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Drug · FAERS side-effect profile with label screen

Apremilast side effects: what 145,474 FDA adverse event reports show

Apremilast · Otezla · 1,170 reaction terms · 568,642 drug–reaction co-reports · data 2026-09-14
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Drug class

Phosphodiesterase 4 Inhibitor

FDA label (Established Pharmacologic Class) · compare the class

Brand names

Otezla

openFDA label

Who reports

145,474 reports · 24% serious · 5,952 with death outcome · 66% female

openFDA FAERS counts, all years, deduplication not applied

Used for

OTEZLA/OTEZLA XR, an inhibitor of phosphodiesterase 4 (PDE4), is indicated for the treatment of: Adult patients with: Active psoriatic arthritis ( 1.1 ) Plaque psoriasis who are candidates for phototherapy or systemic therapy ( 1.2 ) Oral ulcers associ.

FDA label, Indications and Usage

What it is

Apremilast is a member of the class of isoindoles that is isoindole-1,3-dione substituted at position 4 by an acetamido group and at position 1 by a 1-(3-ethoxy-4-methoxyphenyl)-2-(methylsulfonyl)ethyl group.

PubChem CID 11561674 (ChEBI)

Boxed warning

None in the current label

How to read this page. FAERS is a spontaneous-reporting system: counts are not incidence rates and a signal is not proof of causation. Each reaction below is run through an automated screen — is the term in the FDA label (known), in the indications (the disease being treated), an administrative/coding term, or none of these (unlabeled)? That screen is mechanical text matching, not a causality assessment. The 30 hand-written Bradford Hill assessments are on the causality assessment page. Not medical advice.

Causality screen of the 40 strongest signals

Labeled adverse reaction 2Labeled (related wording) 1Likely indication confounding 3Lab value / disease marker 8Not in label — unassessed 26
What the badges mean

Strongest disproportionality signals

Flagged terms (PRR ≥ 2, χ² ≥ 4, n ≥ 10), ranked by PRR; infinite PRRs (no comparator reports) excluded. The EBGM column is a second, shrinkage-based estimate (MGPS) with its 5th percentile EB05 and the BCPNN IC025; a pair flagged by PRR alone is marked PRR-only and should be read as fragile. The strata column recomputes the PRR on serious reports only and flags pairs whose reports are unusually skewed by sex or come mostly from consumers rather than clinicians. 1,130 further terms are in the interactive explorer. Reaction links open the term's cross-drug page.

