Teriparatide

Subcutaneous
Postmenopausal osteoporosis, Primary or hypogonadal osteoporosis in males

Patients at increased risk of osteosarcoma (e.g. Paget's disease of bone, unexplained increases in serum alkaline phosphatase, paediatric patients or young adults with open epiphyses and patients who have received prior external beam or implant radiation therapy involving the skeleton), pre-existing hypercalcaemia, bone metastases or a history of skeletal malignancies, severe renal impairment. Pregnancy and lactation.

Moderate renal impairment, active or recent urolithiasis. Following SC inj, serum calcium concentrations may increase transiently, reaching a max at 4-6 hr and returning to baseline within 16-24 hr; routine calcium monitoring not needed. Patients to contact their doctor if they develop persistent symptoms of hypercalcaemia (e.g, nausea, vomiting, constipation, lethargy, muscle weakness).

Nausea, pain in the limb, headache, dizziness, muscle cramps, inj site reactions, depression, increased uric acid concentrations. Orthostatic hypotension especially at beginning of treatment, if affected, do not drive or operate machinery.

Parenteral/SC: C

Symptoms: Delayed hypercalcaemic effect, orthostatic hypotension, nausea, vomiting, dizziness and headache. Mangement: Treatment is supportive and symptomatic with serum calcium and phosphorus monitoring.

Reduced anabolic effects with bisphosphonates, avoid concurrent use. May affect digoxin effects due to teriparatide effects on calcum.

Description: Teriparatide, a biosynthetic peptide fragment of the biologically active region of the human parathyroid hormone, is a regulator of bone metabolism. By preferentially stimulating the osteoblastic activity over osteoclastic activity, it stimulates new bone formation on trabecular and cortical bone surfaces. Anabolic effects of teriparatide are seen in an increase in skeletal mass, bone strength and bone formation and resorption markers.
Pharmacokinetics:
Absorption: Extensively absorbed after SC inj. Peak plasma concentrations: 30 minutes. Absolute bioavailability: 95%. Serum half-life: 5 minutes (IV), 1 hr (SC).

Store under refrigeration between 2-8°C (36-46°F). Once opened, inj may be stored for up to 28 days at 2-8°C. Recap inj pen when not in use and minimise time outside the refrigerator. Do not freeze and do not store the inj device with the needle attached.

Agents Affecting Bone Metabolism