Otezla (apremilast) is a prescription drug that’s used to treat psoriatic arthritis, plaque psoriasis, and certain types of ulcers. This drug can interact with other medications, such as rifampin.

Otezla comes as an oral tablet. It’s used to treat the following conditions in certain adults:

An interaction can occur because one substance causes another substance to have a different effect than expected. Interactions can also occur if you have certain health conditions.

Keep reading to learn about Otezla’s possible interactions. And for more information about Otezla, including details about its uses, see this article.

Certain health conditions or other factors could raise your risk of harm if you take Otezla. These are known as contraindications. In such cases, your doctor may not prescribe Otezla for you. Otezla’s contraindication is described below.

If you’ve had an allergic reaction. If you have had an allergic reaction to Otezla or any of its ingredients, your doctor likely won’t prescribe Otezla. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better options for you.

There is no known interaction between Otezla and alcohol.

But keep in mind that alcohol can cause side effects that are similar to some of Otezla’s, such as nausea, headache, and diarrhea. Combining alcohol with Otezla may increase your risk of these side effects. Or it could make the side effects worse if you do experience them.

Alcohol can also worsen mouth ulcers you may have from Behcet’s disease.

If you drink alcohol, talk with your doctor about how much, if any, is safe to consume during your Otezla treatment.

Before you start taking Otezla, tell your doctor and pharmacist about any prescription, over-the-counter, or other drugs you take. Sharing this information with them may help prevent possible interactions. (To learn whether Otezla interacts with supplements, herbs, and vitamins, see the “Are there other interactions with Otezla?” section below.)

If you have questions about drug interactions that may affect you, talk with your doctor or pharmacist.

The chart below lists drugs that may interact with Otezla. Keep in mind that this chart does not include all drugs that may interact with Otezla. For more information about some of these interactions, see the “Drug interactions explained” section below.

Drug group or drug nameDrug examplesWhat can happen
rifampin (Rifadin, Rimactane)can make Otezla less effective
certain seizure drugs• phenobarbital
carbamazepine (Tegretol)
phenytoin (Dilantin)
• fosphenytoin (Cerebyx)
primidone (Mysoline)
can make Otezla less effective
drugs containing butalbital• butalbital/acetaminophen (Butapap)
• butalbital/acetaminophen/caffeine/codeine (Fioricet with codeine)
can make Otezla less effective
enzalutamide (Xtandi)can make Otezla less effective
lumacaftor/ivacaftor (Orkambi)can make Otezla less effective
mitotane (Lysodren)can make Otezla less effective

Learn more about certain drug interactions that can occur with Otezla.

Interaction with certain seizure drugs

Otezla can interact with certain seizure drugs. Not all seizure drugs interact with Otezla. But some can interfere with how your body breaks down Otezla.

Examples of seizure medications that can interact with Otezla include:

What could happen

Certain seizure medications can make your body break down Otezla too quickly. This can lower the Otezla level in your body, which can make Otezla less effective at treating your condition.

What you can do

Before starting Otezla treatment, tell your doctor if you take a seizure drug. They can determine whether it interacts with Otezla. If it does, your doctor will likely not prescribe Otezla. Instead, they’ll recommend a different treatment option for your condition.

Interaction with butalbital

Butalbital is one of the active ingredients in certain prescription drugs used to treat headache. (An active ingredient makes a drug work.) Butalbital can interact with Otezla.

Examples of prescription headache medications that contain butalbital include:

  • butalbital/acetaminophen/caffeine
  • butalbital/aspirin/caffeine
  • butalbital/acetaminophen/caffeine/codeine (Fioricet with codeine)
  • butalbital/acetaminophen (Butapap)

What could happen

Taking Otezla with butalbital may make your body break down Otezla too quickly. This can lower the level of Otezla in your body, which can make it less effective at treating your condition.

