How Long Does It Take For Miralax to Work?

How Long Does It Take For Miralax to Work

Constipation is so bothersome and generally decreases your daily productivity. People who have constipation tends to use Miralax as treatment. But, do you know how long does it take for Miralax to work? Is it instantly right after people use it? Or does it need some time to let the magic happens?

Before that, you should know what kind of drug is Miralax. Miralax is a medication in the form of laxative solution to treat irregular constipation or occasional bowel movements. It adds the water amount in the intestinal tract to provoke the movement of bowel.

People with bowel obstruction, intestinal blockage, and eating disorders like anorexia or bulimia should not use Miralax without doctor’s advice. Or else, you could have dangerous Miralax side effects.

This article will help you in answering the question and in informing some important things about Miralax as well, like the precaution, how to use it, and its side effects, whether or not it really is safe for you.

Before Taking Miralax

Tell your doctor beforehand if you:

  • Have allergy to any drugs
  • Have irritable bowel syndrome, ulcerative colitis, nausea or even vomiting with serious stomach pain, and kidney disease
  • Have had an abrupt change in bowel habits that has lasted for 2 weeks at the very least
  • Pregnant or planning to become pregnant since it’s still unknown if Miralax is harmful to an unborn baby.
  • Breastfeeding a baby because it’s also unknown if Miralax passes into breast milk or if it is harmful to a nursing baby.

About taking Miralax during pregnancy, further information is explained below.

There is no evidence about any animal studies. There are also no controlled data in human pregnancy. Systemic exposure if unavoidable, so clinically significant exposure of the baby is not expected. AU TGA pregnancy category B1: Drugs which have been taken by only a limited number if pregnant women and women of childbearing age, without an increase in the frequency of any malformation or other direct or indirect harmful effects on the baby having been observed. Although, studies in animals have not shown evidence of an increased occurrence of fetal damage. US FDA pregnancy category Not Assigned: The US FDA has amended the pregnancy labeling rule for prescription drug products to require labeling that includes a summary of risk, a discussion of the data supporting that summary, and relevant information to help health care providers make prescribing decisions and counsel women about the use of drugs during pregnancy. Pregnancy categories A, B, C, D, and X are being phased out.” (

In other words, Miralax is not recommended for pregnant women unless it’s needed. The same goes for women with nursing child.

The following will answer the question of how long does it take for Miralax to work. It should produce a bowel movement within 1 to 3 days of using the medication.

But how long the reaction occurs may vary depending on the individuals, their diets, how much fluid they take, their exercise, and other factors. Miralax is a polyethylene glycol 3350 type of drug which generally causes loose or even watery feces.

Taking Miralax

How Long Does It Take For Miralax to Work
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Take it precisely as instructed on the label or as prescribed by your doctor. Though Miralax is available in drugstore for purchase freely without prescription, still advice from healthcare provider is better because you can be increasing or lessening the amounts without knowing.

For Miralax powder, the dose marks are on the inside of the medicine cap. Measure your dose with it. Pour the water into 4 to 8 ounces (around 114 to 227 grams) of your preferable hot or cold beverages like juice, water, coffee, tea, or soda. Drink the mixture right away after you stir it. It is not for later consumption.

Do not use Miralax more than once a day. If you’re still constipated after 7 days using the medication, call your doctor immediately. Store Miralax at room temperature and keep it away from heat and moisture.

Miralax Side Effects

Miralax, like all medicines, has side effects which categorized as common and major ones.  are including:

Common side effectsAllergic reaction signsStop taking Miralax and call doctor if
  • Gassy, bloating, upset stomach,
  • Belly pain,
  • Stomach cramps,
  • More frequent stools,
  • Dizziness, or
  • Increased sweating.
  • Hives,
  • Rash,
  • Itching,
  • Wheezing,
  • Difficult breathing or talking,
  • Unusual hoarseness,
  • Tightness in the throat or chest,
  • Swelling of your face, tongue, throat, or lips
  • Swollen, red, peeling or blistered skin with or without fever
  • Serious or even bloody diarrhea,
  • Rectal pain or even bleeding,
  • Very bad dizziness or even passing out,
  • Very bad belly pain,
  • Very bad belly bloating or cramping
  • Blood in your feces, or
  • Serious and worsening stomach pain

Miralax Drug Interactions

The drug interactions are classified as major, moderate, minor, and unknown. Major means you should avoid the drug combination because the risk is greater than the benefits.

