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.


(ter-i-par-a-tide) ,


(trade name)


Therapeutic: hormones
Pharmacologic: parathyroid hormones
Pregnancy Category: C


Treatment of osteoporosis in postmenopausal women at high risk for fractures.To increase bone mass in men with primary or hypogonadal osteoporosis at high risk for fractures.Treatment of osteoporosis in men and women with glucocorticoid-induced osteoporosis at high risk for fractures.Most useful for those have failed or are intolerant to other osteoporosis therapies.


Regulates calcium and phosphate metabolism in bone and kidney by binding to specific cell receptors; stimulates osteoblastic activity.
Increases serum calcium and decreases serum phosphorus.

Therapeutic effects

Increased bone mineral density with reduced risk of fractures.


Absorption: Extensively absorbed after subcut administration.
Distribution: Unknown.
Metabolism and Excretion: Metabolized by the liver; metabolites renally excreted.
Half-life: 1 hr (after subcut use).

Time/action profile (effects on serum calcium)

Subcut2 hr4–6 hr16–24 hr


Contraindicated in: Hypersensitivity; Paget's disease of the bone or other metabolic bone disease; Unexplained ↑ alkaline phosphatase; Pediatric: Safety and efficacy not established; Previous radiation therapy, history of bone metastases, or skeletal malignancy; Pre-existing hypercalcemia; Obstetric / Lactation: Pregnancy or lactation.
Use Cautiously in: Active or recent urolithiasis.

Adverse Reactions/Side Effects


  • orthostatic hypotension


  • muscle spasms


Drug-Drug interaction

Transient hypercalcemia may ↑ the risk of digoxin toxicity.


Subcutaneous (Adults) 20 mcg once daily.


Pre-filled pen delivery device (FORTEO pen): delivers 20 mcg/day

Nursing implications

Nursing assessment

  • Assess patient for bone mineral density before and periodically during therapy.
  • Lab Test Considerations: Effects ↑ serum calcium and ↓ serum phosphorus. Maximum effect is within 4–6 hr. By 16–hr post-dose, serum calcium has returned to near baseline. If hypercalcemia persists, discontinue teriperatide and evaluate cause of hypercalcemia.
    • May asymptomatically ↑ serum uric acid concentrations.

Potential Nursing Diagnoses

Risk for injury (Indications)


  • Use of teriparatide should not continue more than 2 yr.
  • Subcutaneous: Administer subcut into thigh or abdominal wall once daily. May be administered at any time of day without regard to food. Solution should be clear and colorless. Do not use if solid particles appear, or if solution is cloudy or colored. Store pen in the refrigerator; do not freeze or use if it has been frozen. Minimize time out of refrigerator; use immediately and return to refrigerator. Forteo pen can be used for up to 28 days after the first injection. After the 28-day use period, discard the Forteo pen, even if it still contains some unused solution.

Patient/Family Teaching

  • Advise patient to administer medication at same time each day. Administer missed doses as soon as remembered that day. Do not take more than one injection/day.
  • Instruct patient on proper administration technique and disposal of needles. Patient should read Medication Guide and User Manual before starting therapy and re-read them each time prescription is refilled. User manual can be found at Caution patient to throw pen away after 28-day use period and not to share their pen with other patients.
  • Discuss the importance of other treatments for osteoporosis (supplemental calcium and/or vitamin D, weight-bearing exercise, modification of behavioral factors such as smoking and/or alcohol consumption).
  • May cause orthostatic hypotension during first several doses. Caution patient to administer medication in a lying or sitting position. If light-headedness or palpitations occur, lie down until symptoms resolve. Notify health care professional if symptoms persist or worsen.
  • Instruct patient to notify health care professional if persistent symptoms of hypercalcemia (nausea, vomiting, constipation, lethargy, muscle weakness) occur.
  • Emphasize the importance of follow-up tests for bone mineral density.

Evaluation/Desired Outcomes

  • Increased bone mineral density with reduced risk of fractures.


A trademark for the drug teriparatide.
References in periodicals archive ?
Teva has the most robust first-to-files [FTF's] with the FDA and called out three recent filings as being potential long-term, durable assets, including Lilly's Forteo, Celgene's Abraxane and Valeant's Xifaxan.
A recent study of romosozumab in postmenopausal women showed that this drug increased bone mineral density (BMD) at a significantly higher rate than the currently approved drugs Fosamax or Forteo (the only other bone-building therapy).
Sobel prescribes Forteo for severe cases of osteoporosis, for younger patients, and for patients who cannot tolerate bisphosphonate therapy.
Typically reserved for men and women with more severe osteoporosis or those who've suffered fractures while using a bisphosphonate, Forteo is administered as a daily self-injection and can't be used for more than two years.
These revenue declines are expected to be partially offset by growth from a portfolio of other products including Humalog, Trajenta, Cialis, Forteo and Alimta, as well as the animal health business.
In Puerto Rico, the company manufactures pharmaceutical products such as Cymbalta, Cialis, Evista, Strattera, Symbyax, Zyprexa and engages in bulk production for Humalog, Forteo and Humatrope.
Preparing sample dilution: Samples containing Forteo (Eli Lilly, France) and rhPTH were diluted to final concentration of 1 [micro]M/ml with DMEM-F12, 1% BSA (Bovine Serum Albumin) (Sigma, USA).
Eli Lilly & Co's (Indianapolis IN) osteoporosis drug Forteo can regrow bone in jaws damaged by severe bone-destroying conditions called osteonecrosis and periodontitis, doctors reported.
Alternative prescription therapies for osteoporosis may include Evista (tablets with estrogen-like action), Forteo (an injectable form of synthetic parathyroid hormone), and Calcitonin (a nasal spray or injectable form of a hormone involved in calcium metabolism).
The drug called teriparatide or Forteo is "turning back the clock", helping older people's bones to heal like children's.
It appears that Forteo (teriparatide [rDNA origin] injection) is frequently used, but also widely debated in the adult OI community.
The company's patient assistance program would extend assistance beyond the end of 2006 to Medicare patients for two drugs: Forteo (teriparatide injection), and Zyprexa (olanzapine).