Apremilast

• Prescribed by Hospital (due to cost saving) 
• Starter Pack-10mg day 1,
• 10mg twice daily day 2 
• 10mg morning , 20mg evening day 3, 20mg twice daily day 4, 
• 20mg morning 30mg evening day 5, then 30mg twice daily ongoing- 12 hours apart. 
• Taking with food, especially carbohydrate foods can ameliorate any early nausea/diarrhoea and avoid caffeine in first couple of weeks 

Reduce dose to 30mg once daily if eGFR <30 

Stop during serious Infection 

None Required

• Disease modifying drugs will not prevent all flares.  
• These can be managed with IM Depo Steroid as outlined above.  
• If flares become more frequent, or the disease fails to settle between flares an alternative can be discussed with the Rheumatologist. 

Pregnancy, Breastfeeding 

• Rare association with suicidal thoughts  
• Stop if unexplained/significant weight loss 
• GI symptoms, headaches common and usually short lasting 

See BNF – Carbamazepine, Phenytoin, St John’s Wort 

• Treatment is continued indefinitely providing it remains effective and there are no significant side effects.  
• Apremilast takes up to 26 weeks to become effective but may take 6 months.  
• During this period there are likely to be continued symptoms or signs of disease activity.  
• It is reasonable to use IM Depo steroids (Kenalog 40 mg or Depo Medrone 80 mg) up to monthly, depending on the requirements of the individual patient.  
• The dose required is small (eg monthly Kenalog 40 mg = 1.6 mg Prednisolone daily). 

*Secretary 01387 241776  

*Helpline 01387 241095 Rheumatology Nurse Specialists 

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