Moderate means the combinations are usually avoided and only prescribed under special circumstances. Minor means the interaction has minimum risk. And unknown means the interaction has no information available.

The classifications are only a general guideline. It is rather hard to relate certain drug interaction with any individual as there is large number of variables.

In Miralax case, a total of 233 medicines are commonly known to have interactions with this polyethylene glycol 3350 kind of drug. None of major and unknown classifications are there in the list. 232 from 233 drugs are moderate, while one other is minor. The common medications examined in combination with Miralax include acetaminophen (Tylenol), aspirin, ibuprofen, multivitamin, and Vitamin D3 (cholecalciferol).

Miralax, in Comparison

Apparently, in treating constipation and bowel preparation, there is another laxative beside polyethylene glycol 3350 in the brand of Miralax. It is bisacodyl. Let’s take a look at how they differ from each other.

DifferencePolyethylene Glycol 3350 (Miralax)Bisacodyl
PriceMiralax costs USD 1.77 (around IDR 23,500) per unitWhile Bisacodyl costs a bit higher, USD 4.96 (around IDR 65,500) per unit
FormMiralax comes in the form of oral powder for reconstitution which needs to be diluted with certain amount of beveragesWhile Bisacodyl comes in two forms. The one is oral delayed release tablet which taken by mouth and the other is rectal suppository which enters into human system through rectum
Brand NamesOther brands for polyethylene glycol 3350 are including ClearLax, GaviLax, GiaLax, PEG3350, and SunMarkWhile Bisacodyl is available in the brands of Alophen, Bisa-Lax, Carter’s Little Pills, Correctol, Doxidan Tablet, Ducodyl, Dulcolax, and many more
Side EffectsWe’ve learned about Miralax side effects which has common and major one like has been mentioned previously. That's
Gassy, bloating, upset stomach,
Belly pain,
Stomach cramps,
More frequent stools,
Dizziness, or
Increased sweating.
Bisacodyl has them as well. Its side effects include
Abdominal discomfort,
Faintness with therapeutic doses,
Electrolyte and fluid depletion
Diarrhea, and gastric irritation. Bisacodyl rectal administration may cause irritation and burning sensation of the rectal mucosa and mild proctitis
Pregnancy CategoryWhile the risk for Miralax in pregnant women cannot be ruled outBisacodyl has no proven risk in human, and in this case, in pregnant women
Drug InteractionA total of 233 medicines are commonly known to have interactions with Miralax with 232 moderate and 1 minor drug interactionsA total of 282 medicines are commonly known to have interactions with bisacodyl with 281 moderate and 1 minor drug interactions

Miralax Advantages and Disadvantages

When you get constipation, stool moves slowly through the colon allowing too much water to be removed and eventually makes the stool dry, hard, and difficult to pass. To cure that condition, you need laxative medicines.

However, not all laxatives work similarly with Miralax. Stimulant laxative pills like Senokot, Ex-Lax, and Dulcolax forcefully stimulate your colon nerves.

On the other hand, Miralax works with the water in your body to naturally unblock your system by hydrating, softening, and easing. These three steps are claimed to be without harsh side effects.

Miralax used effectively to cure constipation. But besides that, it can be used to clean the body before you have to undergo a surgery and clean the digestive tract as well as its main job is to encourage healthy and regular bowel movements.

When compared to other laxatives like bisacodyl brands, Miralax claims to be excellent for a few reasons. First, it appears as an osmotic laxative. Osmotic laxative means it works with the water within the body to ease and soften stool through the colon. Being works as an osmotic laxative makes Miralax to be more effective and less painful to its users.

Even so, there’s no such thing as perfect medicine in this whole world. Every drug has its own risk and benefits, advantages and disadvantages. The advantages of Miralax have been exposed in three previous paragraphs. It’s time to know what Miralax disadvantages are.

Miralax needs to be dissolved in the right amount of beverages rather than swallow it whole as a pill. It’s okay to do it while you’re at home, but rather difficult when you’re not
Miralax doesn’t work overnight. Through periodic usage, it takes up to four days to have some reaction of bowel movement
Miralax is not recommended to be taken for more than a week. So if you haven’t succeeded within a week, you’ll need to visit your doctor again for other laxative options


Home Remedies for Constipation

While we’re on the subject of constipation, here is some additional information about herbal laxatives which are able to stop constipation and prevent it from happening again.

