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Dermbits

MD, MPH

How do you manage the diarrhea associated with apremilast?

Psoriasis

You. So, diarrhea occurs in about 16% to 18% of the patients on a premolast, and it's about three times greater the rates than that seen in the placebo group. Typically, when diarrhea were to occur, it usually occurs during the first two weeks of therapy. And the duration of the diarrhea is usually about two weeks. In most cases, diarrhea can be managed while on premalast and is not a reason for discontinuing the medication. And some of you may wonder, gosh, what is the mechanism of this premolast related diarrhea? It's a type of secretary diarrhea and it's thought to be really a class wide effect for RPDE four inhibitors. And the proposed mechanism is that premalass can increase, as we know, the intracellular cyclic amp level as a result of that, that can lead to extra activation of the chloride channels in the crypts of the small intestine. So what happens is that there will be an excess secretion of these chloride ions which lead to this secretary diarrhea. And it can take the large bowel, really a couple of weeks to really adapt and adjust. Now, how do we manage this? Typically with over the counter therapies include things like peptobismal or fiber supplements. Those are typically sufficient for most patients. Sometimes you may need to resort to some prescription medications. Oftentimes the oral prescription agent crofellamer can be very helpful in terms of reducing the secretary diarrhea. One can also use lamodal as another option for our patients. So again, the premalass associated diarrhea can occur in about 16% to 18% of patients. Typically mild can be managed without discontinuing a premalis. Through these methods and.