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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.

McGraw-Hill Nurse's Drug Handbook, 7th Ed. Copyright © 2013 by The McGraw-Hill Companies, Inc. All rights reserved


A recombinant human parathyroid hormone analog used in the treatment of osteoporosis.
The American Heritage® Medical Dictionary Copyright © 2007, 2004 by Houghton Mifflin Company. Published by Houghton Mifflin Company. All rights reserved.


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.
Collins Dictionary of Medicine © Robert M. Youngson 2004, 2005
References in periodicals archive ?
According to the company, teriparatide is biosimilar to the biologically active fragment of the human parathyroid hormone, and replaces the natural hormone and stimulates bone formation.
Parathyroid hormone and teriparatide for the treatment of osteoporosis: a review of the evidence and suggested guidelines for its use.
Lee, "Effect of teriparatide on healing of atypical femoral fractures: a systemic review," Journal Bone Metabolism, vol.
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.
Approved treatments for men with low bone mass and high risk for fractures, including those due to hypogonadism, are bisphosphonates (alendronate, risedronate, and zoledronic acid), teriparatide, a recombinant form of human parathyroid hormone amino acids 1-34 [4], and denosumab [31], based on the findings of the ADAMO trial [32].
Suspension of intravenous SFO could promptly improve the hypophosphatemia, and the insufficiency fracture got united with limiting weight bearing toward the right extremity and administration of teriparatide. Long-term SFO administration should be avoided because of a definitive risk of osteomalacia and fragile fracture.
Donley et al., "Teriparatide increases bone formation in modeling and remodeling osteons and enhances IGF-II immunoreactivity in postmenopausal women with osteoporosis," Journal of Bone and Mineral Research, vol.
Teriparatide is indicated for men with severe osteoporosis and those for whom bisphosphonate treatment has been unsuccessful.
A third group of women received injections of teriparatide, a medication that has already been approved for treating osteoporosis.
But there are recent reports which suggest that in addition to stopping bisphosphonates, treating with recombinant paratharmone Teriparatide improves bone quality and healing of atypical femoral fractures.