1. Black seeds
2. Olive leaves
3. Flax seeds
4. Cascara sagrada
5. Certified organic cloves
6. Senna
7. Slippery elm
8. Bentonite
9. Turkey rhubarb
10. Aloe vera
11. Peppermint
12. Wormseed


Hopefully, when you reach the bottom of this article, your question of how long does it take for Miralax to work has found the answer. Nonetheless, all the things that informed in this article should not be used as your decision to take this type of medicine. Because, only health care providers have the knowledge and been on trainings to decide which medicine goes best for which patients.

Repatha Side Effects and Everything You Should Know About It

Repatha Side Effects

Are you currently using Repatha? Or perhaps, consider to start using it? Well before taking any decision, it will be better to know more information about Repatha side effects along with its other details.

Repatha is a brand name of evolocumab type of medicine. It specifically works as liver helper to reduce the levels of low-density lipoprotein or LDL, often refers to ‘bad’ cholesterol, which circulates in one’s blood.

Repatha is used along with a low-fat diet and other cholesterol-reducing medications in people with heterozygous or homozygous familial hypercholesterolemia. Both familial hypercholesterolemias are the inherited types of high cholesterol which can cause high blood levels of LDL and can be the cause of plaque building up inside the arteries.

People with atherosclerosis or arteriosclerosis also use Repatha. Atherosclerosis or arteriosclerosis is heart or blood vessel problems caused by plaque that harden or build up in the arteries. But, it’s unknown if Repatha can lower the risk of heart attack, stroke, or other heart complications in people with high blood levels of cholesterol.

Now, one question emerges as we know how good this medicine is related to reducing high cholesterol level: what are Repatha side effects? Don’t worry; we will discuss the matter in this article. Along with its side effects, how to take the medicine, dosage, and warnings that follow will also be included in the topic.


Repatha Side Effects and Everything You Should Know About It
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Repatha shouldn’t be used by anyone who has allergy to it or by anyone younger than 13 years old without prescriptions. Taking the medicine without advice from healthcare providers only worsen the Repatha side effects on its users. Here are the things you should tell your doctors to make sure that this medicine is safe for you.

  • If you have kidney or liver disease,
  • If you have allergy to latex,
  • If you are pregnant or planning to be pregnant at the moment, because it’s still unknown whether Repatha can harm an unborn baby or not,
  • If you are breastfeeding a baby since it’s also still unknown whether the medicine will pass into breast milk or not.

Repatha Usage

Repatha Side Effects to Usage
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Take Repatha precisely as it was prescribed to you. Depend on the amount of dose given to you, Repatha is generally taken once or twice a month. You may separately use up to three injections at one time.

Follow all the instructions and directions on your prescription package and label. Do not increase or lessen the dosage amount without doctors’ advice since there’re Repatha side effects you should concern about.

Repatha usage suggestions:

  • Repatha is injected beneath the skin. You may inject the medicine yourself with the information of how to do it from your doctor.
  • Repatha is available in a SureClick prefilled autoinjector. Besides that it is also available in a Pushtronex on-body infusor with prefilled cartridge, or a prefilled syringe.
  • With a SureClick autoinjector or a prefilled syringe, you may take up to 15 seconds to inject the medicine. If you have to use more than one injection at a time, be sure to finish all of them in no more than 30 minutes.
  • The Pushtronex on-body infusor is a special hands-free device placed on the skin that needs around 9 minutes to slowly deliver a full dose of Repatha. During that time, you can do activities like bending, reaching, or walking.
  • Doctors will explain about where the perfect places in your body to inject the medicine or to place the on-body infusor. Do not use the same place twice in a row each time you give an injection.
  • The prefilled syringe, injection device, or cartridge is single-use. Dispose it immediately after one use. But you can’t throw the entire medical disposal away randomly. You have to use a puncture-proof ‘sharps’ disposal container. Keep the container away from your children and pets’ reach.
  • It’s safer to store Repatha in the refrigerator in its original box and protect it from heat and light. But do not freeze. Throw away any frozen medicine.
  • Let the medicine cool down at room temperature for 30 to 45 minutes before you use it. Do not heat the injection device.
  • If stored at cool room temperature, use it in no more than 30 days.
  • Do not drop the injection device or do not use the dropped injection device.
  • Do not shake the medicine.
  • Do not use the medicine if it has particles in it or has changed colors.
  • Do not stop taking Repatha without advice from your doctor. Otherwise, your LDL levels may rise.
  • Do not inject Repatha into sore, bruised, hardened, or scarred skin.