What you can do

Before taking Otezla, let your doctor know if you take a headache medication. They can check whether it contains butalbital. If it does, your doctor can recommend a different headache treatment that won’t interact with Otezla. Or they may recommend an alternative to Otezla if you need to continue taking your headache medication.

Interaction with rifampin

Rifampin (Rifadin, Rimactane) can interact with Otezla. Rifampin is an antibiotic prescribed to treat tuberculosis and certain other infections.

What could happen

Taking Otezla with rifampin may cause your body to break down Otezla too quickly. This can lower the level of Otezla in your body, which can make it less effective.

What you can do

Before starting treatment with Otezla, tell your doctor if you take rifampin. Your doctor may not prescribe Otezla until you finish your rifampin treatment.

Otezla may have other interactions. They could occur with supplements, foods, vaccines, or even lab tests. See below for details. Note that the information below does not include all other possible interactions with Otezla.

Does Otezla interact with supplements?

Before you start taking Otezla, talk with your doctor and pharmacist about any supplements, herbs, and vitamins you take. Sharing this information with them may help you avoid possible interactions.

If you have questions about interactions that may affect you, talk with your doctor or pharmacist.

Otezla interactions with herbs

The herbal supplement St. John’s wort may interact with Otezla. Some people use this herb for depression and other conditions.

Taking Otezla with St. John’s wort can make your body get rid of Otezla too quickly. This lowers the level of Otezla in your body and makes the drug less effective.

If you use St. John’s wort, talk with your doctor before taking Otezla. They’ll likely recommend that you stop taking the herb during your Otezla treatment.

Otezla interactions with vitamins

There are currently no reports of Otezla interacting with vitamins. But this doesn’t mean that vitamin interactions won’t be recognized in the future.

For this reason, it’s still important to check with your doctor or pharmacist before taking any of these products while taking Otezla.

Does Otezla interact with food?

There are currently no reports of Otezla interacting with food. If you have questions about eating certain foods during your treatment with Otezla, talk with your doctor.

Does Otezla interact with vaccines?

No vaccines have been reported to interact with Otezla. Talk with your doctor if you have questions about getting vaccines while you’re taking Otezla.

Does Otezla interact with lab tests?

There aren’t any lab tests known to interact with Otezla. If you’re concerned about having lab tests during your Otezla treatment, talk with your doctor.

Does Otezla interact with cannabis or CBD?

There are currently no reports of Otezla interacting with cannabis (commonly called marijuana) or cannabis products such as cannabidiol (CBD). But as with any drug or supplement, talk with your doctor before using cannabis with Otezla.

Note: Cannabis is illegal at a federal level but is legal in many states to varying degrees.

Certain medical conditions or other health factors may raise the risk of interactions with Otezla. Before taking Otezla, talk with your doctor about your health history. They’ll determine whether Otezla is right for you.

Health conditions or other factors that might interact with Otezla include:

Severe kidney problems. If you have severe kidney problems, your body may not be able to get rid of Otezla as well as it should. In this case, your doctor may prescribe a lower dosage of Otezla for you. Before you start Otezla treatment, be sure to talk with your doctor about your health history.

Problems with weight loss. Taking Otezla can decrease your appetite, which may lead to weight loss. If you have concerns about weight loss, talk with your doctor before taking this drug. They’ll likely monitor your weight periodically during your Otezla treatment.

Pregnancy. It is not known whether Otezla is safe to take during pregnancy. Before you start Otezla treatment, let your doctor know if you’re pregnant or planning to become pregnant. They’ll discuss safe treatment options with you.

Breastfeeding. It’s not known whether it’s safe to take Otezla while breastfeeding. If you’re breastfeeding or planning to do so, let your doctor know before you take Otezla. They can discuss your options with you.

Allergic reaction. If you’ve had an allergic reaction to Otezla or any of its ingredients, your doctor will likely not prescribe Otezla. This is because taking the drug could cause another allergic reaction. You can ask your doctor about other treatments that may be better choices for you.

