Folic Acid A Must For Ra Patients Taking Methotrexate
Though it may not seem like a supplement could do much to ease methotrexates potentially uncomfortable side effects, the Arthritis Foundation calls folic acid an absolute must. This is because it doesnt interfere with the drugs positive treatment effects, yet it does ease the angst that some people with RA develop in their gastrointestinal tract when taking this prescribed medication in its normal dose.
Additionally, one piece of research published in the journal Arthritis Research & Therapy explains that methotrexate toxicity can become an issue for patients with RA, especially if they take this drug over long periods. Essentially, one of the main problems occurs when it comes time for patients to be taken off methotrexate as withdrawal occurs as much as 50 percent of the time.
As a result, some doctors are hesitant to prescribe this drug as a treatment option to patients with RA. However, folic acid reduces this concern for these doctors in that it helps reduce methotrexate toxicity. Even in smaller doses, it has proven to be effective in this regard. There are other ways to reduce toxicity as well, such as by taking additional substances, like calcium folinate for instance.
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How Do I Take It
When you first start Otezla, your doctor will give you a 14-day Starter Pack. All of the instructions are printed on the pack. During the first 5 days you gradually increase your dose until you reach the 30 mg twice a day. People with severe kidney disease will follow a different schedule for increasing their dose. Be sure to take Otezla exactly as directed by your doctor.
Otezla can be taken with or without food. Do not crush, chew or split the pill.
How Does Otezla Cause Weight Loss
Many people who take Otezla lose weight. There may be several factors that lead to Otezla-related weight loss.
Otezla blocks an enzyme called phosphodiesterase-4 . In addition to its effects on inflammation, this enzyme is involved in energy metabolism. In animals, blocking this enzyme caused them to be leaner, with smaller fat cells. The same effect may apply in humans.
Also, some people who take Otezla may have a reduced appetite or diarrhea as side effects. These effects might also cause weight loss.
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Is Otezla An Immunosuppressant
Yes, Otezla is called an immunosuppressant drug. This means it suppresses your immune systems activity.
This immune system suppression is how Otezla works to treat certain conditions. It reduces inflammation caused by your immune system and eases symptoms of the conditions.
If you have more questions about how Otezla works, talk with your doctor or pharmacist.
How Does Methotrexate Work To Treat Rheumatoid Arthritis
Methotrexate belongs to a group of medications known as nonbiologic DMARDs . Examples of other nonbiologic DMARDs used to treat RA include , , and .
We dont know exactly how methotrexate works to treat RA yet, but researchers agree that it has an effect on the immune system. Methotrexate is thought to prevent your body from mounting immune and inflammatory responses. One way researchers think it does this is by blocking the effects of folic acid, a chemical that supports the production of new cells. Methotrexate may also ramp up processes in your body that counteract inflammation.
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How And When Does The Psoriatic Arthritis Usually Develop
Several factors play a role in the development of the arthritis such as your genetics, immune system, plus environmental factors. It is believed that 30% of psoriasis patients between the ages of 30 and 50 years old will go on to develop psoriatic arthritis. If you have been diagnosed with psoriasis, it is important to tell your dermatologist if you develop any aches or pains.
Toxicity Or Side Effects Develop
Both conventional systemic drugs and biologics can have severe side effects.
Liver toxicity has been associated with long-term use of the conventional drug methotrexate, while kidney toxicity has been associated with long-term use of cyclosporine.
Because of this risk, conventional systemic drugs like methotrexate, oral retinoids, and cyclosporine are typically only given for a short time.
Biologics also have side effects. Because they affect the immune system, they can increase the risk of infections, such as tuberculosis and pneumonia, as well as staph and fungal infections.
If your healthcare provider finds that any of these toxicities or serious side effects occur, youll probably need to change treatments.
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How Is Otezla Used
The recommended dose of Otezla is 30mg taken orally in tablet form twice daily, approximately 12 hours apart . The initial dose is lower and gradually increased over the first five days, until the full dose of 30mg twice daily is reached from day six onwards. Otezla can be used on its own to treat psoriasis and/or psoriatic arthritis. When used to treat psoriatic arthritis it can also be used in combination with other DMARDs.
Treatment with Otezla is usually reconsidered if the psoriasis/psoriatic arthritis has not responded adequately at 16 weeks, or by 24 weeks if in Scotland.
