(a bal oh PAR a tide)
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Solution Pen-injector, Subcutaneous:
Tymlos: 3120 mcg/1.56 mL (1.56 mL) [contains phenol]
Brand Names: U.S.
- Parathyroid Hormone Analog
Abaloparatide is an analog of human parathyroid hormone related peptide (PTHrP[1-34]), which acts as an agonist at the PTH1 receptor (PTH1R). This results in stimulation of osteoblast function and increased bone mass (Harslof 2016; Leder 2017).
Vd: ~50 L
Hepatic (nonspecific proteolysis)
Urine (as peptide fragments)
Time to Peak
0.51 hours (range: 0.25 to 0.52 hours)
Special Populations: Renal Function Impairment
Maximum serum concentration increased 1-, 1.3- and 1.4-fold in patients with mild, moderate and severe renal impairment, respectively. AUC increased 1.2-, 1.7- and 2.1-fold in patients with mild, moderate and severe renal impairment, respectively.
Use: Labeled Indications
Osteoporosis: Treatment of postmenopausal women with osteoporosis at high risk for fracture defined as a history of osteoporotic fracture, multiple risk factors for fracture, or patients who have failed or are intolerant to other available osteoporosis therapy.
Limitations of use: Use of abaloparatide and parathyroid hormone analogs for >2 years is not recommended.
There are no contraindications listed in the manufacturer's labeling.
Osteoporosis: SubQ: 80 mcg once daily
Refer to adult dosing.
Dosing: Renal Impairment
No dosage adjustment necessary.
Dosing: Hepatic Impairment
There is no dosage adjustment provided in the manufacturer's labeling
SubQ: Inject subcutaneously into the periumbilical region of the abdomen. Rotate the site of the injection every day and administer at approximately the same time every day. Do not administer intravenously or intramuscularly. Initial doses should occur under circumstances in which the patient may sit or lie down, in the event of orthostasis.
Store refrigerated at 2°C to 8°C (36°F to 46°F). Do not freeze or heat. After first use, store for up to 30 days at 20°C to 25°C (68°F to 77°F).
There are no known significant interactions.
Endocrine & metabolic: Increased uric acid (25%)
Genitourinary: Hypercalciuria (11% to 20%)
Immunologic: Antibody development (49%; neutralizing antibodies: 68%; antibody formation was not found to have any clinical significance)
Local: Erythema at injection site (58%)
1% to 10%:
Cardiovascular: Palpitations (5%), orthostatic hypotension (1% to 4%), sinus tachycardia (≤2%), tachycardia (≤2%)
Central nervous system: Dizziness (10%), headache (8%), fatigue (3%)
Endocrine & metabolic: Hypercalcemia (3%)
Gastrointestinal: Nausea (8%), upper abdominal pain (3%)
Local: Swelling at injection site (10%), pain at injection site (9%)
Concerns related to adverse effects:
• Hypercalcemia: May cause or exacerbate hypercalcemia; use is not recommended in patients with preexisting hypercalcemia or with an underlying hypercalcemic disorder (eg, primary hyperparathyroidism).
• Orthostatic hypotension: May cause orthostatic hypotension. Transient orthostatic hypotension usually occurs within 4 hours of dosing.
• Osteosarcoma: [US Boxed Warning]: In animal studies, abaloparatide has been associated with an increase in osteosarcoma; risk was dependent on both dose and duration. Avoid use in patients with an increased risk of osteosarcoma (including Paget disease, bone metastases or skeletal malignancies, hereditary disorders predisposing to osteosarcoma, unexplained elevation of alkaline phosphatase, prior external beam or implant radiation therapy involving the skeleton, or in patients with open epiphyses).
• Urolithiasis: Use may cause hypercalciuria; use with caution in patients with active or recent urolithiasis because of risk of exacerbation.
• Appropriate use: [US Boxed Warning]: Use for >2 years during a patient's lifetime is not recommended.
Orthostatic hypotension; urinary calcium (patients with suspected active urolithiasis or preexisting hypercalciuria); bone mineral density (BMD) should be evaluated 1 to 2 years after initiating therapy and every 2 years thereafter (NOF [Cosman 2014]); serum calcium; consider measuring biochemical markers of bone turnover
Abaloparatide is not indicated for use in women of reproductive potential. Animal reproduction studies have not been conducted.
• Discuss specific use of drug and side effects with patient as it relates to treatment. (HCAHPS: During this hospital stay, were you given any medicine that you had not taken before? Before giving you any new medicine, how often did hospital staff tell you what the medicine was for? How often did hospital staff describe possible side effects in a way you could understand?)
• Patient may experience headache, loss of strength and energy, abdominal pain, or injection site irritation. Have patient report immediately to prescriber signs of high calcium (weakness, confusion, fatigue, headache, nausea and vomiting, constipation, or bone pain), signs of a kidney stone (back pain, abdominal pain, or hematuria), bone pain, skin edema, lump, persistent pain, severe dizziness, passing out, tachycardia, abnormal heartbeat, severe nausea, vomiting, or painful urination (HCAHPS).
• Educate patient about signs of a significant reaction (eg, wheezing; chest tightness; fever; itching; bad cough; blue skin color; seizures; or swelling of face, lips, tongue, or throat). Note: This is not a comprehensive list of all side effects. Patient should consult prescriber for additional questions.
Intended Use and Disclaimer: Should not be printed and given to patients. This information is intended to serve as a concise initial reference for health care professionals to use when discussing medications with a patient. You must ultimately rely on your own discretion, experience, and judgment in diagnosing, treating, and advising patients.