Teriparatide
Indications
Teriparatide is used for:
Digoxin (Use with caution. Teriparatide transiently increases serum calcium, which may lead to digitalis toxicity)
Adult Dose
By subcutaneous injection, 20 micrograms of teriparatide once daily.
Maximum total duration of treatment with teriparatide is 2 years.
After teriparatide is discontinued, patients may continue other osteoporosis therapies.
Hepatic impairment: No data available
NOTE:
In addition to teriparatide, patients should receive calcium and vitamin D supplements if dietary intake is inadequate.
Teriparatide may cause small and transient elevations of serum calcium concentrations. When blood samples are required, obtain the sample at least 16 hours after the most recent teriparatide dose
Child Dose
Do not use in pediatric patients or young adults with open epiphyses
Renal Dose
Moderate renal impairment: Use with caution.
Severe renal impairment: Do not use
Administration
For Subcutaneous administration.
Administer subcutaneously in the thigh or abdomen.
Initially administer in an environment in which the patient can assume a supine or sitting position if orthostatic hypotension occurs.
Before administering teriparatide, visually inspect the product for particulate matter and discoloration
Contra Indications
Hypersensitivity to teriparatide or any of the excipients.
Pre-existing hypercalcemia.
Severe renal impairment.
Metabolic bone diseases other than primary osteoporosis (including hyperparathyroidism and Paget's disease of the bone) or glucocorticoid-induced osteoporosis.
Unexplained elevations of alkaline phosphatase.
Prior external beam or implant radiation therapy to the skeleton.
Patients with skeletal malignancies or bone metastases.
Pregnancy; Breastfeeding
Precautions
Active or recent urolithiasis.
Concurrent use with digitalis.
Pre-existing hypercalciuria.
Active or recent urolithiasis.
Avoid use in patients who are breastfeeding.
Do not use in pediatric patients or young adults with open epiphyses
Pregnancy-Lactation
Pregnancy:
Reproductive toxicity observed in animal studies. Consider discontinuing when pregnancy occurs. Use only if the potential benefit outweighs the potential risk to the fetus.
Lactation:
Potential for tumorigenicity. Breastfeeding is not recommended.
References:
1. Forteo [Internet]. Eli Lilly; [cited 2021 March 12]. Available from: https://dailymed.nlm.nih.gov/dailymed/fda/fdaDrugXsl.cfm?setid=aae667c5-381f-4f92-93df-2ed6158d07b0&type=display
2. Osteotide [Internet]. Virchow; [cited 2021 March 12]. Available from: http://osteotide.org/forHealthcareProviders.html
Interactions
Digoxin (Use with caution. Teriparatide transiently increases serum calcium, which may lead to digitalis toxicity)
Adverse Effects
Side effects of Teriparatide :
Most common adverse events are nausea, pain in limb, headache and dizziness.
Other adverse effects include myalgia, arthralgia, hypercalcaemia, hyperuricemia (especially in patients with moderate renal impairment and those receiving teriparatide 40 mcg/day), and mild injection site reactions such as pain, swelling, erythema, localized bruising, pruritus, and minor bleeding.
Transient orthostatic hypotension observed in clinical studies – usually occurred within 4 hours of an initial dose and spontaneously resolved within a few minutes to a few hours