Depression. Depression or mood changes can be a side effect of taking Otezla. If you’ve had depression or suicidal thoughts or behaviors before, your risk of this side effect may be higher. Talk with your doctor about the risks and benefits of taking Otezla. They’ll let you know whether this medication is safe for you to take.

Help is out there

If you or someone you know is in crisis and considering suicide or self-harm, please seek support:

If you’re calling on behalf of someone else, stay with them until help arrives. You may remove weapons or substances that can cause harm if you can do so safely.

If you are not in the same household, stay on the phone with them until help arrives.

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Find answers to some frequently asked questions about Otezla and possible interactions.

Is there an Otezla interaction that can make joint pain worse?

Yes, certain drug interactions may make joint pain worse in people with psoriatic arthritis (one of the conditions Otezla treats).

Joint pain is a symptom of psoriatic arthritis. If you take a drug that interacts with Otezla by lowering the level of Otezla in your body, this could make Otezla less effective. This may mean the drug isn’t working as well to relieve symptoms of your psoriatic arthritis, including joint pain.

Drugs that can decrease the level of Otezla in your body include:

  • drugs containing butalbital
  • carbamazepine (Tegretol)
  • phenobarbital
  • phenytoin (Dilantin)
  • rifampin (Rifadin, Rimactane)

In addition, joint pain was a rare side effect reported in studies of people taking Otezla. (For more information about Otezla’s side effects, see this article.)

If you have concerns about joint pain while taking Otezla, talk with your doctor. They can recommend ways to reduce your risk of joint pain or manage this side effect.

Does Otezla interact with ibuprofen?

No, Otezla isn’t known to interact with ibuprofen. It should be safe to take these drugs together.

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). Doctors commonly prescribe NSAIDs to ease symptoms of psoriatic arthritis, such as joint pain and swelling. (Otezla is also used to treat psoriatic arthritis.)

If you have questions about taking Otezla with ibuprofen or other drugs, talk with your doctor or pharmacist.

Does Tylenol interact with Otezla?

No. There is no known interaction between Tylenol (acetaminophen) and Otezla. It’s generally considered safe to take these drugs together.

But certain combination drugs prescribed to treat headaches contain acetaminophen and other ingredients that may interact with Otezla. For example, Fioricet with codeine is a combination drug that contains butalbital, acetaminophen, caffeine, and codeine. Butalbital can interact with Otezla.

To learn more about the interaction between Otezla and drugs containing butalbital, see the “Drug interactions explained” section above.

It’s important to tell your doctor all the medications you take before you start Otezla treatment. They’ll let you know whether Otezla is safe for you to take with your other medications.

Taking certain steps can help you avoid interactions with Otezla. Before starting treatment, talk with your doctor and pharmacist. Things to discuss with them include:

  • whether you drink alcohol
  • other medications you take, as well as any supplements and herbs (your doctor or pharmacist can help you fill out a medication list)
  • what to do if you start taking a new drug during your Otezla treatment

It’s also important to read Otezla’s label and other paperwork that may come with the drug. You may see colored stickers on the label that describe interactions. And the paperwork (sometimes called the patient package insert or medication guide) may have other details about interactions. (If you did not get paperwork with Otezla, ask your pharmacist to print a copy for you.) If you need help understanding this information, your doctor or pharmacist can help.

Taking Otezla exactly as prescribed can also help prevent interactions.

If you still have questions about Otezla and its possible interactions, talk with your doctor.

Questions you may want to ask your doctor include:

  • If I take Otezla and have depression, will I be monitored more closely during treatment?
  • Do I need to tell you if I start taking another medication or supplement during my Otezla treatment?
  • Could I still take Otezla even if I have kidney problems?
  • Does my risk of interactions depend on my dosage of Otezla?

To learn more about Otezla, see these articles:

To get information on different conditions and tips for improving your health, subscribe to any of Healthline’s newsletters. You may also want to check out the online communities at Bezzy. It’s a place where people with certain conditions can find support and connect with others.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.