Repatha Dose

Repatha Side Effects Dose Usage 140 mg/mL
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The usual dose for adult with hyperlipidemia is as follows:

  • 140 mg subcutaneously every 2 weeks using prefilled syringe or prefilled SureClick autoinjector, or
  • 420 mg subcutaneously once a month using Pushtronex system (on-body infusor with prefilled cartridge)

The medicine with such dose shouldn’t be given in patients without atherosclerotic cardio vascular disease or familial hypercholesterolemia. Or, the Repatha side effects may occur worse than they should be.

While the usual dose for adult with homozygous familial hypercholesterolemia is as follows:

  • 420 mg subcutaneously once a month
Repatha Side Effects Usage Dose
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Measure low density lipoprotein cholesterol (LDL-C) levels every 4 to 8 weeks after start using the drug.

If you miss a dose, use the missed dose within 7 days after the due injection time. Skip the missed dose if you pass more than 7 days for the injection.

After missed a dose, return to your original schedule and use the drug again when the due time of your next schedule is coming up. Do not use any extra medicine to make up the missed dose.

Repatha Side Effects

Repatha Side Effects Colesterol
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Besides causing the expected effects of reducing the high blood levels of bad cholesterol, Repatha may also cause unwanted side effects. The side effects of Repatha are categorized as common and major effects which you should get medical help if you have them.

While common Repatha side effects themselves are distinguished into more common and less common side effects. These effects occurred may not need any medical attention. They will disappear in time your body has adapted with the medicine work.

More common effects are:

Less common effects are:

While allergic reactions to Repatha are:

  • Hives, severe itching, or rash,
  • Having difficulty with swallowing or breathing,
  • Swelling of your face, tongue, throat, eyes, inside of the nose, or lips,
  • Fever,
  • Nausea,
  • Skin reddening, especially around the ears,
  • Unusual weakness or tiredness.

Repatha Side Effects for Specific Populations

Repatha Side Effects for Specific Populations
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1. Pregnancy

There are no data available related to the risk of using Repatha in pregnant women.

In the animal reproduction studies, there were no effects on pregnancy. It also shows no effects on neonatal/infant development when monkeys were subcutaneously administered evolocumab from organogenesis through parturition at dose exposures up to 12 times results the exposure at the maximum recommended human dose of 420 mg for every month. In a similar study with another drug in the PCSK9 inhibitor antibody class, humoral immune suppression was observed in infant monkeys exposed to that drug in utero at all doses. You should know that the exposures where immune suppression occurred in infant monkeys were greater than those expected clinically. No assessment for immune suppression was conducted with evolocumab in infant monkeys. Measurable evolocumab serum concentrations were observed in the infant monkeys at birth at comparable levels to maternal serum, indicating that evolocumab, like other IgG antibodies, crosses the placental barrier.” (

PCSK9 is proproteinconvertase subtilisin kexin 9
IgG is immunoglobulin G

The entire experiment implies that evolocumab in the brand of Repatha is safe to be used in pregnant women as the monoclonal antibodies are unlikely crossing the placenta in the first trimester.

However, the opposite occurrence is likely to happen in increasing amounts in the second and third trimeseter. All in all, the choice to use ‘likely’ and ‘unlikely’ words emphasize that there are no such things to ensure what really will happen.

Therefore, consider the benefits and risks like Repatha side effects to the fetus before prescribing the medicine to pregnant women.

2. Lactation

There are also no data regarding any harm Repatha can cause to human milk, breastfed infant, or milk production. But still, it will be best to consider the breastfeeding health benefits and development before prescribing the medicine on breastfeeding women.

3. Pediatric Use

The Repatha safety and effectiveness in adolescents (ages 13 to 17 years old) were established and it was confirmed to be generally similar to that observed among adult patients with HoFH (homozygous familial hypercholesterolemia).

Also, the Repatha are safe and effective in pediatric patients with HoFH who are younger than 13 years old and in pediatric patients with primary hyperlipidemia or HeFH weren’t established yet.

4. Geriatric Use

There are no differences in Repatha safety and effectiveness between 1420 patients in the ages of more than 65 years old and younger patients. But we can’t rule out the greater sensitivity of the elderly.

5. Renal Impairment

No need to adjust the dose for patients with mild to moderate renal impairment.