How Long Does It Take To Start Working
While everyone will have a different experience with methotrexate, research suggests that some people will notice improvements within 3months of starting the medication. For some people, it may take longer. Your provider will likely ask you to get a lab test every 2 to 4 weeks over this time period to monitor the levels of methotrexate in your body and make sure you can continue safely taking it.
Its important that you dont stop taking methotrexate unless your provider tells you to. Your arthritis symptoms may return and they may even be worse than before. After about 6 months, your provider will likely reevaluate your treatment plan if your symptoms have not improved. The next step might be trying a combination of methotrexate with another medication.
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Other Dmards And Nausea
Leflunomide
If methotrexate alone isnt controlling your RA symptoms, doctors will often prescribe leflunomide . Leflunomide is usually given alone as a once-daily pill. It can cause nausea, though its usually not as bad as with methotrexate, Dr. Rosian notes. Theres another side effect that might be even more challenging for patients. While queasiness is up there, the biggest reason that people cant tolerate leflunomide, GI-wise, is diarrhea, says Dr. Rosian. Its still treatable, but not as easily as nausea is.
Hydroxychloroquine
Hydroxychloroquine is usually given to patients with mild forms of RA or in combination with other medications for more severe cases. It is also widely used to treat lupus. It can upset your stomach, giving you a queasy feeling. Generally if people can hang in there, even on one a day, they tend to be able after the first month to manage the nausea. I dont know if their body adjusts to it, but it rarely continues to give them problems, says Dr. Rosian.
Sulfasalazine
Most patients can take sulfasalazine with few side effects, according to the American College of Rheumatology, though the most commonly reported are nausea and abdominal discomfort. They tend to occur early in the course of treatment, usually improve over time, and may be avoided or minimized by increasing slowly from a low starting dose.
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Effects On Other Treatments
You may be taking other disease-modifying drugs as well as apremilast. However, apremilast can interact with some medicines, so check with your doctor or a pharmacist before starting any new medicines. Remember to mention you’re on apremilast if youre treated by anyone other than your usual rheumatology team.
You can carry on taking non-steroidal anti-inflammatory drugs or painkillers, if needed, unless your doctor tells you otherwise.
Don’t take over-the-counter or herbal medicines without discussing it first with your doctor. Some of these, including St Johns Wort, can interfere with the treatment.
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What Does Otezla Cost
Costs of prescription drugs can vary depending on many factors. These factors include what your insurance plan covers, and which pharmacy you use.
If you have questions about how to pay for your prescription, talk with your doctor or pharmacist. You can also visit the Otezla manufacturers website to learn about a copay card that may lower the cost of the drug for you.
Dosage: How Much Of Otezla Should I Take
The dose of this medicine will be different for different patients. Follow your doctor’s orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.
- For oral dosage form :
- For psoriatic arthritis, plaque psoriasis, and oral ulcers caused by Behçet’s disease:
- Day 1: 10 milligrams in the morning.
- Day 2: 10 mg in the morning and 10 mg in the evening.
- Day 3: 10 mg in the morning and 20 mg in the evening.
- Day 4: 20 mg in the morning and 20 mg in the evening.
- Day 5: 20 mg in the morning and 30 mg in the evening.
- Day 6 and onwards: 30 mg 2 times a day.
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Moderate To Severe Plaque Psoriasis
As defined in Aetna commercial policies, health care services are not medically necessary when they are more costly than alternative services that are at least as likely to produce equivalent therapeutic or diagnostic results. Avsola , Cimzia , Cosentyx , Enbrel , Remicade , Renflexis , and Siliq are more costly to Aetna than other targeted immune modulators for moderate to severe plaque psoriasis. There is a lack of reliable evidence that Avsola , Cimzia , Cosentyx , Enbrel , Remicade , Renflexis , and Siliq are superior to the lower cost targeted immune modulators: Humira, Ilumya, Inflectra, Otezla, Skyrizi, Stelara, Taltz, and Tremfya for moderate to severe plaque psoriasis. Therefore, Aetna considers Avsola , Cimzia , Cosentyx , Enbrel , Remicade , Renflexis , and Siliq to be medically necessary only for members who have a contraindication, intolerance or ineffective response to the available equivalent alternative targeted immune modulators: Humira, Ilumya, Inflectra, Otezla, Skyrizi, Stelara, Taltz, and Tremfya per criteria below. Requirements for a trial of lower cost targeted immune modulators are waived for persons requesting Cimzia who are pregnant or breastfeeding.