Show:
ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Anti-cyclic citrullinated peptide antibody430265.2
225.9–311.3ROR 266.0 · χ² 39,238 / p <1e-300
92.4 EB05 85.3 · IC025 +6.2
3/3 methods agree
Lab value / disease markerserious n=430 · ♀ 100% (drug 66%) · 95% cliniciannot reported in cached trials
C-reactive protein497175.9
154.2–200.7ROR 176.5 · χ² 38,418 / p <1e-300
78.7 EB05 73.0 · IC025 +6.0
3/3 methods agree
Lab value / disease markerserious n=497 · ♀ 100% (drug 66%) · 97% cliniciannot reported in cached trials
Hepatic enzyme75168.1
120.3–235.0ROR 168.2 · χ² 5,612 / p <1e-300
75.9 EB05 62.5 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious n=75 · ♀ 100% (drug 66%) · 100% cliniciannot reported in cached trials
Lupus vulgaris602148.4
132.4–166.3ROR 149.0 · χ² 42,906 / p <1e-300
72.7 EB05 68.0 · IC025 +6.0
3/3 methods agree
Not in label — unassessedserious n=602 · ♀ 100% (drug 66%) · 96% cliniciannot reported in cached trials
Deep vein thrombosis postoperative975143.3
131.1–156.6ROR 144.3 · χ² 68,321 / p <1e-300
71.5 EB05 67.8 · IC025 +6.0
3/3 methods agree
Not in label — unassessedserious n=975 · ♀ 100% (drug 66%) · 96% cliniciannot reported in cached trials
Rheumatic fever2,152140.7
132.6–149.3ROR 142.8 · χ² 149,501 / p <1e-300
70.9 EB05 68.5 · IC025 +6.1
3/3 methods agree
Not in label — unassessedserious n=2,152 · ♀ 100% (drug 66%) · 96% cliniciannot reported in cached trials
Swollen joint count increased1,531139.7
130.2–149.9ROR 141.2 · χ² 105,931 / p <1e-300
70.7 EB05 67.7 · IC025 +6.0
3/3 methods agree
Lab value / disease markerserious n=1,531 · ♀ 100% (drug 66%) · 96% cliniciannot reported in cached trials
Grip strength111132.9
102.5–172.2ROR 133.0 · χ² 7,417 / p <1e-300
68.2 EB05 58.2 · IC025 +5.4
3/3 methods agree
Not in label — unassessedserious n=111 · ♀ 100% (drug 66%) · 100% cliniciannot reported in cached trials
Swollen joint count115126.9
98.6–163.2ROR 127.0 · χ² 7,499 / p <1e-300
66.6 EB05 57.0 · IC025 +5.4
3/3 methods agree
Labeled adverse reaction
exact term
serious n=115 · ♀ 100% (drug 66%) · 95% cliniciannot reported in cached trials
Red blood cell sedimentation rate130124.1
98.0–157.0ROR 124.2 · χ² 8,382 / p <1e-300
65.9 EB05 56.9 · IC025 +5.4
3/3 methods agree
Lab value / disease markerserious n=130 · 92% cliniciannot reported in cached trials
Facet joint syndrome1,377112.1
104.5–120.3ROR 113.2 · χ² 84,477 / p <1e-300
62.9 EB05 60.1 · IC025 +5.9
3/3 methods agree
Not in label — unassessedserious n=1,377 · ♀ 100% (drug 66%) · 97% cliniciannot reported in cached trials
Subcutaneous drug absorption impaired20788.3
74.2–105.1ROR 88.5 · χ² 10,942 / p <1e-300
54.5 EB05 48.5 · IC025 +5.4
3/3 methods agree
Not in label — unassessedserious n=207 · ♀ 100% (drug 66%) · 100% cliniciannot reported in cached trials
Adjustment disorder with depressed mood76588.2
80.6–96.5ROR 88.7 · χ² 40,549 / p <1e-300
54.6 EB05 51.4 · IC025 +5.6