6. Hepatic Impairment

There is also no need to adjust the dose for patients with mild to moderate hepatic impairment.

Potential Advantages and Disadvantages

Repatha Side Effects Potential Advantages and Disadvantages
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Before Repatha is invented, people with high levels of bad cholesterol were treated with complicated therapy they didn’t obey which led them failed to achieve an optimal LDL-C of 100 mg/dL. At least, one in ten cardiovascular disease (CVD) events is directed right to disobedience.

Now, with the latest breakthrough in cardiology – Repatha – people with HoFH or HoFH can be treated easily with only injections that they get either once a month or once every two weeks.

Furthermore, they can do the treatment by themselves at home. The only disadvantage besides the possible occurrences of Repatha side effects is that it’s more costly than the current standard lipid-modifying therapy (LMT) treatment option.

In Comparison

Repatha Side Effects In Comparison
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Like has been mentioned above, before Repatha is invented, people with high cholesterol are treated with therapy. Apparently, the therapy involves Statins, the most common medications types used to help reduce cholesterol.

While Repatha is injected under the skin, Statins are taken by mouth. They come in the form of capsules or tablets. There are many types of Statins available today, including:

  • Atorvastatin (Lipitor),
  • Flustatin (Lescol),
  • Lovastatin (Altoprev),
  • Pravastatin (Pravachol),
  • Rosucastatin (Crestor),
  • Simvastatin (Zocor), and
  • Pitavastatin (Livalo).

Unlike Repatha that can only be prescribed for certain types of people, Statins can be given to any people with high cholesterol. And since Statins has existed for much longer time (available since 1980s) than Repatha (approved by FDA in 2015), many people know how effective Statins are despite the difficulty they are used in therapy.

On the other hand, since Repatha is newer, it has much less long-term safety data. Also, the cost of Repatha is much more expensive compared to Statins.

We’ve learned about Repatha side effects which including common and major ones. Statins, like all medications, have them as well. The common side effects from Statins are joint and muscle pain, nausea, stomach pain, constipation, and headaches.

And their major effects are liver damage, increased blood glucose levels, higher risk of type 2 diabetes, cognitive (mental) problems, and muscle damage leading to rhabdomyolysis.


That’s all about Repatha side effects, what it is good for, and other thing you should know about this certain medicine. Let’s hope to never get the chance to take any evolocumab in our lifetime due to any reason. Let’s live a healthy life!

Otezla Side Effects, Uses, Dosage, and Warnings

Otezla Side Effects, Uses, Dosage, and Warnings

Otezla, a brand name of apremilast drug kind, is a medication used for treating active psoriatic arthritis symptoms in adults. It relieves swelling in the joints and around them as well as tenderness, but Otezla is not a cure for this disease, nevertheless. Evenmore, only small numbers of people that aware on Otezla side effects.

Besides psoriatic arthritis, this drug is also a medication for treating moderate to severe plaque psoriasis. It supports the treatment of phototherapy or others received by people with the said disease. Otezla acts as an inhibitor that inhibits an enzyme spontaneous production from human immune system that affects particular cells which contribute to inflammation in the body.

We know the drug is extremely helpful yet we aware, too, that nothing comes with only its good side. This article will discuss about Otezla side effects and along with that are its uses, how much patients should take it a day and warnings that follow.


Otezla Side Effects, Uses, Dosage, and Warnings
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Before taking the medicine, you should read and follow all the instruction on the medicine package and label. You should, as well, tell all your medical officers about any allergies you have, medicines you consume, and conditions you are in now. You shouldn’t take Otezla if you have allergy to apremilast.

Things you must tell your doctor in order to make sure this drug is safe for you are:

  • If you have any history related to either depression or suicidal thoughts or actions. This is pretty important because people tend to have depression or thoughts about suicide as Otezla side effects during their medical treatment using this medicine. Your doctor will check the progress you make at regular visits and your family as well as other caregivers should be alert to your symptoms and mood changes.
  • Whether you have kidney disease or not.
  • If you take seizure medication, like phenobarbital, carbamazepine, and phenytoin for example.
  • If you’re in medical treatment of either HIV/AIDS or tuberculosis.
  • Whether or not you are pregnant or planning to become pregnant. Food and Drug Administration (FDA) of United States approved this drug on 2014 for treating adults with said diseases and may be used for pregnant women. Yet in Europe, it is contraindicated during pregnancy as it led to miscarriages and other pregnancy problems in experiments using female pregnant monkeys and mice. Conclusion: it is still unknown whether Otezla can harm an unborn baby.
  • If you’re breastfeeding a baby. It is also unknown if Otezla can harm a nursing baby.

