Apremilast in India: Who It Is For, Cost and Side Effects
Share
Apremilast is a twice-daily tablet for psoriasis and psoriatic arthritis. In India it is sold under many brand names, and online pharmacy listings in October 2026 put it at roughly ₹19–37 per 30 mg tablet. It suits adults with moderate psoriasis who want an oral option without the blood-test routine of older pills. It works more gently than biologics, and loose motions, nausea and headache are common in the first few weeks.
This guide is part of our wider explainer on psoriasis treatment classes, from biologics to pills. Here we cover what apremilast does, who it is for, what it costs in India and which side effects to watch for.
Key takeaways
- Apremilast is a PDE4 inhibitor. It calms inflammation inside immune cells rather than suppressing the whole immune system.
- In the main trials, about 29–33% of people reached PASI 75 (75% clearer skin) by week 16, compared with about 5–6% on placebo. Two Indian real-world studies reported 42–48% at 16 weeks.
- Generic apremilast has been sold in India since 2017. Expect roughly ₹1,100–2,300 a month at full dose, depending on the brand.
- Common side effects are diarrhoea, nausea and headache, mostly in the first weeks. Weight loss and low mood need watching.
- It is a prescription medicine. Start, change or stop it only with your dermatologist.
What is apremilast and how does it work?
Apremilast blocks an enzyme called phosphodiesterase 4 (PDE4). PDE4 helps drive the inflammatory signals that keep psoriasis plaques red, thick and scaly. The National Psoriasis Foundation explains that it works by regulating inflammation within the cell [2].
It is a small-molecule pill, not an injection. It does not target a single immune protein the way biologics such as adalimumab or secukinumab do. That gives it a different balance. It is usually milder in effect but easier to take, and it is not linked to the same infection concerns.
The original brand, Otezla, is approved in the US for:
- adults with plaque psoriasis who are candidates for phototherapy or systemic therapy
- adults with active psoriatic arthritis
- mouth ulcers in Behçet's disease
- children aged 6 and above (at least 20 kg) with moderate-to-severe plaque psoriasis or psoriatic arthritis [1]
In India, Glenmark launched the first apremilast brand, Aprezo, in October 2017 [6]. Several Indian companies now make it.
Who is apremilast for?
Dermatologists usually think of apremilast for people who:
- have psoriasis that creams alone are not controlling, especially when it affects quality of life
- have psoriasis in hard-to-treat places such as the scalp, palms, soles or nails
- also have joint pain from psoriatic arthritis
- cannot take, or do not want, methotrexate or cyclosporine because of liver, kidney or blood-pressure concerns
- would rather not take injections, or cannot afford biologics
Who may need a different option
People with severe, widespread psoriasis often need something stronger, such as a biologic or phototherapy. Apremilast may also be less suitable for people with a history of depression, people who are already underweight, and pregnant women. Your doctor will weigh these points with you.
How well does it work?
In the two large plaque psoriasis trials behind the US approval, 33.1% and 28.8% of people on apremilast 30 mg twice daily reached PASI 75 at week 16. On placebo the figures were 5.3% and 5.8% [1]. In a scalp psoriasis trial, 43.3% had clear or almost-clear scalps at week 16, compared with 13.7% on placebo [1].
Indian experience looks similar or slightly better:
- A study of 70 patients in India found that 42% reached PASI 75 at 16 weeks and 58% by 24 weeks. Quality-of-life scores (DLQI) also improved a lot [4].
- A study of 37 patients at a Kolkata clinic, most of whom had already tried methotrexate, reported PASI 75 in about 48% at 16 weeks [3].
These were small, single-centre studies that looked back at patient records, so treat them as encouraging rather than conclusive. The pattern is clear, though. Apremilast works slowly and steadily. Many people see a change by week 4, and judging it fairly takes about 16–24 weeks.
Apremilast cost in India
Prices vary widely between brands. These are online pharmacy listings we checked in October 2026, for strips of 10 × 30 mg tablets:
| Brand (company) | Listed price |
|---|---|
| Apremist (Corona Remedies) | MRP ₹187.50 per 10 [7] |
| Apraize, Aprenext, Alizap, APXenta (Ipca, Indiabulls, Eris, Ajanta) | About ₹29–34 per tablet [5] |
| Aprezo (Glenmark) | About ₹365 per 10 [5] |
At the usual dose of one tablet twice a day (about 60 tablets a month), that comes to roughly ₹1,100–2,300 a month, plus doctor visits. That is far less than most branded biologics, though more than methotrexate. Prices change and stock varies, so check with your local chemist. Ask your dermatologist whether a cheaper brand of the same salt is suitable. Starter packs for the first week are also sold.
How it is taken
To reduce stomach upset, the dose is built up slowly over five days. It starts at 10 mg on day 1 and reaches 30 mg twice daily from day 6 [1]. It can be taken with or without food. Do not crush or split the tablets.
- Kidney disease: people with severely reduced kidney function are usually kept at 30 mg once daily [1].
