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teriparatide (recombinant)

Forsteo, Forteo

Pharmacologic class: Biosynthetic fragment of human parathyroid hormone

Therapeutic class: Parathyroid hormone

Pregnancy risk category C

FDA Box Warning

In male and female rats, drug increased incidence of osteosarcoma (malignant bone tumor). Because of uncertain relevance of this finding to humans, use drug only in patients for whom potential benefits outweigh potential risk. Don't administer to patient at increased baseline risk for osteosarcoma.


Stimulates new bone growth by binding to specific high-affinity cell-surface receptors


Injection: Multidose prefilled delivery device (pen) with 28 daily doses of 20 mcg/dose (600 mcg/2.4 ml)

Indications and dosages

Osteoporosis in patients at high risk for bone fracture

Adults: 20 mcg/day subcutaneously for up to 2 years


• Hypersensitivity to drug

• Conditions that increase osteosarcoma risk (such as Paget's disease, unexplained alkaline phosphatase elevation, open epiphyses, skeletal radiation therapy)

• Bone cancer metastases or history of bone cancer

• Metabolic bone disease other than osteoporosis

• Hypercalcemia


Use cautiously in:

• urolithiasis, hypotension

• concurrent use of cardiac glycosides

• pregnant or breastfeeding patients.


• Inject subcutaneously into thigh or abdominal wall, with patient lying down.

• Know that prefilled injection pen delivers 20 mcg of drug per actuation and may be reused for up to 28 days after first injection. Discard pen in protected container after 28 days, even if it's not empty.

Adverse reactions

CNS: dizziness, headache, insomnia, depression, vertigo, asthenia

CV: hypertension, angina, syncope

EENT: rhinitis, pharyngitis

GI: nausea, vomiting, diarrhea, dyspepsia, anorexia

Metabolic: hyperuricemia

Musculoskeletal: joint pain, cramps

Respiratory: cough, dyspnea, pneumonia

Skin: rash, sweating

Other: pain


Drug-drug. Digoxin: increased digoxin toxicity

Drug-diagnostic tests. Calcium: increased level

Patient monitoring

• Monitor respiratory and neurologic status and assess patient's mood.

• Monitor bone mineral density tests and calcium level.

Patient teaching

• Instruct patient to promptly report such adverse reactions as cough and difficulty breathing.

• Tell patient that prefilled injection pen delivers 20 mcg of drug per actuation. Inform him that he may reuse it for up to 28 days after first injection, and should then discard it in appropriate receptacle, even if it's not empty.

• Advise patient to establish effective bedtime routine to minimize insomnia.

• Caution patient to avoid driving and other hazardous activities until he knows how drug affects strength and balance.

• As appropriate, review all other significant adverse reactions and interactions, especially those related to the drugs and tests mentioned above.


A recombinant human parathyroid hormone analog used in the treatment of osteoporosis.


a parathyroid hormone used to treat postmenopausal women with osteoporosis and men with primary hypogonadal osteoporosis at high risk for fracture.


A drug used to treat advanced OSTEOPOROSIS. Teriparatide consists of fragments of parathyroid hormone produced by recombinant DNA technology. These preferentially stimulate osteoblasts over osteoclasts thus increasing new bone formation. The drug is given by subcutaneous injection via a pre-filled pen injector.
References in periodicals archive ?
Specifically, "we would caution against the use of teriparatide immediately following denosumab because of this transient decrease in bone density that correlates with high bone turnover," Dr.
In addition to discontinuation of BPs and calcium and vitamin D supplementation, an anabolic agent such as teriparatide may promote fracture healing.
Huang HT, Kang L, Huang PJ et al: Successful teriparatide treatment of atypical fracture after long-term use of alendranate without surgical procedure in a postmenopausal woman: a case report.
Conclusion: We observed significant differences related to ethnicity and geography in the baseline demographics of Latinas enrolled in the DANCE study, criteria cited by physicians for initiating teriparatide therapy, and treatment persistence.
Of note, the incidence of mild, transient hypercalcemia in abaloparatide-treated patients was half that of the teriparatide group.
These identical initial cohorts were maintained by the model and simulated across both the teriparatide and no treatment arms for each replication.
Effects of Intravenous zoledronic acid plus subcutaneous teriparatide [rhPTH(1-34)] in postmenopausal osteoporosis.
In considering possible reasons for this combination's superiority over combined bisphosphonate and teriparatide, Leder said that teriparatide actually stimulates both bone formation and resorption and that denosumab may more completely block teriparatide-induced resorption while only partially interfering with the drug's stimulation of bone formation.
As you have stated; animal studies show that; the prolonged and high dose teriparatide treatment increase the incidence of osteogenic sarcoma.
Based on blood tests, the doses from the device appeared to bump up levels of a molecule called P1NP, which indicates bone building--evidence that teriparatide released from the microchip works as it should.
The programmable device, inserted just below the waistline, stored 20 doses of the drug teriparatide in pinprick-size reservoirs.
5µg subcutaneous injection formulation of Teribone (generic name: teriparatide acetate) for the indication of osteoporosis with high risk of fracture, upon listing in the NHI Drug Price Standard.