Like has been mentioned before, US FDA approved this drug for treating adults, so do not give Otezla to anyone under 18 years old without prescription.

Otezla Usage

Otezla usage suggestions for
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Take Otezla precisely as your doctor prescribes you. Follow all instructions and directions on the medicine package and label. Your doctor may change the dosing schedule or your dose sometimes to ensure you get the best outcome. Do not increase or lessen the amount of Otezla, and you shouldn’t consume it longer than it is recommended.

Otezla usage suggestions:

  • It can be taken with or without food.
  • Swallow it whole without chewing, breaking, or crushing the tablet.
  • Store at room temperature. Keep it away from heat and moisture.
  • Record your body weight meticulously during Otezla treatment. If you undergo any major weight loss as one of the Otezla side effects, go tell your doctor immediately.

The usual dose for adults with psoriatic arthritis is as follows:

  • Day 1: 10 mg orally once a day (AM)
  • Day 2: 10 mg orally twice a day (AM and PM)
  • Day 3: 10 mg orally once a day (AM); 20 mg orally once a day (PM)
  • Day 4: 20 mg orally twice a day (AM and PM)
  • Day 5: 20 mg orally once a day (AM); 30 g orally once a day (PM)

Maintenance dose: 30 mg orally twice a day (AM and PM). Maintenance dose starts from Day 6 and after.

If you miss a dose, take the missed dose as soon as you remember. But skip it if your next scheduled dose comes up closer. Don’t take any extra medicine to make up the missed dose.

For patients with severe kidney disorders, Otezla dosage should be reduced to 30 mg once per day. It is suggested, for starting dosage titration in this group, that this medicine be titrated using only the AM schedules and skip the PM doses.

Otezla Side Effects

Otezla Side Effects, Adverse Reaction Frequency
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This drug affects its users in some ways. The Otezla side effects can be categorized as common effects, where common effects has two groups of more common and less common side effects, allergic signs, and major side effects which you should call your doctor immediately whenever you have one of them.

The common side effects may not require any medical attention. These happen because your body needs to adapt with how Otezla works. In time your body gets used to this medicine, the common side effects will disappear. But still you should consult your health care professional if any of the following side effects continue, or if there’s any that takes your concern.

More common side effects

Less common side effects

On the contrary with the previous ones, the following side effects will need medical attention. Check with your doctor immediately if these occur during Otezla treatment.

Allergic signs:

  • Hives, itching, rash,
  • Difficult breathing or swallowing,
  • Swelling of your hands, feet, face, lips, throat, eyelids, or lips,
  • Fast heartbeat,
  • Fever,
  • Hoarseness,
  • Irritation,
  • Joint pain or stiffness,
  • Tightness in the chest

Major side effects:

  • Major weight loss,
  • Mood changes, like feeling empty or sad, lose the interest and pleasure, and irritability,
  • New or worsening depression,
  • Thoughts of hurting yourself or even suicide,
  • Discouragement, and
  • Behavior changes, like lack of appetite, tiredness, and having trouble with concentrating and sleeping.

Otezla Warnings

As there are so many Otezla side effects both minor and major, you should continue reading the following warnings.

1. Diarrhea, Nausea, and Vomiting

These three are listed as more common side effects of Otezla. Though has been stated that the common ones may not need any medical attention, still the occurrences of diarrhea, nausea, and vomiting should not be underestimated.

Wrong measurement can lead to severe side effects and complications.

There have been post marketing reports of severe diarrhea, nausea, and vomiting associated with the use of Otezla. Most events occurred within the first few weeks of treatment. In some cases, patients were hospitalized. Patients 65 years of age or older and patients taking medications that can lead to volume depletion or hypotension may be at higher risk of complications from severe diarrhea, nausea, or vomiting.” (

2. Depression

It is strongly suggested that patients should tell their doctor if they have any history of depression or suicidal thoughts or behavior, as taking Otezla may increase such reactions of depression. The prescribers have to thoroughly weigh the benefits and risks in treating such patients with Otezla.