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Otezla For Mouth Ulcers Caused By Behets Disease
Otezla is approved to treat mouth ulcers that occur with Behçets disease.
Behçets disease is an autoimmune disease. It causes damage to certain blood vessels that can lead to sores in your mouth, rashes, and other symptoms.
Effectiveness for Behçets disease
In a clinical study, 53% of people who took Otezla had their mouth ulcers completely cleared after 12 weeks. In comparison, 22% of people taking a placebo had that same result.
For 30% of people who took Otezla for 6 weeks, their mouth ulcers completely cleared and stayed cleared for another 6 weeks. In comparison, 5% of people taking a placebo had the same result.
Also, during the study, people taking Otezla had an average of 1.5 mouth ulcers. People taking the placebo had an average of 2.6 mouth ulcers.
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Otezla For Other Conditions
In addition to the uses listed above, Otezla may be used off-label for other uses. Off-label drug use is when a drug thats approved for one use is used for a different one thats not approved. And you may wonder if Otezla is used for certain other conditions. Below is information on other possible uses for Otezla.
Otezla for other forms of psoriasis
There are several forms of psoriasis, but Otezla is only approved to treat plaque psoriasis.
However, Otezla is used off-label for adults with guttate psoriasis, nail psoriasis, palmoplantar psoriasis, pustular psoriasis, and scalp psoriasis. Its not recommended for off-label use in treating erythrodermic psoriasis.
If you have questions about treatment options for psoriasis, talk with your doctor.
Otezla for eczema
Eczema, also called atopic dermatitis, can result in long-lasting or recurring rashes on the face, head, or arms and legs.
In 2012, one small evaluated Otezla for treating adults with eczema and found that it reduced itching and the severity of eczema. However, currently the American Academy of Dermatology doesnt recommend Otezla for treating eczema.
If youd like to know about treatment options for eczema, talk with your doctor.
Otezla for rheumatoid arthritis
Currently, the doesnt recommend Otezla for treating rheumatoid arthritis .
One evaluated Otezla in people with RA who didnt respond adequately to treatment with methotrexate. Otezla didnt improve symptoms any better than taking a placebo pill.
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How Should I Use This Medication
The starting dose of apremilast is 10 mg daily on the first day, then 10 mg taken in the morning and again in the evening on the second day. The dose is increased by 10 mg each day until the recommended adult dose of 30 mg taken by mouth twice daily has been reached. This gradual dose increase helps to reduce the risk of gastrointestinal side effects such as nausea, vomiting, and diarrhea.
Many things can affect the dose of medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.
It is important to take this medication exactly as prescribed by your doctor.
If you miss a dose, take it as soon as possible and continue with your regular schedule. If it is almost time for your next dose, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice.
Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.
Do not dispose of medications in wastewater or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.
How Does This Medication Work What Will It Do For Me
Apremilast belongs to the class of medications called immunosuppressants. It is used to treat adults with moderate-to-severe plaque psoriasis who may respond to phototherapy or systemic therapy. It may also be used to treat adults with psoriatic arthritis who cannot use other disease-modifying treatments, or have tried other treatments which were either not effective, or not well-tolerated.
Plaque psoriasis is a non-contagious skin condition in which parts of the immune system become active, causing inflammation. Psoriatic arthritis is an autoimmune illness which causes joint inflammation. This medication works by reducing the activity of a chemical produced in the body that causes this inflammation.
Apremilast is also used to treat mouth ulcers associated with Behcet’s disease. Behcet’s disease is a rare autoimmune disorder which causes blood vessel inflammation resulting in mouth sores, rashes, and other symptoms throughout the body.
This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.
Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.
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What Should I Avoid While Taking Otezla
There are many potential drug interactions for Otezla. We have listed below some of the most common, but this is not a complete list and you should inform your doctor about any medications you are taking before you start receiving Otezla.
Potential interactions that could reduce the effectiveness of Otezla:
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Is Otezla A Biologic Drug
No, Otezla isnt a biologic drug. Biologics are drugs made from living cells. They work against a specific part of your immune system.
Certain nonbiologic drugs, including Otezla, also act on your immune system. Nonbiologic drugs are made from chemicals rather than from living cells.
If you have more questions about how Otezla works, talk with your doctor or pharmacist.
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