3/3 methods agree
Not in label — unassessedserious n=760 · ♀ 100% (drug 66%) · 96% cliniciannot reported in cached trials
Retinitis60381.5
73.7–90.1ROR 81.8 · χ² 30,353 / p <1e-300
52.0 EB05 48.6 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=603 · ♀ 100% (drug 66%) · 97% cliniciannot reported in cached trials
Dislocation of vertebra76775.8
69.5–82.7ROR 76.2 · χ² 36,799 / p <1e-300
49.6 EB05 46.7 · IC025 +5.5
3/3 methods agree
Not in label — unassessedserious n=767 · ♀ 100% (drug 66%) · 96% cliniciannot reported in cached trials
X-ray abnormal59972.7
65.9–80.3ROR 73.0 · χ² 27,930 / p <1e-300
48.3 EB05 45.1 · IC025 +5.4
3/3 methods agree
Lab value / disease markerserious n=599 · ♀ 100% (drug 66%) · 98% cliniciannot reported in cached trials
Hypocholesterolaemia9564.2
50.4–81.8ROR 64.2 · χ² 4,020 / p <1e-300
44.1 EB05 37.1 · IC025 +4.8
3/3 methods agree
Not in label — unassessedserious n=94 · ♀ 100% (drug 66%) · 100% cliniciannot reported in cached trials
Rheumatoid factor positive1,75062.7
59.2–66.3ROR 63.4 · χ² 73,522 / p <1e-300
43.7 EB05 42.0 · IC025 +5.4
3/3 methods agree
Lab value / disease markerserious n=1,750 · ♀ 100% (drug 66%) · 96% cliniciannot reported in cached trials
Anti-cyclic citrullinated peptide antibody positive2,09460.1
57.1–63.2ROR 61.0 · χ² 85,356 / p <1e-300
42.4 EB05 40.9 · IC025 +5.3
3/3 methods agree
Lab value / disease markerserious PRR 103.9 · ♀ 98% (drug 66%) · 96% cliniciannot reported in cached trials
Duodenal ulcer perforation2,15559.8
56.9–62.9ROR 60.7 · χ² 87,506 / p <1e-300
42.3 EB05 40.8 · IC025 +5.3
3/3 methods agree
Not in label — unassessedserious PRR 103.0 · ♀ 100% (drug 66%) · 96% cliniciannot reported in cached trials
Sleep disorder due to general medical condition, hypersomnia type2855.7
36.0–86.3ROR 55.7 · χ² 1,040 / p 2e-228
39.2 EB05 28.5 · IC025 +3.9
3/3 methods agree
Not in label — unassessedserious n=28 · ♀ 100% (drug 66%) · 100% cliniciannot reported in cached trials
Peripheral venous disease1,01549.0
45.6–52.6ROR 49.3 · χ² 35,390 / p <1e-300
36.6 EB05 34.7 · IC025 +5.1
3/3 methods agree
Not in label — unassessedserious n=1,013 · ♀ 100% (drug 66%) · 96% cliniciannot reported in cached trials
Seronegative arthritis28348.4
42.3–55.4ROR 48.5 · χ² 9,757 / p <1e-300
36.2 EB05 32.8 · IC025 +4.9
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious n=283 · ♀ 97% (drug 66%) · 95% cliniciannot reported in cached trials
C-reactive protein abnormal1,57746.9
44.3–49.7ROR 47.4 · χ² 53,181 / p <1e-300
35.5 EB05 34.0 · IC025 +5.0
3/3 methods agree
Lab value / disease markerserious n=1,572 · ♀ 91% (drug 66%) · 95% cliniciannot reported in cached trials
Bone erosion85445.6
42.3–49.3ROR 45.9 · χ² 28,150 / p <1e-300
34.7 EB05 32.8 · IC025 +5.0
3/3 methods agree
Not in label — unassessedserious n=854 · ♀ 96% (drug 66%) · 92% cliniciannot reported in cached trials
Enthesopathy35942.3
37.6–47.6ROR 42.4 · χ² 11,114 / p <1e-300
