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Generic Name: teriparatide (Subcutaneous route)

ter-i-PAR-a-tide

Subcutaneous route(Solution)

In male and female rats, teriparatide caused an increase in the incidence of osteosarcoma that was dependent on dose and treatment duration. Teriparatide should not be prescribed for patients who are at increased baseline risk for osteosarcoma (including those with Paget's disease of bone or unexplained elevations of alkaline phosphatase, open epiphyses, or prior external beam or implant radiation therapy involving the skeleton) .

Commonly used brand name(s)

In the U.S.

  • Forteo

Available Dosage Forms:

  • Solution

Therapeutic Class: Calcium Regulator

Pharmacologic Class: Parathyroid

Uses For Forteo

Teriparatide is a synthetic form of the natural human parathyroid hormone and is used by injection to treat osteoporosis. Teriparatide forms new bone, increases bone mineral density and bone strength, and as a result reduces the chance of getting a fracture (broken bone). Teriparatide can be used by men or postmenopausal women with osteoporosis who are at high risk for having fractures. Teriparatide can be used by people who have had a fracture related to osteoporosis, or who have multiple risk factors for fracture, or who cannot use other osteoporosis treatments.

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Teriparatide has been used by injection into a vein as a test to help diagnose problems of the parathyroid gland. This test determines whether you have hypoparathyroidism or a type of pseudohypoparathyroidism.

This product, for use as a test to help diagnose problems of the parathyroid gland, was withdrawn from the U.S. market in January 1997.

Before Using Forteo

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

Allergies

Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

Pediatric

Appropriate studies have not been performed on the relationship of age to the effects of teriparatide in the pediatric population. Safety and efficacy have not been established. Use in children or young adults is not recommended due to possible effects on growing bones .

Geriatric

Appropriate studies performed to date have not demonstrated geriatrics-specific problems that would limit the usefulness of teriparatide in the elderly .

Pregnancy

Pregnancy Category Explanation
All Trimesters C Animal studies have shown an adverse effect and there are no adequate studies in pregnant women OR no animal studies have been conducted and there are no adequate studies in pregnant women.

Breast Feeding

There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

Interactions with Medicines

Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Tell your healthcare professional if you are taking any other prescription or nonprescription (over-the-counter [OTC]) medicine.

Interactions with Food/Tobacco/Alcohol

Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

Other Medical Problems

The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Alkaline phosphatase (an enzyme in the blood), elevated levels or
  • Bone cancer, or history of or
  • Hypercalcemia (high calcium in the blood) or
  • Metabolic bone disease or
  • Paget's disease (bone disease) or
  • Radiation therapy of bones, history of—Should not use in these conditions.
  • Urolithiasis (kidney stone), active or recent—May make this condition worse.

Proper Use of Forteo

If you are injecting this medicine yourself, use it exactly as directed by your doctor. Special patient instructions will come with the medicine. Read the directions carefully before using the medicine. Make sure you understand:

  • Where to give the injection.
  • How to give the injection.
  • How long the injection is stable.

If you have any questions, check with your health care professional.

Do not use the medicine if you see solid particles in the liquid.

Do not use the medicine beyond the expiration date on the package.

For the first few doses, inject the medicine where you can sit or lie down right away in case you get dizzy.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For subcutaneous injection dosage form:
    • For osteoporosis:
      • Adults—20 micrograms (mcg) once daily, injected under the skin on the thigh or abdominal (gut) wall.
      • Children—Use and dose must be determined by your doctor.

Missed Dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

Store in the refrigerator. Do not freeze.

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Throw away the teriparatide pen at 28 days after the first injection, even if there is still medicine in it. Do not use the medicine if it has been frozen.

Precautions While Using Forteo

It is very important that your doctor check your progress at regular visits to make sure that this medicine is working properly and to check for unwanted effects.

Do not inject this medicine into a vein or muscle.

This medicine may cause lightheadedness or fast heartbeats. If this happens, sit or lie down until you feel better. If you do not feel better, call your health care provider before continuing treatment.

Forteo Side Effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common
  • Abdominal pain
  • confusion
  • constipation
  • depression
  • dry mouth
  • headache
  • incoherent speech
  • increased urination
  • loss of appetite
  • metallic taste
  • muscle weakness
  • nausea
  • thirst
  • unusual tiredness
  • vomiting
  • weight loss
Less common
  • Arm, back, or jaw pain
  • chest pain or discomfort
  • chest tightness or heaviness
  • cough
  • difficult or labored breathing
  • fainting
  • fast or irregular heartbeat
  • fever or chills
  • nausea
  • shortness of breath
  • sneezing
  • sore throat
  • sweating
  • tightness in the chest
  • wheezing
Incidence not known
  • Hives or welts
  • itching
  • redness of the skin
  • skin rash
  • swelling or puffiness of the mouth and face

Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

More common
  • Acid or sour stomach
  • belching
  • blurred vision
  • body aches or pain
  • congestion
  • diarrhea
  • difficulty having a bowel movement (stool)
  • difficulty with moving
  • dizziness
  • heartburn
  • hoarseness
  • indigestion
  • lack or loss of strength
  • muscle pain or stiffness
  • muscle spasm
  • nervousness
  • pain in the joints
  • pounding in the ears
  • runny nose
  • tender, swollen glands in the neck
  • trouble with swallowing
  • voice changes
Less common
  • Abdominal or stomach cramps
  • back pain
  • discomfort
  • discouragement
  • feeling of constant movement of self or surroundings
  • feeling sad or empty
  • indigestion
  • irritability
  • lack of appetite
  • leg cramps
  • loss of interest or pleasure
  • neck pain
  • rash
  • sensation of spinning
  • sleeplessness
  • swollen mouth and tongue
  • tiredness
  • tooth disorder
  • trouble concentrating
  • trouble sleeping
  • unpleasant taste
  • urge to have bowel movement
Rare
  • Pain at the place of injection during or following the injection
  • tingling feeling in the hands and feet
  • urge for bowel movement
Incidence not known
  • Bruising at the injection site
  • flushing
  • minor bleeding at the injection site
  • unusually warm skin

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

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