Patients and their families or other caregivers should be alerted the possible occurrences of depression, suicidal thoughts, or other drastic mood changes and to call the healthcare providers immediately if such effects occur. Then, the prescribers should evaluate whether to continue treating the patients with Otezla after that.

3. Weight Decrease

During treatment with Otezla, weight decrease from 5% to 10% of body weight is still understandable and considered common. But still, patients should have their body weight monitored consecutively. Any major or unexplained weight loss should be evaluated and prescribers should consider discontinuing treatment with Otezla.

Drug Interaction

It is not recommended to use cytochrome P450 enzyme inducers, such as phenobarbital, rifampin, phenytoin, and carbamazepine, at the same time with using Otezla. Enzyme inducers work in reducting the aprmilast systemic exposure which leads to Otezla efficacy loss.

In a complete classification, there are total of 70 kinds of drugs that are known to combine with Otezla or apremilast. The classifications cover major, moderate, and minor drug interactions.

By definition, major drug interactions means the combinations should be avoided because the risk is greater than the benefit, moderate drug interactions means the combinations are commonly avoided unless under certain circumstances, while minor drug interactions means the combinations minimize the risk.

Some common medications which are examined to be combined with Otezla are aspirin, Fish Oil, folic acid, ibuprofen, metformin, and Vitamin D3.

All in all, do not stop taking any medications without advice from your healthcare providers despite all of the Otezla side effects that may occur to you. But then again, it is strongly recommended to tell your doctor about all the medicine you’re taking at the moment before you take Otezla.

Potential Advantages and Disadvantages

Taking apremilast in the brand of Otezla should be under prescriptions because taking it carelessly without healthcare providers’ consent will only worsen ones diseases. It could lead to other adverse effects, such as interstitial lung disease, or liver toxicity.

It is also possible to increase the risk of serious infections besides all the side effects Otezla causes, like depression, suicidal thoughts or behavior, weight loss, and drug interactions.

Further disadvantage of this drug is its cost. The wholesale acquisition cost (WAC) is USD1.875 (equals to IDR25.040.625) and the average wholesale price (AWP) is USD2.250 (equals to IDR30.006.000) for 60 tablets of 30 mg apremilast. While for 2-week starter apremilast, the WAC is USD843,75 (around IDR11.252.250) and the AWP is USD1.012,50 (around IDR13.502.700).

From the prolog in the first two paragraphs, we know that Otezla is extremely helpful in reducing the symptoms of psoriasis and active psoriatic arthritis in adults. But what else are the Otezla advantages? Do they outweigh the disadvantages or do they really worth the Otezla side effects?

Well, psoriasis is a chronic inflammatory disease that affects around up to 3% of the world population. It is taking up almost all the population of Indonesia, the fourth most populous country in the whole world.

While psoriatic arthritis is a disease that happens in around 30% of people with psoriasis. Patients with both diseases usually experience decreased functionality, quality of life, and productivity, highly potential in work absence and even long-term disability.

Now, with the right amount of dose, Otezla can help to overcome the possible disability ones have to undergo in the future because of psoriasis and psoriatic arthritis.

In Comparison

Apparently, Otezla (apremilast) is not the only medication which is able in treating patients with psoriasis and psoriatic arthritis. There is also Stelara (ustekinumab) in comparison that is also can do the same. Let’s take a look at how these two drugs differ from each other.

People take Otezla by mouth as it forms an oral tablet, while Stelara should be injected. As these two are both specialty drugs to treat certain diseases, their cost are expensive. However, the estimated monthly cost for Stelara is a little bit higher than Otezla.

We’ve learned about Otezla side effects which include common and major ones. Stelara, like all drugs, has them as well. Their common side effects are pretty similar: headache and respiratory infections.

But instead of diarrhea, nausea, and weight loss that Otezla causes, Stelara affects in tiredness and nose or throat infections. Meanwhile, the major side effects of Stelara are allergic reaction with symptoms like wheezing, tightness in the throat, and trouble breathing. And also increase the risk of skin cancer.

How about their effectiveness in treating patients? When using the medicines with DMARD (disease-modifying anti-rheumatic drug) treatment, Otezla shows that more than one-third of patients have improvement by 20%, while Stelara shows that about one-half of patients have improvement by 20% and about one-fourth of patients have 50% improvement.


After all, this article aims to give the information about what Otezla side effects are and what it is good for. It is always in our sane mind to hopefully never get the chance to take any apremilast in our lifetime due to any reason. Let’s live a healthy life!