32.7 EB05 30.0 · IC025 +4.8
3/3 methods agree
Not in label — unassessedserious n=344not reported in cached trials
Helicobacter infection2,12937.9
36.1–39.8ROR 38.5 · χ² 60,310 / p <1e-300
30.1 EB05 29.0 · IC025 +4.8
3/3 methods agree
Not in label — unassessedserious PRR 77.4 · ♀ 100% (drug 66%) · 96% cliniciannot reported in cached trials
Psoriatic arthropathy8,17536.6
35.8–37.5ROR 38.8 · χ² 225,415 / p <1e-300
29.3 EB05 28.8 · IC025 +4.8
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious PRR 62.7not reported in cached trials
Folliculitis2,07536.1
34.4–37.9ROR 36.6 · χ² 56,388 / p <1e-300
28.9 EB05 27.9 · IC025 +4.8
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 81.6 · ♀ 99% (drug 66%) · 96% cliniciannot reported in cached trials
Muscle injury1,58634.4
32.6–36.3ROR 34.8 · χ² 41,330 / p <1e-300
27.8 EB05 26.7 · IC025 +4.7
3/3 methods agree
Not in label — unassessedserious PRR 73.4 · ♀ 100% (drug 66%) · 97% cliniciannot reported in cached trials
Hand deformity2,40632.3
30.9–33.8ROR 32.9 · χ² 59,472 / p <1e-300
26.5 EB05 25.6 · IC025 +4.7
3/3 methods agree
Not in label — unassessedserious PRR 70.1 · ♀ 99% (drug 66%) · 96% cliniciannot reported in cached trials
Sleep disorder due to general medical condition, insomnia type1,16631.7
29.8–33.8ROR 32.0 · χ² 28,325 / p <1e-300
26.1 EB05 24.9 · IC025 +4.6
3/3 methods agree
Not in label — unassessedserious n=1,149 · ♀ 99% (drug 66%) · 96% cliniciannot reported in cached trials
Pemphigus2,21331.1
29.7–32.5ROR 31.5 · χ² 52,809 / p <1e-300
25.6 EB05 24.8 · IC025 +4.6
3/3 methods agree
Not in label — unassessedserious PRR 62.7 · ♀ 100% (drug 66%) · 96% cliniciannot reported in cached trials
Granuloma skin14329.9
25.0–35.8ROR 29.9 · χ² 3,275 / p <1e-300
24.8 EB05 21.6 · IC025 +4.2
3/3 methods agree
Not in label — unassessedserious n=143 · 92% cliniciannot reported in cached trials
Breast cancer stage iii1,06928.6
26.8–30.5ROR 28.8 · χ² 23,650 / p <1e-300
23.9 EB05 22.8 · IC025 +4.5
3/3 methods agree
Not in label — unassessedserious n=1,069 · ♀ 100% (drug 66%) · 97% cliniciannot reported in cached trials
Synovitis2,98128.4
27.3–29.5ROR 29.0 · χ² 65,619 / p <1e-300
23.8 EB05 23.1 · IC025 +4.5
3/3 methods agree
Not in label — unassessedserious PRR 60.8 · ♀ 95% (drug 66%) · 95% cliniciannot reported in cached trials
Onychomadesis67828.0
25.8–30.4ROR 28.1 · χ² 14,700 / p <1e-300
23.5 EB05 22.1 · IC025 +4.4
3/3 methods agree
Not in label — unassessedserious n=645 · ♀ 98% (drug 66%) · 94% cliniciannot reported in cached trials
Psoriasis20,58526.8
26.4–27.2ROR 31.1 · χ² 432,584 / p <1e-300
22.7 EB05 22.4 · IC025 +4.5
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious PRR 26.3not reported in cached trials
Overlap syndrome10826.6
21.7–32.7ROR 26.6 · χ² 2,219 / p <1e-300
22.5 EB05 19.1 · IC025 +4.0
3/3 methods agree
Not in label — unassessedserious n=108 · ♀ 100% (drug 66%) · 92% cliniciannot reported in cached trials

