Managing Apremilast-Induced Gastrointestinal Symptoms

Introduction to Apremilast-Induced GI Symptoms

• The American Academy of Dermatology notes that apremilast does not cause gastritis, but rather gastrointestinal symptoms such as diarrhea, nausea, and vomiting, which are typically self-limited and resolve within the first month without intervention 1

Understanding the GI Side Effects

• 70-80% of GI adverse effects occur within the first 2 weeks of treatment 1
• 75-80% of GI adverse effects are mild in severity 1
• 60-65% of GI adverse effects resolve within the first month with continued dosing and without intervention 1

Initial Management Strategy

• The American Academy of Dermatology recommends that most patients should continue apremilast without dose modification, as symptoms typically resolve spontaneously within 4 weeks 1
• Ensure proper hydration, especially in elderly patients who are at higher risk for dehydration-related complications 1

Special Populations at Higher Risk

• Elderly patients (≥65 years) require closer monitoring due to a higher risk of dehydration from GI effects 1

Common Pitfalls to Avoid

• Do not prematurely discontinue apremilast for mild-to-moderate GI symptoms in the first 2-4 weeks, as most resolve spontaneously 1
• Do not confuse functional GI symptoms with gastritis—apremilast does not cause inflammatory gastric disease 1
• Do not forget the mandatory 5-day titration schedule when initiating therapy, as this reduces GI symptoms 1