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doi: 10.1016/j.biopha.2018.08.088 142 SheikhA

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Holding at a dose for an extra 4 weeks before escalating is a medically supported strategy when: Nausea or vomiting persists beyond 2 weeks at the current dose You are unable to eat at least 1,000 calories per day comfortably Dehydration symptoms appear (dark urine, dizziness on standing, dry mouth) You are losing weight faster than 1 to 2 pounds per week on the current dose (aggressive weight loss increases side effect risk) In the STEP trials, delayed escalation did not compromise overall weight loss outcomes at 68 weeks

The loss of bone density causes the bones to become porous and brittle and may result in the bones fracturing, leading to loss of mobility and independence

In animals, apremilast crossed the placenta in both mice and monkeys and was associated with fetal demise, insufficient ossification, and a dose-dependent decline in infant birth weight [97]

These symptoms usually decrease over time but can be bothersome for some patients