Trial evidence (ClinicalTrials.gov)

✓ Trial adverse-event data found on ClinicalTrials.gov

Largest completed trials with posted results that list Apremilast as a study intervention. The right-hand column of the signal table shows whether each FAERS term was also recorded in these trials, with a real denominator (0 of 40 signal terms matched).

Caveats: trial populations, doses and follow-up differ from the reporting population; AE terms are sponsor-coded and matched here by wording; absence from a trial list means the term was not reported above the sponsor's frequency threshold, not that it cannot occur.

Most frequently reported reactions

By raw co-report count, regardless of disproportionality. Common terms here are often the illness itself or generic outcomes.

ReactionReportsPRR 95% CI · ROR · χ²/pEBGM EB05 · IC025Label screenSerious-only & strataTrial cross-check
Diarrhoea (diarrhea)24,6245.7
5.6–5.8ROR 6.7 · χ² 94,634 / p <1e-300
5.5 EB05 5.5 · IC025 +2.4
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 4.7NCT03611751: 35/254 (13.8%) on Apremilast; 19/254 (7.5%) control
Nausea22,1774.1
4.1–4.2ROR 4.7 · χ² 53,339 / p <1e-300
4.1 EB05 4.0 · IC025 +2.0
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 4.1NCT03611751: 26/254 (10.2%) on Apremilast; 3/254 (1.2%) control
Psoriasis20,58526.8
26.4–27.2ROR 31.1 · χ² 432,584 / p <1e-300
22.7 EB05 22.4 · IC025 +4.5
3/3 methods agree
Likely indication confounding
term in indications; also in warnings
serious PRR 26.3not reported in cached trials
Headache17,9134.2
4.2–4.3ROR 4.7 · χ² 43,996 / p <1e-300
4.1 EB05 4.1 · IC025 +2.0
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 5.1NCT03611751: 30/254 (11.8%) on Apremilast; 14/254 (5.5%) control
Drug ineffective (drug did not work)15,5651.7
1.7–1.7ROR 1.8 · χ² 4,863 / p <1e-300
1.7 EB05 1.7 · IC025 +0.7Reporting / coding artifactserious PRR 3.8not reported in cached trials
Abdominal discomfort8,2347.4
7.3–7.6ROR 7.8 · χ² 43,802 / p <1e-300
7.1 EB05 7.0 · IC025 +2.8
3/3 methods agree
Not in label — unassessedserious PRR 13.7not reported in cached trials
Psoriatic arthropathy8,17536.6
35.8–37.5ROR 38.8 · χ² 225,415 / p <1e-300
29.3 EB05 28.8 · IC025 +4.8
3/3 methods agree
Likely indication confounding
shares a disease stem with the indications wording
serious PRR 62.7not reported in cached trials
Pain6,9271.6
1.6–1.7ROR 1.7 · χ² 1,717 / p <1e-300
1.6 EB05 1.6 · IC025 +0.7Labeled adverse reaction
exact term
serious PRR 3.2NCT01194219: 1/804 (0.1%) on Apremilast; 1/560 (0.2%) control (serious AE)
Rash6,7762.3
2.2–2.3ROR 2.3 · χ² 4,852 / p <1e-300
2.3 EB05 2.2 · IC025 +1.1
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 6.0not reported in cached trials
Vomiting6,5552.0
2.0–2.1ROR 2.1 · χ² 3,453 / p <1e-300
2.0 EB05 2.0 · IC025 +1.0Labeled adverse reaction
exact term
serious PRR 3.3not reported in cached trials
Arthralgia (joint pain)6,4362.3
2.2–2.3ROR 2.3 · χ² 4,532 / p <1e-300
2.2 EB05 2.2 · IC025 +1.1
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 5.4NCT01194219: 51/804 (6.3%) on Apremilast; 5/282 (1.8%) control
Fatigue (tiredness)6,2251.2
1.1–1.2ROR 1.2 · χ² 135 / p 1e-31
1.2 EB05 1.1 · IC025 +0.2Labeled adverse reaction
exact term
serious PRR 3.1not reported in cached trials
Depression5,5723.6
3.5–3.7ROR 3.7 · χ² 10,204 / p <1e-300
3.5 EB05 3.4 · IC025 +1.8
3/3 methods agree
Labeled adverse reaction
exact term
serious PRR 5.1NCT03611751: 1/501 (0.2%) on Apremilast; 1/254 (0.4%) control (serious AE)
Off label use (used outside approved label)5,2910.9
0.9–0.9ROR 0.9 · χ² 93 / p 3e-22
0.9 EB05 0.9 · IC025 -0.2
PRR-only: not supported by EBGM or IC
Reporting / coding artifactserious PRR 2.6not reported in cached trials

Unlabeled candidate signals

These flagged terms were not found in the FDA label text and do not match an artifact pattern. They are the pairs that would merit a structured assessment (temporality, dose-response, biological plausibility, consistency across databases, trial or cohort evidence). The screen has not done that; string-matching misses label wording, and a strong PRR can still be stimulated reporting, co-medication, or the disease itself.

Want to assess one of these properly? The runbook describes the Bradford Hill / trial-evidence workflow used on the assessment page, and handoff_top1000_signals.csv lists the strongest unassessed pairs across all drugs.

Common questions

What are the most reported side effects of Apremilast?

In FDA FAERS, the most frequently co-reported reaction terms for Apremilast are diarrhoea, nausea, psoriasis, headache, abdominal discomfort, psoriatic arthropathy. These are report counts, not rates: FAERS has no denominator, reporting is voluntary and uneven, and a term can be reported because of the illness being treated rather than the drug.

Does Apremilast have an FDA boxed warning?

No. The FDA label retrieved for Apremilast has no boxed warning; see the label's Warnings and Precautions for the recognised risks.

Do FAERS signals prove that Apremilast causes these side effects?

No. A disproportionality signal (PRR, ROR) means a reaction is reported more often with this drug than with others in the database. That can reflect a real effect, but also the disease being treated, stimulated reporting after news or litigation, co-medications, or how reports are coded. Causality needs temporality, dose-response, biological plausibility, consistency across data sources and, ideally, trial or cohort evidence. This page screens each term against the FDA label and ClinicalTrials.gov results; it does not establish causation.

Sources & methods

Page generated 2026-10-08. Label and PubChem text are retrieved automatically and may lag the current label; always check the current prescribing information. OpenPV is a beta research tool of the Open Source Medicine Foundation.