teriparatide: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
teriparatide: clinical details
Prescribing considerations
- Confirm an authorised osteoporosis indication and increased fracture risk.
- Correct or investigate pre-existing hypercalcaemia and assess renal function, bone disease history, skeletal radiotherapy and malignancy risk.
- Use caution with moderate renal impairment, active or recent urolithiasis, hepatic impairment and in younger adults, where experience is limited.
- Ensure adequate calcium and vitamin D intake while avoiding unnecessary supplementation that could contribute to hypercalcaemia.
- Train the patient in injection technique and record the biological product name and batch number for traceability.
Contraindications and cautions
- Hypersensitivity to teriparatide or an excipient
- Pregnancy or breastfeeding
- Pre-existing hypercalcaemia
- Severe renal impairment
- Metabolic bone disease other than primary or glucocorticoid-induced osteoporosis, including hyperparathyroidism or Paget's disease
- Unexplained elevation of alkaline phosphatase
- Previous external-beam or implant radiotherapy involving the skeleton
- Skeletal malignancy or bone metastases
Monitoring
- Review renal function, calcium status, alkaline phosphatase and relevant bone or malignancy history before initiation.
- Routine serum calcium monitoring is not required in normocalcaemic patients; if measured during treatment, sample timing should account for the transient post-injection rise.
- Assess persistent symptoms compatible with hypercalcaemia and review patients who develop kidney stones, marked dizziness, hypotension or significant injection reactions.
- Review subsequent osteoporosis management when teriparatide is stopped.
Clinical pharmacology
Teriparatide is recombinant human parathyroid hormone fragment 1–34. It stimulates osteoblast-mediated bone formation and is believed to be metabolised mainly in the liver and kidneys.
Formulation and product differences
- The selected Forsteo product is a clear, colourless solution in a disposable pre-filled pen.
- Needles are not supplied; compatible sterile pen needles are fitted for each injection.
- The pen must remain refrigerated, must not be frozen and must not be stored with a needle attached.
teriparatide interactions
Tell the prescriber or pharmacist about all medicines and supplements.
Digoxin and other digitalis medicines
A temporary rise in blood calcium may increase susceptibility to digitalis toxicity; clinical caution is required.
Hydrochlorothiazide
A pharmacodynamic study found no clinically significant interaction.
Raloxifene or hormone replacement therapy
Studies found no alteration in effects on blood or urine calcium or in clinical adverse events.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.