come from a specialist (dermatologist or rheumatologist) to approve prior authorization. If you need help finding a provider who prescribes Apremilast, Medfinder can help connect you with the right specialist.

Is Apremilast a controlled substance?

No, Apremilast is not a controlled substance. It has no DEA schedule and does not carry any risk of abuse or dependence. There are no special prescribing restrictions, prescription limits, or refill limitations associated with controlled substance regulations. Your doctor can prescribe it with a standard prescription, and refills can be processed through your specialty pharmacy without additional DEA requirements.

Common Side Effects of Apremilast

The most frequently reported side effects of Apremilast are gastrointestinal and typically improve after the first few weeks of treatment. The 5-day dose titration schedule is designed to minimize these effects.

• Diarrhea — the most common side effect, especially during the first 2 weeks
• Nausea — usually mild and temporary
• Upper respiratory tract infection
• Headache and tension headache
• Abdominal pain
• Vomiting
• Fatigue
• Decreased appetite

Serious side effects are less common but include severe diarrhea or vomiting, depression and suicidal thoughts (patients should be closely monitored), unexplained weight loss, and rare hypersensitivity reactions. Contact your doctor immediately if you experience mood changes, significant weight loss, or severe GI symptoms.

Alternative Medications to Apremilast

If you cannot access or tolerate Apremilast, several alternatives may be appropriate depending on your condition. Always discuss options with your healthcare provider before making changes.

• Methotrexate — A traditional systemic immunosuppressant available as oral tablets or injection. Much less expensive than Apremilast (often under $50/month), but requires regular blood work to monitor liver function and blood counts.
• Deucravacitinib (Sotyktu) — A newer oral TYK2 inhibitor approved for moderate-to-severe plaque psoriasis. Like Apremilast, it's a pill, but works through a different mechanism. May be an option if Apremilast isn't effective.
• Adalimumab (Humira) — A TNF inhibitor biologic given by injection, approved for both psoriasis and psoriatic arthritis. Biosimilars are now available at lower cost than the original brand.
• Secukinumab (Cosentyx) — An IL-17A inhibitor biologic given by injection. Generally considered more effective than Apremilast for moderate-to-severe psoriasis, but requires injections and is more expensive.

Drug Interactions with Apremilast

Apremilast has relatively few drug interactions compared to many other systemic medications, but there are important ones to know about:

• Strong CYP450 inducers (major interaction — avoid): Rifampin, phenobarbital, carbamazepine, and phenytoin can reduce Apremilast levels by up to 72%, making it ineffective. These should not be taken together.
• St. John's Wort — This herbal supplement is a CYP450 inducer and may decrease Apremilast's effectiveness.
• Other moderate CYP450 inducers — May reduce Apremilast levels; discuss with your doctor.

Apremilast does not have significant food interactions and can be taken with or without food. Always tell your doctor about all medications and supplements you take, including over-the-counter products and herbal remedies.

Final Thoughts on Apremilast

Apremilast (Otezla) is a well-established oral treatment for plaque psoriasis, psoriatic arthritis, and Behçet's disease oral ulcers. While it's not currently in shortage, the high cost ($5,000–$6,800/month without insurance) and specialty pharmacy requirements can make accessing it challenging. The good news is that Amgen offers robust savings programs — eligible commercially insured patients may pay as little as $0 through the copay card program, and uninsured patients may qualify for free medication through the Amgen Safety Net Foundation.

If you're struggling to access Apremilast or navigate the prior authorization process, Medfinder can help you find pharmacies and streamline the process. For more information about Apremilast availability, pricing, and tips to save money, explore our blog articles below.