- Tuberculosis medicines: rifampicin, which is widely used for TB in India, sharply lowers apremilast levels, as do some epilepsy medicines such as carbamazepine and phenytoin. They are not recommended together [1]. Always tell your doctor about every medicine you take, including Ayurvedic and homeopathic ones.
- Blood tests: the label does not call for the routine monitoring that methotrexate needs [1]. Your doctor may still order baseline tests.
Side effects and safety
Common side effects
In the psoriasis trials, about 17% of people had diarrhoea and 17% had nausea. Upper respiratory infections (9%) and tension headaches (8%) were also common [1]. In the Indian studies, diarrhoea, nausea and headache were also the most common. Most cases were mild and settled within the first few weeks [3][4].
Practical tips that many patients find useful:
- Drink enough water. Sip ORS if you have loose motions, especially in hot weather.
- Keep meals light and less oily during the first fortnight.
- Report vomiting or diarrhoea that does not stop. Older adults and people on BP or water tablets are at higher risk of dehydration [1].
Weight loss
About 12% of plaque psoriasis patients lost 5–10% of their body weight, compared with 5% on placebo [1]. Check your weight monthly. For children, growth should also be tracked.
Mood changes
Depression was reported slightly more often than with placebo (about 1.3% vs 0.4% in psoriasis trials) [1]. If you or your family notice low mood, withdrawal or thoughts of self-harm, contact your doctor straight away.
Pregnancy, breastfeeding and children
Human data in pregnancy are very limited, and animal studies at high doses showed fetal loss [1]. Most doctors avoid it in pregnancy and while trying to conceive, so discuss family planning first. For children, apremilast is approved abroad from age 6 at weight-based doses [1]. Its use in a child should be decided by a dermatologist.
Apremilast compared with other options
| Option | How it's taken | Typical strength | Monitoring |
|---|---|---|---|
| Apremilast | Tablet, twice daily | Moderate | Weight, mood |
| Methotrexate | Weekly tablet or injection | Moderate | Regular blood tests |
| Biologics | Injection every 2–12 weeks | High | TB screening, infections |
| Newer pills (TYK2, JAK, IL-23 oral) | Tablet | Moderate to high | Varies |
For more on newer pills, read our explainer on icotrokinra, the new IL-23 pill. Whatever medicine you take, gentle daily skin care still matters. A fragrance-light cleanser and regular moisturising help with dryness and itching. Some people add steroid-free products such as our body psoriasis care range alongside their prescribed treatment, not instead of it.
When to see a doctor
Contact your dermatologist or go to a hospital promptly if you have:
- diarrhoea or vomiting that lasts more than a day or two, or signs of dehydration (dizziness, very little urine)
- swelling of the face, lips or throat, or difficulty breathing (a possible allergic reaction)
- low mood, anxiety or any thoughts of self-harm
- steady, unexplained weight loss
- psoriasis spreading quickly, pus-filled bumps, or red skin over most of the body with fever or chills
- pregnancy, or plans to become pregnant, while on the medicine
Do not stop apremilast or any prescribed treatment on your own. Talk to your doctor first.
Frequently asked questions
Is apremilast a steroid?
No. Apremilast is a non-steroidal PDE4 inhibitor. It does not cause the skin thinning linked to long-term use of steroid creams.
Is apremilast available in India without a prescription?
It is a prescription medicine in India. It should be started and monitored by a dermatologist or rheumatologist who has examined you.
How long should I take apremilast?
It is meant to be taken continuously to keep psoriasis under control [2]. Your doctor will usually review your progress at around 16–24 weeks and decide whether to continue.
Can I take apremilast with methotrexate or phototherapy?
According to the National Psoriasis Foundation, it can be used with phototherapy or creams, and it has been studied with methotrexate [2]. Any combination should be decided by your doctor.
Can I take Ayurvedic medicines with apremilast?
Tell your doctor about every herbal or Ayurvedic product you take. Some herbs can affect how the liver processes medicines. Topical oils and moisturisers are generally less of a concern than oral herbs, but always check first.
Sources
- Otezla (apremilast) Prescribing Information – Drugs.com
- Otezla (apremilast) – National Psoriasis Foundation
- De A, Das S, Dhoot D, Sarda A. Real-World Insight on Apremilast Therapy in Patients with Plaque Psoriasis: Indian Experience. Indian J Dermatol. 2020;65(5):396–400
- Shah BJ, Mistry D, Chaudhary N, Shah S. Real-world efficacy and safety of apremilast monotherapy in moderate-to-severe psoriasis. Indian Dermatol Online J. 2020;11(1):51–57
- Aprezo 30 mg tablet: price and substitutes – Tata 1mg (accessed October 2026)
- Glenmark launches oral drug for psoriasis treatment in India – Medical Dialogues (October 2017)
- Apremist 30 mg tablet – PharmEasy (accessed October 2026)
This article is for general information and is not medical advice. Please consult a qualified dermatologist or Ayurvedic doctor for diagnosis and treatment.